RESUMO
BACKGROUND: Although the frequency of heart failure makes it among the costliest of illnesses, there are scant Canadian data on annual costs of treatment or the costs as the condition advances. Our objective was to estimate mean prevalence- and incidence-based direct medical costs among older adults discharged alive after a first hospital admission for heart failure. METHODS: We conducted a retrospective cohort study using population-based administrative health databases for Nova Scotia. The cohort comprised persons 50 years of age or older with an incident hospital admission for heart failure between 2009 and 2012. We considered the costs (expressed as 2020 Canadian dollars) of hospital admissions, physician visits and, for patients 65 years of age or older, outpatient cardiac medications. We estimated costs for calendar years, longitudinally and in the last 2 years of life. We analyzed costs from the perspective of a third-party public payer. RESULTS: The cohort consisted of 3327 patients (mean age 77.6 yr; 1605 [48.2%] women). Median survival was 2.5 and 2.2 years among men and women, respectively. Annual prevalence-based costs were about $7100. Mean incidence-based costs ranged between $65 000 and $164 000 in the year after diagnosis and decreased by 90% subsequently. Costs were 4 to 7 times higher in the year before death than in the period from 1 to 2 years before death. INTERPRETATION: The direct medical costs of treating patients with heart failure in Nova Scotia displayed a reverse J shape, with costs highest after diagnosis, declining subsequently and then increasing during the final year of life. Strategies designed to improve the quality of care immediately after diagnosis and during more advanced stages of disease might reduce these costs.
Assuntos
Insuficiência Cardíaca , Hospitalização , Melhoria de Qualidade/organização & administração , Assistência Terminal , Idoso , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Progressão da Doença , Feminino , Gastos em Saúde , Necessidades e Demandas de Serviços de Saúde , Insuficiência Cardíaca/economia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Nova Escócia/epidemiologia , Qualidade da Assistência à Saúde/normas , Assistência Terminal/economia , Assistência Terminal/estatística & dados numéricosRESUMO
PURPOSE: Anticoagulant therapy for at least 3-6 months is currently recommended for treatment of venous thromboembolism (VTE) in patients with cancer, but the optimal duration of treatment is unknown. This study examines the association between the duration of anticoagulation treatment and VTE recurrence in cancer patients. METHODS: The Humana claims database was used to identify newly diagnosed cancer patients who had their first VTE diagnosis between January 1, 2013, and May 31, 2015, and initiated injectable or oral anticoagulant therapy. Follow-up was calculated from the index treatment initiation to the end of eligibility or end of data (June 2015). VTE recurrence was defined as a hospitalization with a primary diagnosis of VTE. Cox proportional hazards models were used to evaluate the risk of VTE recurrence by duration of therapy in patients who discontinued therapy. RESULTS: The study included 1158 patients. Compared to patients treated for 0 to 3 months, VTE recurrences were significantly lower among patients treated for 3 to 6, or over 6 months. After adjustment for baseline characteristics, patients treated for 3 to 6 months (HR [95%CI], 0.53; 0.37-0.76) and more than 6 months (HR [95%CI], 0.48; 0.34-0.68) were still significantly less likely to have VTE recurrences compared to patients treated for 0 to 3 months (both p < 0.01). Findings were similar using a VTE event definition that included outpatient visits. CONCLUSIONS: Among newly diagnosed cancer patients with VTE, anticoagulant therapy lasting more than 3 months was associated with a lower risk of VTE recurrence.
Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Tromboembolia Venosa/tratamento farmacológico , Adulto , Idoso , Bases de Dados Factuais , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Modelos de Riscos Proporcionais , Recidiva , Fatores de Risco , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/patologiaRESUMO
Reaction time (RT) of erroneous responses in go/no-go tasks tends to be shorter than RT of correct responses. An opposite difference has been reported ( Halperin, Wolf, Greenblatt, & Young, 1991 ) which could be attributed to differences in go trial probability, or to high memory demand. Two experiments aimed here to test these two explanations, a simultaneous matching task with low memory load (Experiment 1), and a sequential matching task with high memory load (Experiment 2). Go trial probability was also manipulated. Short false positive RT was obtained only in the sequential matching task with high go trial probability, while long false positive RT was obtained in the other three conditions. Low go trial probability and high memory load were both found to be sufficient, by themselves, to create long false positives attributable to confusion. Short false positives in the high go trial probability/low memory load condition were attributed to failure of response inhibition.
