Total Health Care Expenditures Research Articles

Excess costs of depression among a population-based older adults with chronic diseases in Singapore

BackgroundThere is limited evidence on the economic burden of depression among the older population in Singapore.ObjectiveWe aim to evaluate the impact of depression on healthcare expenditure and productivity loss among older adults with chronic diseases in Singapore.MethodsUsing the data from the Well-being of the Singapore Elderly study (WiSE), a 2011 national representative survey of older adults aged 60 years and above, 2510 respondents were included in this study. The sample comprised 44% male and 56% female respondents with 75% respondents aged between 60 and 74 years old. Healthcare utilisation data was obtained from respondents and healthcare cost was tabulated by multiplying each service unit by the unit cost price. These services include care from polyclinic doctors, private general practitioners (GP), outpatient specialists and inpatient care. We modelled the relationship of healthcare cost and depression using two-part models (probit & generalised linear model - loglink and gamma distribution).ResultsFor total healthcare expenditure, older adults with both depression and chronic diseases were associated with an average annual incremental cost of $7940 (95% CI 1490–14400; p = 0.016), compared to those without these conditions. They were also associated with an average incremental cost of $257 (95% CI 38.7–475; p = 0.021) for primary care. Likewise, in the case of specialist outpatient clinics, they had an average incremental cost of $970 (95% CI 163–1780; p = 0.018). However, for inpatient setting, the average incremental cost of $6180 (95% CI 418–12800; p = 0.066) was not significant. Additionally, older adults with depression and chronic diseases contribute to an annual productivity loss of $676 (95% CI 346–1010; p < 0.001).DiscussionThis study provides evidence that there are significant incremental costs associated with depression amongst the older adults with chronic diseases in Singapore’s primary healthcare setting. The increased somatic presentations among the depressed older adults and the underdiagnosis of depression in primary care may contribute to higher utilisation of healthcare resources which entail higher expenditure. This is one of the first studies to look at the cost of depression using a representative sample of Singaporean older adults and taking into account the multi-ethnic nature of the population. Analyses were restricted to a cross-sectional design, and data relied heavily on the accuracy of self-report utilisation on health care services which was subjected to recall bias.ConclusionDepression was found to inflate the total healthcare expenditure among older adults with chronic disease by two-fold. This study provides evidence that there are significant incremental costs associated with depression among the older adults with chronic diseases, demonstrating a need for more resources to improve systematic and clinical care for depressed older adults with chronic diseases.

The role of Pharmaceutical Marketing in Prescribing Decisions in a Developing Country: A Comprehensive Study Exploiting Theory of Planned Behaviour

Background: Prescription medicines have become a major component of health systems in both developed and developing countries contributing to, may be, more than half of the total health care expenditure in the developing countries. Although literature directly attributing rise in medicines expenditure to prescribers’ decision, but still only a few researches had employed studies with sound theoretical foundations to comprehensively examine prescribing decision behaviours. Our objective was to investigate potentially modifiable factors, which may influence prescribing decisions of physicians employing theory of planned behaviour. Method: A quantitative survey approach was used to investigate the proposed hypotheses. Population was physicians in outpatient clinics in both private and governmental hospitals in Sana’a, capital city of Yemen. A structured questionnaire was designed to measure the influence of drug-promoting marketing techniques on physicians’ prescribing decisions. Data was collected through an anonymous survey questionnaire. The hypotheses were tested by multiple regressions analysis. Ethical approval was obtained from the Ethical Committee of the Ministry of Public Health and Population (MoPHP), and participants provided written consent before enrolling in the study. Result: Physicians admitted the presence of promotional influence on their prescribing decision. The study revealed that receiving low-value promotional items, belief of physicians that it is appropriate to accept both low- and high-value promotional items, physicians’ exposure to company-direct sources of information, and drug promotion-related factor all are positively and significantly related to physicians’ prescribing decisions (? = 0.438, p &lt;0.001; ? = 0.089, p =0.027; ? = 0.157, p &lt;0.001; ? = 0.093, p =0.032; and ?= 0.118, p = 0.007 respectively). Conclusion: This research clarified the role played by pharmaceutical companies to influence prescribing decisions of physicians. Therefore, could provide theoretical framework for policymakers in Yemen, and other countries with similar conditions, to develop a suitable policy and strategy in terms of drug promotion.

