Higher total energy costs strain the elderly, especially low-income, across 31 developed countries.

Addressing the total energy cost burden of elderly people is essential for designing equitable and effective energy policies, especially in responding to energy crisis in an aging society. It is due to the double impact of energy price hikes on households-through direct impact on fuel bills and indirect impact on the prices of goods and services consumed. However, while examining the household energy cost burden of the elderly, their indirect energy consumption and associated cost burden remain poorly understood. This study quantifies and compares the direct and indirect energy footprints and associated total energy cost burdens for different age groups across 31 developed countries. It reveals that the elderly have larger per capita energy footprints, resulting from higher levels of both direct and indirect energy consumption compared with the younger age groups. More importantly, the elderly, especially the low-income elderly, have a higher total energy cost burden rate. As the share of elderly in the total population rapidly grows in these countries, the larger per capita energy footprint and associated cost burden rate of elderly people would make these aging countries more vulnerable in times of energy crises. It is therefore crucial to develop policies that aim to reduce energy consumption and costs, improve energy efficiency, and support low-income elderly populations. Such policies are necessary to reduce the vulnerability of these aging countries to the energy crisis.

National Hospitalization Rates and In-Hospital Mortality Rates of HIV-Related Opportunistic Infections in the United States, 2011-2018.

BACKGROUND: Human immunodeficiency virus (HIV)-related opportunistic infections (OIs) cause substantial morbidity and mortality among people with HIV (PWH). US hospitalization and in-hospital mortality rates associated with OIs have not been published using data from the past decade. METHODS: We analyzed the National Inpatient Sample for the years 2011 through 2018. We used sociodemographic, financial, and hospital-level variables and identified hospitalizations for PWH and OI diagnoses. Using survey-weighted methods, we estimated all OI-related US hospitalization rates and in-hospital mortality per 100 000 PWH and modeled associated factors using survey-based multivariable logistic regression techniques. RESULTS: From 2011 to 2018, there were an estimated 1 710 164 (95% confidence interval [CI], 1 659 566-1 760 762) hospital discharges for PWH with 154 430 (95% CI, 148 669-159 717 [9.2%]) associated with an OI, of which 9336 (95% CI, 8813-9857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age, male sex, non-White race/ethnicity, and being uninsured (all likelihood ratio [LR] P < .001). Higher OI-related mortality was associated with older age (LR P < .001), male sex (LR P = .001), Hispanic race/ethnicity (LR P < .001), and being uninsured (LR P = .009). The OI-related hospitalization rate fell from 2725.3 (95% CI, 2266.9-3183.7) per 100 000 PWH in 2011 to 1647.3 (95% CI, 1492.5-1802.1) in 2018 (P < .001), but the proportion of hospitalizations with mortality was stable (5.9% in 2011 and 2018). CONCLUSIONS: Our findings indicate an ongoing need for continued funding of HIV testing, health insurance for all PWH, OI screening initiatives, review of current prophylaxis guidelines, and recruitment of more HIV clinicians.

Current status of the cost burden of first-line systemic treatment for patients with advanced hepatocellular carcinoma in Japan, 2021-22.

BACKGROUND: Although recent advances in systemic therapies for hepatocellular carcinoma (HCC) have led to prolonged patient survival, the high costs of the drugs place a heavy burden on both patients and society. The objectives of this study were to examine the treatment regimens used as first-line systemic treatment for patients with advanced HCC in Japan and to estimate the treatment costs per regimen. METHODS: For this study, we aggregated the data of patients who had received first-line systemic treatment for advanced HCC between July 2021 and June 2022. The treatment cost per month of each regimen was estimated based on standard usage, assuming an average weight of 60 kg for male patients. The data were categorized by the treatment regimen, and the treatments were categorized based on the cost into very high-cost (≥1 000 000 Japanese yen [JPY]/month), high-cost (≥500 000 JPY/month) and other (<500 000 JPY/month) treatments. RESULTS: Of the total of 552 patients from 24 institutions whose data were analyzed in this study, 439 (79.5%) received atezolizumab plus bevacizumab, 98 (17.8%) received lenvatinib and 15 (2.7%) received sorafenib as the first-line treatment. The treatment cost per month for each of the above regimens was as follows: atezolizumab plus bevacizumab, 1 176 284 JPY; lenvatinib, 362 295 JPY and sorafenib, 571 644 JPY. In total, 82.2% of patients received high-cost regimens, and the majority of these patients received a very high-cost regimen of atezolizumab plus bevacizumab. CONCLUSIONS: Advances in systemic therapies for HCC have led to prolonged patient survival. However, the treatment costs are also increasing, imposing a burden on both the patients and society.