Assuntos
Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Adolescente , Adulto , Confusão/psicologia , Feminino , Humanos , Masculino , Memória/fisiologia , Probabilidade , Adulto JovemRESUMO
OBJECTIVE: To compare kidney size (used as proxy for total renal angiomyolipoma [rAML] size) and kidney function outcomes between patients with tuberous sclerosis complex (TSC) and rAML treated and not treated with everolimus. METHODS: Medical charts of adults with TSC-associated rAML followed at a specialty medical center in the Netherlands (1990-2015). Included patients treated with everolimus (n = 33, of which 27 were included in the kidney size analyses and 27 in the kidney function analyses [21 patients in both]; index date = everolimus initiation) and non-treated patients (n = 39, of which 29 were included in the kidney size analyses and 33 in the kidney function analyses [23 patients in both]; index date = one date among all dates with outcome measurement).Percent change in kidney size and kidney function from the index date to the best measurement in the two years post-index date (best response) compared between patients treated and not treated with everolimus. RESULTS: Compared with non-treated patients, significantly more everolimus-treated patients experienced a reduction in the size of their largest kidney in the two years post-index date (85.2% vs. 37.9%, p < 0.01). Also, there was a tendency towards more improvement in the estimated glomerular filtration rate (eGFR) among the everolimus-treated patients (55.6% vs. 33.3%, p = 0.08). CONCLUSIONS: The study results suggest that everolimus is effective in controlling and even reversing the growth of the kidneys, used as a proxy for rAML size, as well as preserving or improving kidney function in patients with TSC and rAML treated in a real-world, observational setting.
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Angiomiolipoma , Everolimo/administração & dosagem , Neoplasias Renais , Esclerose Tuberosa , Adolescente , Adulto , Idoso , Angiomiolipoma/tratamento farmacológico , Angiomiolipoma/patologia , Angiomiolipoma/fisiopatologia , Everolimo/efeitos adversos , Feminino , Humanos , Testes de Função Renal , Neoplasias Renais/tratamento farmacológico , Neoplasias Renais/patologia , Neoplasias Renais/fisiopatologia , Masculino , Pessoa de Meia-Idade , Países Baixos , Tamanho do Órgão/efeitos dos fármacos , Esclerose Tuberosa/tratamento farmacológico , Esclerose Tuberosa/patologia , Esclerose Tuberosa/fisiopatologiaRESUMO
Two behavioral estimates of interhemispheric transfer time, the crossed-uncrossed difference (CUD) and the unilateral field advantage (UFA), are thought to, respectively, index transfer of premotor and visual information across the corpus callosum in neurotypical participants. However, no attempt to manipulate visual and motor contingencies in a set of tasks while measuring the CUD and the UFA has yet been reported. In two go/no-go comparison experiments, stimulus pair orientations were manipulated. The hand of response changed after each correct response in the second, but not the first experiment. No correlation was found between the CUD and the UFA, supporting the hypothesis that these two measures index different types of information transfer across hemispheres. An effect of manipulation of stimulus pair orientation on UFAs was attributed to the homotopy of callosal fibers transferring visual information, while an effect of hand switching on CUDs was attributed mostly to spatial compatibility.