Healthcare Expenditure on Atrial Fibrillation in the United States: The Medical Expenditure Panel Survey 2016-2021.

To provide a contemporary nationally representative assessment of atrial fibrillation (AF) and atrial flutter (AFL) expenditures in the United States. AF prevalence is rising over time and management is evolving. However, there has been no contemporary national assessment of expenditures of AF. Using Medical Expenditure Panel Survey (MEPS) 2016-2021 data, we identified individuals with AF or AFL using International Classification of Disease (ICD)-10 codes and reported total and categorized expenditures. Using two-part and gamma regression models, respectively, we estimated the incremental expenditures with AF for the entire population and for individuals with common coexisting comorbidities. Among individuals with AF, we identified characteristics associated with higher expenditures. Of a weighted surveyed population of 248,067,064 adults, 3,564,763 (1.4%) had AF. Mean age was 71.9 ± 10.6 years and 45.7% were female. Mean unadjusted annual total healthcare expenditure for individuals with AF was $25,451 ± $1,100 compared with $9,254 ± $82 for individuals without AF. The highest spending categories were inpatient visits ($7,975 ± $733) and prescriptions ($6,505 ± $372). AF expenditures increased over the study period by 11.1%. After adjustment, the incremental annual expenditure attributable to AF was $6,188 per person. Incremental expenditures with AF were highest for those with cancer ($11,967, 95% CI $4,410 - $19,525), while AF did not significantly increase expenditures in HF (-$2,756, 95% CI -$10,048 - $4,535). Modified Charlson Comorbidity Index of 1 or ≥2, uninsured status, cancer, poor income level, ASCVD, COPD, and later survey year were associated with higher expenditures. AF is associated with substantial healthcare expenditures which are increasing over time. With changes in screening and management, expenditures need periodic reassessments. Introduction: AF prevalence is rising, but contemporary national expenditure assessments are lacking.Methods: Two-part and gamma regression models of MEPS 2016-2021 data (all-payer cross-sectional US survey) estimated AF effect on healthcare expenditures.Results: Of 248,067,064 adults, 1.4% had AF, with mean age 72.1 years and 45.7% female. Mean unadjusted annual expenditure was $25,451 ± $1,100 ($9,254 ± $82 without AF). Incremental adjusted annual expenditure attributable to AF was $6,188. Modified CCI of 1 or ≥2, uninsured status, cancer, poor income level, ASCVD, COPD, and later survey year were associated with higher expenditure.Discussion: AF expenditures are substantial and increasing.

Are post-communist countries paying increased healthcare costs because of risky behaviour?

Abstract Background Based on the annual Country Health Profiles, we can see the difference in population behaviour across EU countries and the associated health risks. At first glance, the so-called post-communist countries are characterised by above-average per-capita harmful consumption of sin goods, alcohol and tobacco. Is this harmful consumption associated with increased healthcare costs? Methods The idea of the study is based on balanced panel-data published in Country Health Profiles. The member countries were divided into groups based on their health risk scores - high risk (above average), and low risk (below average). The group of countries with high risk is mostly composed of post-communist countries. The detailed per-capita annual data for the period 2013-2021 was collected, such as GDP, consumption of sin goods, alcohol, and tobacco. The analysis is based on fixed-effects linear regression models, following recent recommendations on suppressing the excessive role of statistical-inference tools. Results We built various models for different groups of countries, and in this abstract, we present results for the group of post-communist countries - a simple model of harmful consumption (sin goods, GDP) and a more complex model (alcohol, tobacco, GDP). The results show that in the case of the post-communist countries group, for a fixed level of GDP per capita, higher consumption of sin goods by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 0.244 per capita. For a fixed level of GDP per capita and tobacco consumption per capita, higher consumption of alcohol by EUR 1 per capita corresponds with total healthcare expenditures higher by EUR 1.367 per capita. Conclusions Harmful consumption has a multiplier effect in the health sector; besides direct impact, it influences an increase in healthcare expenditures. More emphasis should be placed on prevention and awareness of consumers to reduce harmful consumption. Key messages • For fixed GDP per capita, higher harmful consumption corresponds with higher healthcare costs in post-communist countries. • For fixed GDP per capita and tobacco consumption per capita, a €1 higher alcohol consumption corresponds with more than €1 higher healthcare expenditure in the post-communist countries.