Cost burden of chemotherapy for Indonesian healthcare insurance and social security/Jaminan Kesehatan Nasional (JKN) patients with non-Hodgkin lymphoma.

BACKGROUND: Cancer is among the leading causes of death globally, posing a significant economic burden on the healthcare sector. Among other types of cancer in Indonesia, non-Hodgkin lymphoma (NHL) ranks fifth in terms of prevalence. Chemotherapy for NHL patients is funded by a national health insurance scheme through the National Healthcare Insurance and Social Security/Jaminan Kesehatan Nasional (JKN). OBJECTIVE: This study aimed to analyze cost burden of chemotherapy for JKN patients with NHL. DATA SOURCE: A retrospective cross-sectional observational study was conducted among NHL patients receiving chemotherapy at a hospital in East Java, Indonesia in 2021. Data were collected from medical record documents and a total of 44 patient visits were recorded in this study. DATA SUMMARY: The result showed that patient visits were dominated by females (55%), a significant proportion were aged 31 to 40 years (32%), and the majority were JKN participants in the Contribution Assistance Recipients/Penerima Bantuan Iuran (PBI) category (64%). The most chemotherapy regimen given was R-CHOP (68%) and the mean total cost for NHL patients was Indonesian Rupiah (IDR) 5,178,146. The highest mean cost burden was on chemotherapy drugs with a value of IDR 6,333,315. Based on the regimen, the highest cost burden was R-CHOP-Bleo with a mean cost of IDR 8,764,091. CONCLUSION: Based on the results, the highest cost burden for chemotherapy among JKN patients with NHL in Indonesia was attributed to R-CHOP-Bleo regimen with a mean of IDR 8,764,091.

Healthcare Cost Burden and Self-Reported Frequency of Depressive/Anxious Feelings in Older Adults.

Using the 2018-2021 National Health Interview Survey data, we examined the associations between healthcare cost burden and depressive/anxious feelings in older adults. Nearly12% reported healthcare cost burden and 18% daily/weekly depressive/anxious feelings. Healthcare cost burden was higher among women, racial/ethnic minorities, those with chronic illnesses, mobility impairment, and those with Medicare Part D, but lower among individuals with Medicare-Medicaid dual eligibility, Medicare Advantage, VA/military insurance, and private insurance. Daily/weekly depressive/anxious feelings was higher among healthcare cost burden reporters. The COVID-19 pandemic-related medical care access problems were also associated with a higher risk of reporting healthcare cost burden and depression/anxiety.

Transitions into and out of housing cost burden and their asymmetric effects on depressive symptoms: the moderating role of housing tenure.

OBJECTIVES: This study uses an approach that estimates the asymmetric effects of transitioning into and out of housing cost burden on psychological health. STUDY DESIGN: We used data from 14 waves of the Korean Welfare Panel Study. METHODS: We estimated an asymmetric fixed-effects model to examine whether transitioning into and out of housing cost burden is associated with depressive symptoms. Interaction models were used to assess whether these effects differ by housing tenure. RESULTS: A standard fixed-effects model indicates that housing cost burden is associated with depressive symptoms (b = 0.126). However, the results of the asymmetric fixed-effects model suggest that transitioning out of housing cost burden reduces depressive symptoms (b = -0.171), while transitioning into housing cost burden is not associated with a change in depressive symptoms. These asymmetric effects of housing cost burden on depressive symptoms are more pronounced for renters than for owner-occupiers. CONCLUSION: The findings suggest that alleviating housing cost burden can improve the psychological well-being of individuals, particularly among renters.

Exploring the Health and Economic Burden Among Truck Drivers in Australia: A Health Economic Modelling Study.