Assuntos
Corpo Caloso/fisiologia , Função Executiva/fisiologia , Lateralidade Funcional/fisiologia , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologia , Percepção Visual/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Percepção Espacial/fisiologia , Transferência de Experiência , Adulto JovemRESUMO
Anticoagulation is used to treat venous thromboembolism (VTE) in cancer patients, but may be associated with an increased risk of bleeding. VTE recurrence and major bleeding were assessed in cancer patients treated for VTE with the most currently prescribed anticoagulants in clinical practice. Newly diagnosed cancer patients (first VTE 1/1/2013-05/31/2015) who initiated rivaroxaban, low-molecular-weight heparin (LMWH), or warfarin were identified from Humana claims data and observed until end of eligibility or end of data availability. VTE recurrence was a hospitalization with a primary diagnosis of VTE ≥7 days after first VTE. Major bleeding events on treatment were identified using validated criteria. Cohorts were compared using Kaplan-Meier rates at 6 and 12 months and Cox proportional hazards models. Cohorts were adjusted for their differences at baseline. A total of 2428 patients (rivaroxaban: 707; LMWH: 660; warfarin: 1061) met inclusion criteria. Patient characteristics were well balanced after weighting. There was a trend for lower VTE recurrence rates in rivaroxaban users compared to LMWH users at 6 months (13.2% vs. 17.1%; P = .060) and significantly lower at 12 months (16.5% vs. 22.2%; P = .030) [HR: 0.72, 95% CI: (0.52-0.95); P = .024]. VTE recurrence rates were also lower for rivaroxaban than warfarin users at 6 months (13.2% vs. 17.5%; P = .014) and 12 months (15.7% vs. 19.9%; P = .017) [HR: 0.74, 95% CI: (0.56-0.96); P = .028]. Major bleeding rates were similar across cohorts. This real-world analysis suggests cancer patients with VTE treated with rivaroxaban had significantly lower risk of recurrent VTE and similar risk of bleeding compared to those treated with LMWH or warfarin.
Assuntos
Anticoagulantes/uso terapêutico , Neoplasias/complicações , Tromboembolia Venosa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Inibidores do Fator Xa/uso terapêutico , Feminino , Hemorragia/induzido quimicamente , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Rivaroxabana/uso terapêutico , Resultado do Tratamento , Tromboembolia Venosa/etiologia , Varfarina/uso terapêuticoRESUMO
PURPOSE: To describe the patient characteristics, treatments, disease monitoring, and kidney function of patients with sporadic angiomyolipoma (sAML), stratified by the number and size of renal angiomyolipomas (AMLs). METHODS: Single-center retrospective analysis of patients with sAML treated from 1990 to 2015 in a dedicated clinic for inheritable tumor syndromes in a tertiary referral center from the Netherlands. Patients' first AML assessment at the clinic was defined as the index date. Patient characteristics were measured at the index date. Treatments, disease monitoring, and kidney function were measured post-index date. RESULTS: The study sample included 53 patients followed for a total of 184.6 patient-years. At the index date, the largest AML was ≥ 3.5 cm for 26 patients and < 3.5 cm for 27 patients (including six patients with five or more AMLs of < 3.5 cm). As compared to patients with AMLs < 3.5 cm, patients with largest AML ≥ 3.5 cm had higher frequency of pre-index bleeding episodes (31 vs. 4%), pre-index hypertension (35 vs. 15%), post-index nephrectomy (19 vs. 4%), post-index embolization (8 vs. 0%), and post-index renal scans (1.14 vs. 0.74 scans/year). Kidney impairment was especially pronounced in young adults with AML ≥ 3.5 cm. On average, patients with sAML developed chronic kidney disease stage two earlier than the general Dutch population (age 42 vs. 55 years), but later than the patients with tuberous sclerosis complex (35 years). CONCLUSIONS: Patients with sAML, especially those with larger AMLs, have high disease burden.