Marginal health care expenditures and health-related quality of life burden in patients with migraine.

Migraine, characterized by recurrent, severe headaches, presents a considerable challenge for patients, health care systems, and employers in the United States. However, there is a lack of recent estimates of the economic and humanistic burden in this population. To assess the incremental burden of migraine on the total all-cause health care costs and health-related quality of life (HRQoL) in the United States, using data from the Medical Expenditure Panel Survey (MEPS). This retrospective cross-sectional study included adults (≥18 years) with and without migraine on the 2019-2021 full-year consolidated MEPS Household Component and Medical Provider Component data files. Descriptive analyses were conducted to compare health care expenditures and HRQoL among patients with and without migraine. To estimate the marginal effect of migraine on total health care spending, a two-part model generalized linear models was employed. HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) scores based on the items in the Veterans Rand 12 Health Survey. A multivariate linear regression with log-link was conducted to understanding the factors associated with PCS and MCS scores. All analyses accounted for complex survey design of MEPS. The study included approximately 1.14 million patients with migraine and approximately 184 million patients without migraine. The patients with migraine were majorly female (82.81%), aged 18-45 years (50.24%), and residing in the southern region of the United States (41.45%). A two-part model revealed that marginal total health care expenditures among patients with migraine were $6,078.56 (95% CI = $4,618.45-$8,141.34) higher compared with those without migraine. In terms of HRQoL, average PCS scores in migraine and nonmigraine groups were 39.79 and 42.15, respectively. The average MCS scores were 46.63 and 49.95 for migraine and nonmigraine groups, respectively. After adjusting for sociodemographic characteristics, multivariable linear regression models revealed that the PCS score was 2.14 (95% CI = 1.17-4.55) units lower, and the MCS score was 3.19 (95% CI = 2.51-6.07) units lower among patients with migraine compared with those without. Migraine imposes a substantial economic burden on both health care payers and patients in the United States. Notably, prescription drugs make up nearly half of the overall cost. Additionally, patients with migraine experience lower levels of physical and mental HRQoL compared with those without migraine.

Trends in health care expenditures and incremental health care cost in adults with atrial fibrillation in the United States

BackgroundAtrial fibrillation (AF) is associated with increased healthcare costs; however, comprehensive data on the financial burden of AF remain limited. ObjectivesTo delineate healthcare expenditures among patients with AF. MethodsWe used the longitudinal panels from the Medical Expenditure Panel Survey (MEPS) covering 2016-2019 to estimate healthcare expenditures associated with AF. We identified individuals aged ≥18 with AF in the first year of each panel (2016-2018) using the ICD-10 code. Covariates included sociodemographic characteristics and comorbidities. Healthcare expenditures were derived from the second year of each panel (2017-2019) to reflect the cost of having the condition for an entire year. Adjusted mean annual costs were calculated, including total healthcare expenditure, hospital inpatient, emergency room visits, office based, outpatient visits, home health visits, prescribed medicines, and other expenses. Adjusted models were used to estimate the mean annual incremental total healthcare cost associated with AF. ResultsThe weighted study population included 3,080,055 adults with AF (382 respondents, mean age 71.5, 89.9% White). The adjusted annual total healthcare cost among adults with AF totaled $14,083 (95% CI, $10,887 – 17,279) compared to $8,771 (95% CI, $ 8,106 – 9,436) for those without AF. Primary drivers of cost over time were hospital inpatient care, office based visits, and prescribed medications. The annual incremental total healthcare cost associated with AF was $5,312 per adult (in 2019 US dollars). ConclusionAdults with AF in the US face a higher financial burden across various healthcare services compared to those without the condition, with consistently increasing expenses in inpatient care and prescribed medicines. Further research is needed to identify the independent contribution of AF to these costs.

