Indirect costs assessment and intangible costs description of rheumatoid arthritis patients with biological therapy in Morocco: ECORAM Study.

INTRODUCTION: The aims of study are to estimate the indirect costs and intangible costs of RA in Morocco and to identify the factors likely to influence these costs among suffering patients. METHODS: In the current study, data were collected by face-to-face interviews using a questionnaire in addition to the patient's files. Indirect costs including productivity losses and formal care, and intangible costs such as the cessation of physical and leisure activities, family care and divorce or remaining single until menopause's age for women due to the disease were reported for 110 RA patients. RESULTS: The results show that among patients who lost totally or partially their salary, the annual average costs is $2337.73 ± 1649.80 per patient, with a minimum and a maximum of $600 and $9630 respectively. As regards formal care, only 13 patients reported that they paid for care services; the annual average cost was $421.84 ± 261.34 with a minimum of $252 and a maximum of $1200. Statistical analysis revealed significant differences between annual lost salary and gender (p = .04) disease duration (p = .016) and sport/leisure activities cessation (p = .08). CONCLUSION: Besides the burden in terms of productivity loss and caregivers' costs, the intangible costs are considerable, especially those related to divorce and spinsterhood. These conclusions may contribute to the understanding of the socio-economic impact of the disease and to the development of strategies for better governance of RA in Morocco.

Economic burden of chronic migraine in OECD countries: a systematic review.

BACKGROUND: Chronic migraine (CM) is a significant neurological condition affecting a substantial portion of the global population. The economic burden of CM includes both direct healthcare costs and indirect costs resulting from productivity losses and intangible impacts on patients' quality of life. However, there is limited research that comprehensively evaluates all cost components associated with CM, highlighting the need for a systematic review. METHODS: We conducted a systematic literature search in databases including MEDLINE, Embase, and CINAHL to identify studies estimating the cost of illness of chronic migraines. The search was restricted to English language articles published from inception to October 2021, and only findings from Organisation for Economic Co-operation and Development (OECD) countries were included. Methodology features and key findings were extracted from the studies, and reported costs were converted to GBP for cross-country comparisons. RESULTS: Thirteen cost-of-illness studies on CM from various OECD countries were included in this review. The studies demonstrated substantial variations in monetary estimates, but consistently highlighted the considerable economic burden of CM. Direct costs, particularly hospitalisation and medication expenses, were identified as the highest contributors. However, indirect costs, such as productivity losses due to absenteeism and presenteeism, were often underexplored in the reviewed studies. Additionally, intangible costs related to emotional and social impacts on patients were largely overlooked. CONCLUSION: Chronic migraine imposes a significant economic burden on individuals, healthcare systems, and society. Policymakers and healthcare stakeholders should consider both direct and indirect cost components, as well as intangible costs, in developing targeted strategies for effective CM management and resource allocation. Further research focusing on comprehensive cost assessments and sensitivity analyses is needed to enhance the understanding of CM's economic implications and inform evidence-based healthcare policy decisions. Addressing these research gaps can alleviate the economic burden of CM and improve patient outcomes.

The prevalence and economic burden of treatment-resistant depression in Thailand.

BACKGROUND: The objectives of this study were to investigate the proportion of treatment-resistant depression (TRD) among patients with diagnosed major depressive disorder (MDD) and undergoing antidepressant treatment, to estimate the economic cost of MDD, TRD, and non-treatment-resistant depression (non-TRD), and to examine the differences between TRD and non-TRD MDD in a Thai public tertiary hospital. METHODS: This was a combined study between retrospective review of medical records and a cross-sectional survey. The sample size was 500 dyads of antidepressant-treated MDD patients and their unpaid caregivers. MDD patients' medical records, the concept of healthcare resource utilization, the Work Productivity and Activity Impairment Questionnaire: depression and mood & mental state versions (WPAI: D, MM), the Class Impairment Questionnaire (CIQ), and the Family Experiences Interview Schedule (FEIS) were applied as the tools of the study. Pearson Chi's square, Fisher's Exact test, and independent T-test were employed for statistical analysis. RESULTS: The proportion of TRD was 19.6% among antidepressant-treated MDD patients in a Thai tertiary public hospital. The results of the study indicated that several factors showed a statistically significant association with TRD criteria. These factors included younger age of MDD patients, a younger age of onset of MDD, lower body mass index (BMI), a history of suicide attempts and self-harm, as well as frequent smoking behavior. The annualized economic cost of TRD was 276,059.97 baht per person ($7,668.33), which was significantly higher than that of cost of non-TRD (173,487.04 baht or $4,819.08). The aggregated economic costs of MDD were 96.8 million baht annually ($2.69 M) if calculated from 500 MDD patients and unpaid caregivers. This contributed to the economic cost of TRD 27.05 million baht (98 respondents) and the economic cost of non-TRD 69.74 million baht (402 respondents). CONCLUSIONS: The economic burden associated with TRD was significantly higher compared to non-TRD among antidepressant-treated MDD patients. Specifically, both direct medical costs and indirect costs were notably elevated in the TRD group.