Assuntos
Angiomiolipoma/patologia , Angiomiolipoma/terapia , Hemorragia/complicações , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Insuficiência Renal Crônica/etiologia , Adulto , Fatores Etários , Idoso , Angiomiolipoma/complicações , Angiomiolipoma/diagnóstico por imagem , Embolização Terapêutica , Feminino , Taxa de Filtração Glomerular , Humanos , Hipertensão/complicações , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Nefrectomia , Países Baixos , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Centros de Atenção Terciária , Tomografia Computadorizada por Raios X , Carga Tumoral , UltrassonografiaAssuntos
Antineoplásicos/administração & dosagem , Bortezomib/administração & dosagem , Linfoma de Célula do Manto/tratamento farmacológico , Linfoma de Célula do Manto/epidemiologia , Padrões de Prática Médica , Inibidores de Proteassoma/administração & dosagem , Antineoplásicos/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bortezomib/efeitos adversos , Feminino , Humanos , Injeções Subcutâneas , Linfoma de Célula do Manto/patologia , Masculino , Inibidores de Proteassoma/efeitos adversos , Recidiva , Retratamento , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Recommended therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer are burdensome, and compliance with guidelines is unknown. OBJECTIVES: To describe current treatment patterns and to evaluate patient persistence on various anticoagulants. PATIENTS/METHODS: Medical and pharmacy claims from the Humana Database were analyzed (01/2007-12/2014). Newly diagnosed cancer patients treated with anticoagulants were categorized into one of the following cohorts: low-molecular-weight heparin (LMWH), warfarin, and rivaroxaban. Discontinuation, switching, and persistence with the index therapy were analyzed. RESULTS: A total of 2941 newly diagnosed patients with cancer who developed VTE and received anticoagulation in outpatient settings were identified. Of these, 97% initiated anticoagulation with LMWH (n=735; 25%), warfarin (n=1403; 47.7%), or rivaroxaban (n=709; 24.1%). Median treatment durations for the LMWH, warfarin, and rivaroxaban cohorts were 3.3, 7.9, and 7.9 months, respectively; Kaplan-Meier rates of persistence to the initial therapy were 37%, 61%, and 61% at 6 months. Warfarin and rivaroxaban users were significantly more likely to remain on initial therapy compared to LMWH (adjusted hazard ratios [HRs; 95% CI]: warfarin, 0.33 [0.28-0.38]; rivaroxaban, 0.38 [0.32-0.46]). The proportion of patients that switched from their initial treatment to another anticoagulation treatment was 22.9%, 7.9%, and 4.7% in the LMWH, warfarin, and rivaroxaban cohorts, respectively. CONCLUSIONS: This real-world analysis showed that, despite guideline recommendations, warfarin and rivaroxaban are at least as equally utilized as LMWH for the treatment of cancer-associated thrombosis. LMWH was associated with significantly lower persistence, shorter duration of treatment, and more switching than warfarin and rivaroxaban.
RESUMO
The concept of social cognition refers to a set of skills and to emotional and social experiences regulating relationships between individuals. This concept is appropriate in order to help us to explain individual human behaviours and behaviours in groups. Social cognition involves social knowledge, perception and processing of social cues, and the representation of mental states. The concept of social cognition thus refers to a multitude of skills. This paper stops on several of them, namely theory of mind, empathy, moral reasoning, emotional processing and emotional regulation. We propose a conceptual approach to each of these skills also stopping on their cerebral underpinnings. We also make an inventory of knowledge about the effects of age and neurodegenerative diseases on social cognition.