The evolution of animal-based dietary structure has contributed to the increase of healthcare expenditures in China

The trends of diversified diets in China have generated a growing number of nutritional health problems, and healthcare investment is bearing a large burden from the diets, hindering the economic progress of the country and its residents toward affluence. This study linked the evolution of the Chinese dietary structure to changes in health expenditures and predicts future dietary patterns and their impact on health costs over the next 30 years. We found that in the past 30 years, the Chinese dietary structure has shifted towards a nutritional surplus type, and the structure of health expenditures has also shown a trend of two increases and one decrease. The consumption of plant-based foods is significant correlated with lower health expenditures, and animal-based foods show a significant impact on increase of health expenditures. Among nutrients, fat is significant correlated with increased health expenditures, whereas calorie intake is significant correlated with lower health expenditures. By 2030, the Chinese dietary structure will still evolve to a high-protein and high-fatty type. This shift will result in a decrease in per capita healthcare expenditure by 41.66 yuan and increases in household, state, personal, and total healthcare expenditures by 76.83 yuan, 18.76 billion yuan, 95.28 billion yuan, and 17.67 billion yuan, respectively. These findings demonstrate that adjusting dietary structures will bring the dual benefits of improved national health status and a favorable cycle of health expenditures.

Characteristics and outcomes of heart failure in Japan: A hospital-based administrative database analysis.

Epidemiological and outcome studies on patients in Japan with heart failure (HF) categorized by left ventricular ejection fraction (LVEF) are currently limited. The aim of this non-interventional database study was to provide further information on these patients. Administrative claims data and electronic medical records from hospitals participating in the Voluntary Hospitals in Japan (VHJ) organization were used. Patients hospitalized with a primary diagnosis of HF between 1 April 2017 and 30 March 2020 were categorized by baseline LVEF on echocardiogram: HF with reduced EF (HFrEF, LVEF <40%); HF with preserved EF (HFpEF, LVEF ≥50%); and HF with mildly reduced EF (HFmrEF, 40% to <50% LVEF). Patients were evaluated for baseline characteristics, pre-admission diagnosis, prescription drugs, length of hospitalization, HF treatment cost, overall cost of hospitalization, and in-hospital prescription. An exploratory analysis compared post-hospitalization mortality and re-hospitalization rates. In total, 10646 hospitalized patients from 17 VHJ hospitals were enrolled. Of these, 7212 were included in the analysis set and categorized into HFpEF (3183, 44.1%), HFmrEF (1280, 17.7%), and HFrEF (2749, 38.1%) groups based on baseline LVEF. Beta-blocker use increased during hospitalization, with a mean (95% confidence interval [CI]) of 23.3% (22.3-24.3) of patients receiving these agents before admission versus 69.4% (68.3-70.5) at discharge. Administration of diuretics, angiotensin converting enzyme (ACE) inhibitors, and angiotensin II receptor blockers (ARBs) showed a similar trend. Differences in treatments were observed between HF categories at discharge, with a higher proportion (95% CI) of ACE inhibitor use in the HFrEF group (40.6% [38.7-42.4]) versus HFmrEF (27.5% [25.1-30.0]) and HFpEF (20.6% [19.2-22.1]) groups (P<0.0001), and more ARB use in the HFmrEF and HFpEF groups (32.5% [29.9-35.1] and 31.2% [29.6-32.9], respectively) versus HFrEF (25.1% [23.5-26.8]; P<0.0001). Mean (standard deviation [SD]) length of hospitalization was 22.2 (23.3) days, and the median (interquartile range) was 17 (11-25) days. Estimated average cost of HF treatment per patient during index hospitalization was 300090 yen with HFrEF treatment costing the most. Average total healthcare expenditure during hospitalization was 1225650 yen per index hospitalization per patient, with HFrEF also the most expensive. During a mean (SD) observation period of 324 (304) days, ~21% of patients in each group required re-hospitalization for HF, and 625 patients (8.7%) died. The proportion of patients in each HF category was largely consistent with existing data. Discharge medications indicated high prescription of guideline-directed therapy. This study provides real-world data on patients with HF in Japan that can help inform future clinical decision-making.