Measuring the costs of crime using the willingness-to-pay method.

BACKGROUND: Criminal justice policy decisions are increasingly being influenced by the ratio of the monetary benefits to the monetary costs. While policies based on evidence and analysed via cost-benefit studies are a welcome development, cost-benefit calculations are only as robust as the data upon which they are based. For England and Wales up to the present, cost-of-crime estimates used in cost-benefit analyses have been calculated by the Home Office using a multi-method approach. However, the intangible costs of crime have not been estimated adequately in England and Wales. AIM: The main aim was to quantify the intangible costs of crime using the willingness-to-pay (WTP) method. Also, stated preferences for different crime reduction methods were investigated. METHOD: This study utilises samples from the City of Cambridge (n = 534) and from Criminal Justice Practitioners (n = 124), to assess their WTP to prevent a range of crimes from happening in their neighbourhood, and their preferred crime reduction techniques. A Contingent Valuation Survey (CVS) was used. RESULTS: Overall, both samples gave a higher WTP for low volume, high harm crimes than for high volume, low harm crimes. Both samples supported funding youth programmes in preference to other forms of crime reduction initiatives. CONCLUSION: It is proposed that a CVS should be included in the next Crime Survey for England and Wales, in order to collect relevant WTP data on crime at the national level.

The intangible costs of overweight and obesity in Germany.

BACKGROUND: Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany. METHODS: By applying a life satisfaction-based compensation value analysis to 2002-2018 German Socio-Economic Panel Survey data for adults aged 18-65, the intangible costs of overweight and obesity are estimated. We apply individual income as a reference for estimating the value of the loss of subjective well-being due to overweight and obesity. RESULTS: The intangible costs of overweight and obesity in 2018 amount to 42,450 and 13,853 euros, respectively. A one unit increase in BMI induced a 2553 euros annual well-being loss in the overweight and obese relative to those of normal weight. When extrapolated to the entire country, this figure represents approximately 4.3 billion euros, an intangible cost of obesity similar in magnitude to the direct and indirect costs documented in other studies for Germany. These losses, our analysis reveals, have remained remarkably stable since 2002. CONCLUSIONS: Our results underscore how existing research into obesity's economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger.

The Economic Burden of Malignant Brain Tumors.

Malignant brain tumors consist of primary malignant tumors and metastatic brain tumors. The global incidence and prevalence of CNS cancers are increasing, their mortality and morbidity are relatively higher than other cancers (e.g., bladder cancer), and the management of disease utilizes sophisticated and expensive diagnostic and therapeutic technology. Therefore, malignant brain tumors, both primary and metastatic, impose a significant economic burden on patients, their families, and healthcare systems all around the world. To the best of our knowledge, there is no comprehensive and global systematic review for examining the costs of brain tumors, though sporadic reports highlight the importance of the problem. Besides, each study takes place in a setting with different methods (e.g., different treatment methods) and costs to manage brain tumors; therefore, we are unable to compare the costs between countries. Nevertheless, the general patterns seem to suggest that, among all, gliomas and glioblastomas are the most financially burdensome types of malignant brain cancer. Finally, most of the available studies have examined the economic burden of all gliomas or only glioblastoma. Hence, we are left with a substantial gap in knowledge to understand the actual economic burden of metastatic brain tumors, and there is a need for further accurate and internationally comparable studies on the subject, particularly with a focus on indirect and intangible costs.

The costs of celiac disease: a contingent valuation in Switzerland.

This paper proposes a first monetary measure of the private costs of celiac disease, including intangible costs (physical symptoms, logistical constraints, etc.) in Switzerland. This auto-immune disease damages the intestine when patients ingest gluten. The only treatment currently available is a gluten-free diet, which implies great nutritional constraints. To get a monetary equivalent of the costs borne by celiac patients, we used a contingent valuation. The scenario suggested to celiac patients a treatment in form of a daily pill, which would allow them to eat normally and avoid any physical pain from celiac disease. Mean Willingness To Pay (WTP) for the treatment is found to be around CHF 87 (approx. USD 87) per month. WTP is positively influenced by direct and indirect costs of the disease. Oppositely, individuals, who find the gluten-free diet healthier are willing to pay less. Finally, unlike symptoms before diagnostic, the current presence or intensity of physical symptoms are found to be insignificant. The latter result can be explained by the fact that, individuals facing stronger symptoms are more likely to adhere strictly to the GFD and hence to reduce their frequency.