Assuntos
Envelhecimento/psicologia , Doenças Neurodegenerativas/psicologia , Percepção Social , Idoso , Idoso de 80 Anos ou mais , Cognição , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Many elderly patients with acute myeloid leukemia (AML) are considered ineligible for standard intensive induction therapy due to performance status and comorbidities. We analyzed treatment patterns and outcomes among elderly patients newly diagnosed with AML in the US community oncology setting. METHODS: A retrospective observational study was conducted using patient-level data from a network of US community oncology practices provided by Altos Solutions. Patients aged ≥ 60 years, diagnosed with AML between November 2005 and February 2014, with ≥ 1 recorded visit and ≥ 6 months between diagnosis and data cutoff, were included. Only patients who received active treatment or best supportive care (BSC) per National Comprehensive Cancer Network (NCCN) AML Guidelines were analyzed. RESULTS: Of 1139 patients meeting the inclusion criteria, 922 (median age 76 years) received NCCN-recommended treatments: standard induction (n = 5), low-intensity therapy (n = 425), BSC with hydroxyurea (HU) (n = 36), or BSC without HU (n = 455). For the low-intensity therapy cohort, median time from diagnosis to treatment initiation was 17 days; median duration of therapy was 5.1 months. Median overall survival (OS) from diagnosis in the low-intensity, BSC with HU, and BSC without HU groups was 12.3, 7.0, and 49.4 months, respectively. Median time to next therapy/death was 10.1 months in patients receiving low-intensity therapy. A higher proportion of patients receiving low-intensity therapy required transfusion or other supportive care versus those receiving BSC. CONCLUSIONS: As expected, OS in patients receiving low-intensity therapy or BSC with HU is poor for elderly patients with AML. Remarkably, intensive induction strategies are rarely used for older patients in community oncology practice.
Assuntos
Leucemia Mieloide Aguda/epidemiologia , Padrões de Prática Médica , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Transfusão de Sangue , Serviços de Saúde Comunitária/estatística & dados numéricos , Gerenciamento Clínico , Registros Eletrônicos de Saúde , Feminino , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/mortalidade , Leucemia Mieloide Aguda/terapia , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Vigilância da População , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Sub-optimal patient adherence to iron chelation therapy (ICT) may impact patient outcomes and increase cost of care. This study evaluated the economic burden of ICT non-adherence in patients with sickle cell disease (SCD) or thalassemia. METHODS: Patients with SCD or thalassemia were identified from six state Medicaid programs (1997-2013). Adherence was estimated using the medication possession ratio (MPR) of ≥0.80. All-cause and disease-specific resource utilization per-patient-per-month (PPPM) was assessed and compared between adherent and non-adherent patients using adjusted incidence rate ratios (aIRR). All-cause and disease-specific healthcare costs were computed using mean cost PPPM. Regression models adjusting for baseline characteristics were used to compare adherent and non-adherent patients. RESULTS: A total of 728 eligible patients treated with ICT in the SCD cohort, 461 (63%) adherent, and 218 in the thalassemia cohort, 137 (63%) adherent, were included in this study. In SCD patients, the adjusted rate of all-cause outpatient visits PPPM was higher in adherent patients vs non-adherent patients (aIRR [95% CI]: 1.05 [1.01-1.08], p < 0.0001). Conversely, adherent patients incurred fewer all-cause inpatients visits (0.87 [0.81-0.94], p < 0.001) and ER visits (0.86 [0.78-0.93], p < 0.001). Similar trends were observed in SCD-related resource utilization rates and in thalassemia patients. Total all-cause costs were similar between adherent and non-adherent patients, but inpatient costs (adjusted cost difference = -$1530 PPPM, p = 0.0360) were lower in adherent patients. CONCLUSION: Patients adherent to ICT had less acute care need and lower inpatient costs than non-adherent patients, although they had more outpatient visits. Improved adherence may be linked to better disease monitoring and has the potential to avoid important downstream costs associated with acute care visits and reduce the financial burden on health programs and managed care plans treating SCD and thalassemia patients.
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Anemia Falciforme/tratamento farmacológico , Terapia por Quelação/economia , Quelantes de Ferro/economia , Quelantes de Ferro/uso terapêutico , Medicaid/economia , Adesão à Medicação , Talassemia/tratamento farmacológico , Adolescente , Adulto , Comorbidade , Feminino , Custos de Cuidados de Saúde , Humanos , Revisão da Utilização de Seguros , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Estados UnidosRESUMO
Little is known about how people characterise and classify the experience of déjà vu. The term déjà vu might capture a range of different phenomena and people may use it differently. We examined the description of déjà vu in two languages: French and English, hypothesising that the use of déjà vu would vary between the two languages. In French, the phrase déjà vu can be used to indicate a veridical experience of recognition - as in "I have already seen this face before". However, the same is not true in English. In an online questionnaire, we found equal rates of déjà vu amongst French and English speakers, and key differences in how the experience was described. As expected, the French group described the experience as being more frequent, but there was the unexpected finding that they found it to be more troubling.