Background The transport and logistics industry contributes to a significant proportion of the Australian economy. However, few studies have explored the economic and clinical burden attributed to poor truck driver health. We therefore estimated the work-related mortality burden among truck drivers over a 10-year period. Methods Dynamic life table modelling was used to simulate the follow-up of the Australian male working-age population (aged 15-65 years) over a 10-year period of follow-up (2021-2030). The model estimated the number of deaths occurring among the Australian working population, as well as deaths occurring for male truck drivers. Data from the Driving Health study and other published sources were used to inform work-related mortality and associated productivity loss, hospitalisations and medication costs, patient utilities and the value of statistical life year (VoSLY). All outcomes were discounted by 5% per annum. Results Over 10 years, poor truck driver health was associated with a loss of 21,173 years of life lived (discounted), or 18,294 QALYs (discounted). Healthcare costs amounted to AU$485 million (discounted) over this period. From a broader, societal perspective, a total cost of AU$2.6 billion (discounted) in lost productivity and AU$4.7 billion in lost years of life was estimated over a 10-year period. Scenario analyses supported the robustness of our findings. Conclusions The health and economic consequences of poor driver health are significant, and highlight the need for interventions to reduce the burden of work-related injury or disease for truck drivers and other transport workers.

Housing cost burden, homeownership, and self-rated health among migrant workers in Chinese cities: The confounding effect of residence duration.

Housing is a critical social determinant of health. Research on the impact of housing on health among migrants is more complex than that of the general population because of migrants' health decline over time: while migrants exhibit a health advantage upon arrival, they gradually lose it as they stay longer in the host city. Existing studies on migrants' housing and health have paid little attention to the confounding effect of residence duration and are thus prone to misleading results. Using data from the 2017 China Migrants Dynamic Survey (CMDS), this study fills in the gap by examining how the incorporation of residence duration alters the relationship of housing cost burden and homeownership with migrant self-rated health (SRH). The study shows that migrant workers with higher housing cost burden and longer residence duration tend to have worse SRH. Incorporating residence duration attenuates the crude association between homeownership and worse SRH. The results imply that the health decline among migrants can be attributed to the discriminatory hukou system-a system that limits migrants' access to social welfare and puts them in a socioeconomically disadvantaged position. The study thus emphasizes the removal of structural and socio-economic barriers faced by the migrant population.

Housing cost burden and material hardship among older adults: How do they influence psychological health?

OBJECTIVES: Despite a growing body of evidence for the association between housing cost burden and psychological health, few studies have focused on the potential mediators of this association and the extent to which housing cost burden poses a threat to older adults' psychological health. This study aims to assess (a) the link between housing cost burden and psychological health among older adults and (b) how the association is mediated by material hardship. METHODS: Using thirteen waves of a nationally representative longitudinal study in Korea, this study assessed the association between housing cost burden and depressive symptoms among older adults aged 65 or over. Mediation tests were conducted to identify whether material hardship explains the link between housing cost burden and depressive symptoms. We used fixed-effects models to take into account individual-level heterogeneity. RESULTS: Housing cost burden was significantly associated with depressive symptoms among older adults, regardless of their housing tenure status. Different types of material hardship partially mediated the association between housing cost burden and depressive symptoms in older adults. Older adults with severe housing cost burden are more susceptible to all types of material hardship compared to those with a moderate burden. CONCLUSIONS: To contribute further to the social causation discussions, future studies should seek to identify protective factors of depressive symptoms among older adults and other potential mechanisms of the association between older adults' socioeconomic conditions and their psychological health.

Prevention and control of non-communicable diseases in iran: the case for Investment.