Estimating the economic consequences of substance use and substance use disorders.

INTRODUCTION: This contribution gives an overview on estimating the economic impact of substance use (SU) and substance use disorders (SUDs) from a societal perspective. AREAS COVERED: In this Expert Review, we first discuss the scope of the economic costs of SU to society and the methods used to estimate them. In general, cost studies should not be limited to SUDs, but should also include costs related to the consequences of any type of SU to achieve a comprehensive picture of the societal burden. Further, estimating potentially avoidable costs will increase the value of cost studies. Importantly, methodologically sound cost studies shed light on the magnitude of societal problems related to SU and can be used as a reference point to evaluate regulatory policies and other preventive measures. The area of estimating potential economic benefits of SU is understudied and lacks a theoretical and methodological framework. EXPERT OPINION: Overall, economic studies on the impact of SU and SUDs can strongly contribute to better-informed decision-making in the creation of regulatory and control policies. The least developed area of research refers to a consensus methodology that could be used in studies which compare economic costs to potential economic benefits.

Cost of Cancer: Healthcare Expenditures and Economic Impact.

Healthcare expenditures for cancer account for a low share of total healthcare expenditures, compared to the relative burden of the disease. The share has also not changed very much over the last decades. Cost for cancer drugs has increased as a share of total expenditures, but this has been offset by a reduction of inpatient hospital care for cancer. Accounting for the cost of cancer should not be limited to healthcare expenditures. Resources are also used for public and private care of cancer patients outside the healthcare sector, for example for palliative care. Informal care by family and friends is an important complement to professional care, and estimates indicate that this amounts to between half and one-third of the costs of formal care. Indirect costs related to the loss of production for persons with cancer are estimated to be of the same magnitude as the direct healthcare expenditures. Indirect costs related to premature mortality dominate the estimate of indirect costs, but those costs have declined over time, despite increasing incomes, due to the reduction in mortality due to cancer in the economically active age groups. Estimates of indirect costs due to morbidity are uncertain and vary significantly between published studies. A full accounting of the costs of cancer should include an estimate of the health burden of cancer. Loss of quality-adjusted life expectancy (QALY) can be measured and valued based on the willingness to pay for a QALY. Such estimates are possible to derive from decisions about allocating resources for cancer. There are few estimates of these costs, but available studies indicate that the intangible costs of lost QALY are by far the dominating cost of cancer. The value for policy-making of costs of cancer estimates increases when results with consistent methods and data are available that allow comparisons between countries and over time. The evidence about the cost of cancer is still limited, but when current scientific progress produces an increasing number of new options for prevention, diagnosis and treatment, studies of the cost of cancer become increasingly important to inform decisions about resource allocation.

The economic burden of occupational non-melanoma skin cancer due to solar radiation.

Solar ultraviolet (UV) radiation is the second most prevalent carcinogenic exposure in Canada and is similarly important in other countries with large Caucasian populations. The objective of this article was to estimate the economic burden associated with newly diagnosed non-melanoma skin cancers (NMSCs) attributable to occupational solar radiation exposure. Key cost categories considered were direct costs (healthcare costs, out-of-pocket costs (OOPCs), and informal caregiver costs); indirect costs (productivity/output costs and home production costs); and intangible costs (monetary value of the loss of health-related quality of life (HRQoL)). To generate the burden estimates, we used secondary data from multiple sources applied to computational methods developed from an extensive review of the literature. An estimated 2,846 (5.3%) of the 53,696 newly diagnosed cases of basal cell carcinoma (BCC) and 1,710 (9.2%) of the 18,549 newly diagnosed cases of squamous cell carcinoma (SCC) in 2011 in Canada were attributable to occupational solar radiation exposure. The combined total for direct and indirect costs of occupational NMSC cases is $28.9 million ($15.9 million for BCC and $13.0 million for SCC), and for intangible costs is $5.7 million ($0.6 million for BCC and $5.1 million for SCC). On a per-case basis, the total costs are $5,670 for BCC and $10,555 for SCC. The higher per-case cost for SCC is largely a result of a lower survival rate, and hence higher indirect and intangible costs. Our estimates can be used to raise awareness of occupational solar UV exposure as an important causal factor in NMSCs and can highlight the importance of occupational BCC and SCC among other occupational cancers.

Societal costs of multiple sclerosis in Ireland.