Out-of-Pocket Expenditures for Health: A Case Study

Background of the Study: Health is a prime component in rural population who uses their muscle power for doing economic activities. Meanwhile according to the Economic Survey of India’s 2021 report, India was among the 10 worst performing countries in terms of prioritising health in government budgets, at both state and central levels. India was placed or ranked in 67th in the list of 189 countries in Out of Pocket Expenditure per capita in PPP (in $) for 2018. World Health Organisation report (March 2022) stated that high of Out-Of-Pocket Expenditure (OOPE) on health is impoverishing some 55 million Indians annually, with over 17 per cent households incurring catastrophic levels of health expenditures every year. The Economic Survey 2023 reported that the share of government expenditure in Total Health Expenditure (THE) has increased over time from 28.6% in financial year 2014 to 40.6% in Financial Year2019. However, OOPE is still higher at 48.2% of the total expenditure. Objectives: To explore the Out of Pocket Expenditure (OOPE) for health in India, Interstate and rural villages of Theni district, Tamil Nadu Methodology: Purposive non random sampling was used to reach the sample element. Sample elements or respondents were from rural Theni District. Sample size was 300. Data was collected using an interview schedule in the catchment area of Primary Health Centre, taluk hospital and district healthcare hospital. Interview was conducted in Tamil and then the interview output was transcribed and translated into English, followed by a descriptive analysis. Ordinary Least Square estimation was used to find the implications of individual income on pocket out expenditure for health. Findings of the Study: The secondary data from the website of World Health Organisation and from the reports of National Health Accounts reflects a difference in data information for every concerned period at least two to three per cent exist. The interstate data information for the period 2019 to 2020 revealed that the spending from government health care expenditure and out of pocket expenditure is not equal to total health care expenditure. Hence, the researcher made an attempt to explore the out of pocket expenditure among the rural population and their willingness to spend from their pocket. Furthermore, the impact of annual income and annual healthcare expenditure is examined by simple linear regression analysis, for to understand the role of income in shaping healthcare spending behaviour. The R Square value is very poor, and reflects the role of explanatory variable income is not impacting the out of pocket health care expenditure. The Keynesian theory of psychological law of consumption is invalid in out of pocket healthcare expenditure with respect to income of the respondents. 13 percentages of respondents were willing to do out of pocket expenditure for their health ailing. The 39.7percentages of respondents were disagreeing to do out of pocket expenditure for their health. Conclusion: Overall, this study emphasizes the importance of understanding out-of-pocket health expenditures is increasing in rural (feckless management of public healthcare) with attitude of unwilling to pay from their pocket because of existing zero priced healthcare system, which is available in their near locality. Policy makers needs to concentrate on enhancing the healthcare supply such as medical personals, drugs, lab facility, beds, and in general in all aspects for to cater the demand of rural inhabitants and protect them from pushing into impoverishment.

European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics.

This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.

Racial and Ethnic Disparity in Healthcare Expenditure and Resource Utilization Among Patients with Cardiovascular Diseases.