Assuntos
Comparação Transcultural , Déjà Vu , Idioma , Adulto , Feminino , França , Humanos , Masculino , Reino Unido , Adulto JovemRESUMO
PURPOSE: Comparative data on rehospitalization patterns and associated institutional costs after inpatient treatment with paliperidone palmitate or oral antipsychotic therapy are reported. METHODS: A retrospective cohort study was conducted using discharge and billing records from a large hospital database. Selected clinical and cost outcomes were compared in a cohort of adult patients who received the long-acting antipsychotic paliperidone palmitate during a schizophrenia-related index hospital stay and a cohort of patients who received oral antipsychotic therapy during their index admission. Inverse probability-of-treatment weights based on propensity scores were used to reduce confounding. Rates of all-cause and schizophrenia-related rehospitalization and emergency room (ER) use in the two cohorts over periods of up to 12 months were analyzed using a multivariate Cox proportional hazard model. Institutional costs for the evaluated postdischarge events were compared via multivariate linear regression analysis. RESULTS: In the first 12 months after index hospital discharge, the risk of all-cause rehospitalization and ER use was significantly lower in the paliperidone palmitate cohort than in the oral antipsychotic cohort (hazard ratio, 0.61; 95% confidence interval [CI], 0.59-0.63; p < 0.0001); institutional costs during the first 6 months after discharge were significantly lower in the paliperidone palmitate cohort than in the comparator group (adjusted mean monthly cost difference -$404; 95% CI, -$781 to -$148; p < 0.0001). CONCLUSION: The use of paliperidone palmitate therapy during patients' index hospital admission for schizophrenia was associated with a reduced risk of hospital readmission or ER use and lower postdischarge institutional costs.
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Antipsicóticos/economia , Antipsicóticos/uso terapêutico , Isoxazóis/economia , Isoxazóis/uso terapêutico , Palmitatos/economia , Palmitatos/uso terapêutico , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Esquizofrenia/tratamento farmacológico , Esquizofrenia/economia , Adulto , Idoso , Estudos de Coortes , Custos e Análise de Custo , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Determinação de Ponto Final , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Palmitato de Paliperidona , Pontuação de Propensão , Estudos RetrospectivosRESUMO
OBJECTIVE: Most women with moderate to severe vasomotor symptoms (VMS) are untreated. This retrospective matched-cohort study aims to evaluate the healthcare resource utilization, work loss, and cost burden associated with untreated VMS. METHODS: Health insurance claims (1999-2011) were used to match (1:1) women with untreated VMS with control women using propensity score. Healthcare resource utilization, work productivity loss (disability + medically related absenteeism), and associated costs were compared between cohorts. RESULTS: During the 12-month follow-up, women with untreated VMS (n = 252,273; mean age, 56 y) had significantly higher healthcare resource utilization than women in the control cohort: 82% higher for all-cause outpatient visits (95% CI, 81-83; P < 0.001) and 121% higher (95% CI, 118-124; P < 0.001) for VMS-related outpatient visits. Mean direct costs per patient per year were significantly higher for VMS women (direct cost difference, US$1,346; 95% CI, 1,249-1,449; P < 0.001). VMS women had 57% (95% CI, 51-63; P < 0.001) more indirect work productivity loss days than controls, corresponding to an incremental indirect cost per patient per year associated with untreated VMS of US$770 (95% CI, 726-816; P < 0.001). CONCLUSIONS: This study shows that untreated VMS are associated with significantly higher frequency of outpatient visits and incremental direct and indirect costs.