AIMS: This paper evaluates the impact of multiple sclerosis (MS) in Ireland, and estimates the associated direct, indirect, and intangible costs to society based on a large nationally representative sample. MATERIALS AND METHODS: A questionnaire was developed to capture the demographics, disease characteristics, healthcare use, informal care, employment, and wellbeing. Referencing international studies, standardized survey instruments were included (e.g. CSRI, MFIS-5, EQ-5D) or adapted (EDSS) for inclusion in an online survey platform. Recruitment was directed at people with MS via the MS Society mailing list and social media platforms, as well as in traditional media. The economic costing was primarily conducted using a 'bottom-up' methodology, and national estimates were achieved using 'prevalence-based' extrapolation. RESULTS: A total of 594 people completed the survey in full. The sample had geographic, disease, and demographic characteristics indicating good representativeness. At an individual level, average societal cost was estimated at €47,683; the average annual costs for those with mild, moderate, and severe MS were calculated as €34,942, €57,857, and €100,554, respectively. For a total Irish MS population of 9,000, the total societal costs of MS amounted to €429m. Direct costs accounted for just 30% of the total societal costs, indirect costs amounted to 50% of the total, and intangible or QoL costs represented 20%. The societal cost associated with a relapse in the sample is estimated as €2,438. LIMITATIONS AND CONCLUSIONS: The findings highlight that up to 70% of the total costs associated with MS are not routinely counted. These "hidden" costs are higher in Ireland than the rest of Europe, due in part to significantly lower levels of workforce participation, a higher likelihood of permanent workforce withdrawal, and higher levels of informal care needs. The relationship between disease progression and costs emphasize the societal importance of managing and slowing the progression of the illness.

Alzheimer's disease costs: what we know and what we should take into account.

BACKGROUND/OBJECTIVE: Alzheimer's disease (AD) is a very costly pathology. Total costs of AD result from the sum of direct and indirect costs. Intangible costs represent an additional burden that is difficult to quantify. This paper has reviewed the evaluation of the costs of AD and the methodologies to estimate them, and proposes the use of some tools which may be useful in establishing the financial weight of the disease. METHOD: A systematic literature search was conducted using the Pubmed and Medline databases as a source of published papers. RESULTS: In AD, direct and indirect costs and their sum (total costs) are very high and tend to increase parallel with the evolution of the pathology. The evolution of AD is characterized by the loss of functional autonomy, the onset of behavioral and sleep disorders, and the development of delusions and hallucinations. This requires more frequent medical examinations and hospitalizations resulting in higher direct costs, which become the relevant weight. None of the papers reviewed investigated intangible cost. CONCLUSION: The calculation of costs of AD is frequently based on cognitive decline and the degree of dependence of patients. The evaluation of intangible costs (psychological pain of the patient and of the unpaid caregivers' and their impaired quality of life) is a missing aspect in all reviewed studies. Due to the complexity of AD, it will be necessary to adopt cost evaluation systems including the different dimensions of the problem and its various aspects.

Direct, indirect, and intangible costs after severe trauma up to occupational reintegration - an empirical analysis of 113 seriously injured patients.

AIM: Although seriously injured patients account for a high medical as well as socioeconomic burden of disease in the German health care system, there are only very few data describing the costs that arise between the days of accident and occupational reintegration. With this study, a comprehensive cost model is developed that describes the direct, indirect and intangible costs of an accident and their relationship with socioeconomic background of the patients. METHODS: This study included 113 patients who each had at least two injuries and a total Abbreviated Injury Scale (AIS) greater than or equal to five. We calculated the direct, indirect and intangible costs that arose between the day of the accident and occupational reintegration. Direct costs were the treatment costs at hospitals and rehabilitation centers. Indirect costs were calculated using the human capital approach on the basis of the work days lost due to injury, including sickness allowance benefits. Intangible costs were assessed using the Short Form Survey (SF-36) and represented in non-monetary form. Following univariate analysis, a bivariate analysis of the above costs and the patients' sociodemographic and socioeconomic characteristics was performed. RESULTS: At an average Injury Severity Score (ISS) of 19.2, the average direct cost per patient were €35,661. An average of 185.2 work days were lost, resulting in indirect costs of €17,205. The resulting total costs per patient were €50,431. A bivariate analysis showed that the costs for hospital treatment were 58% higher in patients who graduated from lower secondary school [Hauptschule] (ISS 19.5) than in patients with qualification for university admission [Abitur] (ISS 19.4). CONCLUSIONS: The direct costs of treating trauma patients at the hospital appear to be lower in patients with a higher level of education than in the comparison group with a lower educational level. Because of missing data, the calculated indirect costs can merely represent a general trend, so that the bivariate analysis can only be seen as a starting point for further studies.