Despite extensive research, significant gaps remain in understanding racial disparity among individuals with cardiovascular diseases (CVD). These disparities, influenced by factors such as access to care and comorbid conditions, necessitate further investigation to develop targeted interventions. To evaluate the factors contributing to racial and ethnic disparities in healthcare resource utilization and total healthcare expenditure among individuals with CVD. Using data from the Medical Expenditure Panel Survey spanning 2014-2021, total healthcare expenditure and having a CVD visit were compared among Hispanic, Black, and White adults with CVD. Descriptive analysis, linear regression, and logistic regression models were used to compare the results. Multivariable models were used to evaluate the effect of demographic and socioeconomic factors on total healthcare expenditure and the likelihood of having a CVD visit among different races. With a weighted sample of 17,722,706, the study found that Hispanic and Black cohorts had 23% and 11% lower healthcare expenditures (both p < 0.001). Hispanic and Black cohorts also had lower odds of having a CVD visit (odds ratio [OR] = 0.61, 95% confidence interval [CI]:0.55-0.68; OR = 0.58, 95% CI: 0.52-0.65, respectively) compared to the White cohort. Key predictors included physical and cognitive limitations, insurance status, income, region, and the year of data collection. This study highlights the need for targeted interventions to address healthcare disparities and promote health equity among minority populations with CVD.

Economic and Humanistic Burden of Rheumatoid Arthritis: Results From the US National Survey Data 2018-2020.

Our objective was to estimate the economic and humanistic burden among US adults with rheumatoid arthritis (RA). This study analyzed results from the Medical Expenditure Panel Survey from 2018 to 2020. Adults (aged ≥18 years) self-reporting with RA or with the presence of the International Classification of Disease, 10th Revision clinical modification codes were identified. Healthcare expenditures (inpatient care, outpatient care, emergency department, office visits, prescription medications, home health, and others) were measured. The Short Form 12 Health Survey physical component summary (PCS), mental component summary (MCS), activities of daily living (ADL), and instrumental ADL (IADL) were measured. Two-part models assessed the incremental increase in the health care expenditures for the RA group compared to the non-RA group. In addition, the multivariable linear regression was used to evaluate the marginal difference in PCS and MCS between those with RA and those without RA, whereas the multivariable logistic regression models were used to evaluate the association between ADL and IADL by RA status. Annually, 4.27 million adults with RA were identified. The two-part model showed significantly higher total annual healthcare expenditures in the RA group than non-RA group (mean $3,382.971 [95% confidence interval (CI) $1,816.50-$4,949.44]). Compared to the non-RA group, the RA group was associated with lower PCS scores (mean4.78 [95% CI 3.47-6.09]) and similarly lower MCS scores (mean -0.84 [95% CI -2.18 to 0.50]), as well as increased odds of requesting ADL (adjusted odds ratio [aOR] 2.02 [95% CI 1.59-2.56]) and IADL assistance (aOR 2.11 [95% CI 1.57-2.84]). RA was associated with higher health care expenditures, particularly prescription medication costs, and was associated with suboptimal quality of life.

Understanding racial disparities in health care expenditures for cervical cancer.

Cervical cancer demonstrates a notable efficacy in treatment, evidenced by a 92% 5-year survival rate among cases diagnosed at a localized stage. In 2020, the estimated annual national expenditure for cervical cancer care amounted to $2.3 billion in the United States. Limited real-world data are available for racial disparities in health care expenditures for cervical cancer. To evaluate racial disparities associated with annual health care expenditures among patients diagnosed with cervical cancer in the United States. A retrospective observational cohort study of annual health care expenditures in patients with cervical cancer diagnosed during 2014-2019 was performed using the Medical Expenditure Panel Survey data. In addition to the descriptive weighted analysis, an unadjusted analysis of the annual health care expenditure was conducted. An adjusted linear regression model with log transformation of the outcome variable was used to evaluate the total annual health care expenditure as well as expenditures by category across the racial groups. Overall, 826 patients with cervical cancer were identified from the Medical Expenditure Panel Survey during 2014-2019. The majority were classified as White patients (81.2%) and in the age group of 45-64 years (44.65%). On average, the total annual health care expenditure was $11,537 (95% CI = $9,887-$13,186) among the White cohort, $10,659 (95% CI = $6,704-$14,614) among the African American cohort, and $8,726 (95% CI = $6,113-$11,340) among the Hispanic cohort. After adjusting for covariates, the average total annual health care expenditure for the Hispanic cohort was 35% of the total health care expenditure of the White cohort (P < 0.001) and 46% of the African American cohort's health care expenditure (P = 0.02). Specifically, adjusted costs of office-based and outpatient visits for the Hispanic cohort were 47% (P = 0.009) and 57% (P = 0.005) lower than for the White cohort, respectively. The total annual home health care expenditure for the African American cohort was 49% lower than White patients (P = 0.03), and the Hispanic cohort's total expenditure, excluding prescription medicines, was 57% lower than African American patients (P = 0.02). This study provides valuable information regarding the health care disparities that need to be addressed among certain minority races. Reducing the disparities in health care spending across racial groups should be included as a crucial element in tackling well-established health care inequities.

Clinical and financial significance of insomnia within a large payor-provider health system.

Insomnia has profound negative effects on behavioral health, physical health, and functional domains. Leveraging claims data from one of the nation's largest payor-provider systems, the current study examined the real-world prevalence of insomnia, comorbidity of insomnia with behavioral health and other sleep disorders, and the impact of insomnia on total health care costs. Prevalence and costs associated with insomnia were assessed by examining claims data on approximately 3 million insured members during the year 2022. Using propensity score matching, total health care expenditures were calculated and compared for members with insomnia relative to matched cohorts without insomnia. Generalized linear modeling tested for differences between the cohorts. Nine percent of members were identified as having insomnia; 64% of those also had depression, anxiety, and/or substance use disorder. Median total health care costs among individuals with insomnia were 4-6 times greater than among those without insomnia. A disproportionate amount (21.1%) of total claims spend came from members with insomnia. Findings demonstrate a high degree of clinical need and behavioral health comorbidity associated with insomnia within a large insured cohort. Beyond the clinical significance, the current results demonstrate substantial financial need and opportunity for adequately treating insomnia. This is especially the case for the high proportion of members with insomnia and cooccurring depression, anxiety, and/or substance use disorders. Overall, the findings point to the important role payors and providers may have in promoting greater attention to sleep and insomnia.

Trends in direct health care costs among US adults with atherosclerotic cardiovascular disease with and without diabetes

ObjectivePopulation-based national data on the trends in expenditures related to coexisting atherosclerotic cardiovascular diseases (ASCVD) and diabetes is scarce. We assessed the trends in direct health care expenditures for ASCVD among individuals with and without diabetes, which can help to better define the burden of the co-occurrence of diabetes and ASCVD.MethodsWe used 12-year data (2008–2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).ResultsThe total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808–$15,619) in 2008–2009 to $19,145 (95% CI: $17,988–$20,301) in 2008–2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721–$5646) in 2008–2009 to $7501 (95% CI: $6678–$8325) in 2018–2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643–$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.ConclusionsIn the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.

Life expectancy in relation to societal development level: significant discordant factors.

The aim of this study is to determine the interdependence between life expectancy and numerous social indicators, i.e., to determine the factors that encourage an increase or decrease in life expectancy. Pearson coefficients as well as linear and logarithmic trends and correlations between the dependent variable of life expectancy and numerous independent variables were calculated and analysed. The calculations were carried out for all countries in the world for which data is available. Based on the strength of the correlations between life expectancy and numerous indicators, we have tried to determine the reasons for the different values of life expectancy in the various countries. Important factors for achieving high life expectancy values are economic development and healthcare spending but the spread of "diseases of the modern era", such as obesity or diabetes, have a significant negative impact on life expectancy. Other important limiting factors for life expectancy are large income inequalities, a higher share of private healthcare expenditure in total healthcare expenditure and lower total healthcare expenditure. Less developed societies can significantly increase their life expectancy by providing clean water and safe sanitation and by combating various infectious diseases (especially HIV). Life expectancy is a meaningful indicator of the state of social development and accurately reflects the general state of a particular society. It has been shown that GDP per capita (PPP) is a key determinant of life expectancy, while other important factors play the role of a further modifier.

Clustering analysis for predicting racial disparities in genitourinary cancer–related financial burden.

e13612 Background: Healthcare costs in the United States (US) are significantly impacted by genitourinary (GU) cancers. Prostate cancer treatment alone cost the US more than $22 billion in 2020. We sought to utilize machine learning (ML)-based classification to investigate differences in the total cost of healthcare expenditure among patients with GU cancer in the US. Methods: The study included eligible adult GU cases from the 2019–2021 Medical Expenditure Panel Survey. Renal cell, prostate, urothelial, testicular, and penile cancers were identified using ICD-10 CM codes. Patients were clustered using demographic information such as age, race, sex, marital status, highest degree, insurance status, perceived health status, and perceived mental health status. The analysis accounted for the complex survey design and sampling weights. The cluster groups were taken into account when conducting descriptive and regression analyses. GU cancer cases were divided into low-, medium-, and high-risk healthcare expenditure clusters. Results: The study included a representative sample of 9,061,181 cases of GU cancer in the US between 2019 and 2021. The average age of the sample was 71.6 years (95% CI: 70.7, 72.5). There were 7.9% Hispanic (Hisp), 74.8% non-Hispanic White (NHW), 13.8% non-Hispanic Black (NHB), and 3.5% individuals from Asian or other races. Overall, the mean total healthcare expenditures within low-, med-, and high-risk clusters were $17974 (13816, 22133), $20496 (13100, 27893), and $30512 (21389, 39635), respectively. Regression analysis showed that, after adjusting for sampling weight, cluster, gender, family income, age, insurance status, and survey year, the mean total expenditure was higher by $11209.70 and $13100.81 in med- and high-risk clusters when compared to the low-risk cluster (ref.). Within each race or ethnicity, the proportion of Hisp or NHB individuals was higher in med- and high-risk clusters. Med- and high-risk clusters were more likely to contain people with cognitive impairments, poor health status, and financial difficulties in their families. Conclusions: We used an unsupervised clustering algorithm that can distinguish between GU cases with high and low expenditure based solely on sociodemographic variables. We demonstrate that our findings were consistent for all three data cohorts. This approach can predict the disparity in utilization in any insured population. [Table: see text]

Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data

BackgroundHealth services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data.MethodsData were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013).ResultsBased on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30–39, 40–49, 50–59, 60–69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women.ConclusionsThe prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.

Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort

Background & aimsDespite its high prevalence in the western world metabolic dysfunction-associated steatotic liver disease (MASLD) does not benefit from targeted pharmacological therapy. We measured healthcare utilisation and identified factors associated with high-cost MASLD patients in France.MethodsThe prevalent population with MASLD (including non-alcoholic steatohepatitis) in the CONSTANCES cohort, a nationally representative sample of 200,000 adults aged between 18 and 69, was linked to the French centralised national claims database (SNDS). Study participants were identified by the fatty liver index (FLI) over the period 2015–2019. MASLD individuals were classified according as “high-cost” (above 90th percentile) or “non-high cost” (below 90th percentile). Factors significantly associated with high costs were identified using a multivariate logistic regression model.ResultsA total of 14,437 predominantly male (69%) participants with an average age of 53 ± SD 12 years were included. They mainly belonged to socially deprived population groups with co-morbidities such as diabetes, high blood pressure, mental health disorders and cardiovascular complications. The average expenditure was €1860 ± SD 4634 per year. High-cost MASLD cost €10,863 ± SD 10,859 per year. Conditions associated with high-cost were mental health disorders OR 1.79 (1.44–2.22), cardiovascular diseases OR 1.54 (1.21–1.95), metabolic comorbidities OR 1.50 (1.25–1.81), and respiratory disease OR 1.50 (1.11–2.00). The 10% high-cost participants accounted for 58% of the total national health care expenditures for MASLD.ConclusionOur results emphasize the need for comprehensive management of the comorbid conditions which were the major cost drivers of MASLD.Graphical

Healthcare and economic cost burden of emergency medical services treated non-traumatic shock using a population-based cohort in Victoria, Australia

ObjectivesWe aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock.DesignWe conducted a population-based cohort study, where EMS-treated...