BACKGROUND: Non-communicable diseases are imposing a considerable burden on Iran. This study aims to assess the Return on Investment (ROI) for implementation of Non-communicable diseases (NCDs) prevention program in Iran. METHODS: Four disease groups including cardiovascular diseases, diabetes, cancer, and respiratory diseases were included in our ROI analysis. The study followed four steps: 1) Estimating the total economic burden of NCDs using the Cost-of-Illness approach. 2) Estimating the total costs of implementing clinical and preventive interventions using an ingredient based costing at delivering level and a program costing method at central level.3) Calculating health impacts and economic benefits of interventions using the impact measures of avoided incidence, avoided mortality, healthy life years (HLYs) gained, and avoided direct treatment costs. 4) Calculating the ROI for each intervention in 5- and 15- year time horizons. RESULTS: The total economic burden of NCDs to the Iranian economy was IRR 838.49 trillion per year (2018), which was equivalent to 5% of the country's annual Gross Domestic Product (GDP). The package of NCD will lead to 549 000 deaths averted and 2 370 000 healthy life years gained over 15 years, and, financially, Iranian economy will gain IRR 542.22 trillion over 15 years. The highest ROI was observed for the package of physical activity interventions, followed by the interventions addressing salt, tobacco package and clinical interventions. Conclusions NCDs in Iran are causing a surge in health care costs and are contributing to reduced productivity. Those actions to prevent NCDs in Iran, as well as yielding to a notable health impact, are giving a good economic return to the society. This study underscores an essential need for establishment of a national multi-sectorial NCD coordination mechanism to bring together and strengthen existing cross-agency initiatives on NCDs.

The cost of care for children hospitalised with Invasive Group A Streptococcal Disease in Australia.

BACKGROUND: Invasive Group A Streptococcal (iGAS) disease exerts an important burden among Australian children. No Australian hospitalisation cost estimates for treating children with iGAS disease exist, so the financial impact of this condition is unknown. AIM: To determine the minimum annual healthcare cost for children (< 18 years) hospitalised with iGAS disease in Australia from a healthcare sector perspective. METHODS: A cost analysis including children with laboratory-confirmed iGAS disease hospitalised at the Royal Children's Hospital (Victoria, Australia; July 2016 to June 2019) was performed. Results were extrapolated against the national minimum iGAS disease incidence. This analysis included healthcare cost from the 7 days prior to the index admission via General Practitioner (GP) and Emergency Department (ED) consultations; the index admission itself; and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations. Additional extrapolations of national cost data by age group, Aboriginal and Torres Strait Islander ethnicity and jurisdiction were performed. RESULTS: Of the 65 included children, 35% (n = 23) were female, 5% (n = 3) were Aboriginal and Torres Strait Islander, and the average age was 4.4 years (SD 4.6; 65% aged 0-4). The iGAS disease related healthcare cost per child was $67,799 (SD $92,410). These costs were distributed across the 7 days prior to the index admission via GP and ED consultations (0.2 and 1.1% of total costs, respectively), the index admission itself (88.7% of the total costs); and the 6 months post index admission via rehabilitation admissions, acute re-admissions and outpatient consultations (5.3, 4.5 and 0.1% of total costs, respectively). Based on a national minimum paediatric incidence estimation of 1.63 per 100,000 children aged < 18 (95%CI: 1.11-2.32), the total annual healthcare cost for children with iGAS in 2019 was $6,200,862. The financial burden reflects the overrepresentation of Aboriginal and Torres Strait Islander people in the occurrence of iGAS disease. Costs were concentrated among children aged 0-4 years (62%). CONCLUSION: As these cost estimations were based on a minimum incidence, true costs may be higher. Strengthening of surveillance and control of iGAS disease, including a mandate for national notification of iGAS disease, is warranted. TRIAL REGISTRATION: The current study is a part of ongoing iGAS surveillance work across seven paediatric health services in Australia. As this is not a clinical trial, it has not undergone trial registration.

Severe Housing-Cost Burden and Low-Income Young Children's Exposure to Adverse Experiences: A Cross-Sectional Survey of WIC Participants in Los Angeles County.

OBJECTIVE: Substantial literature has documented adverse childhood experiences' (ACEs) link with poor health in childhood and adulthood. Despite many American low-income families spending more than a third of their income toward housing costs, little research has been published about a link between severe housing-cost burden and ACEs. The objective of this study was to examine the association of severe housing-cost burden to the ACEs to which young, low-income children are exposed. METHODS: Participants were 2-5-year-olds who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. We used data from the 2017 Los Angeles County WIC Survey, a survey of a random sample of all WIC participants living in Los Angeles County. Separate multiple logistic regression analyses were conducted to examine the association of severe housing-cost burden (very difficult to pay for housing) with the ACEs of financial hardship (household food insecurity, extreme poverty, parent's unemployment and underemployment), household dysfunction (parent's poor mental well-being and parent's separation), housing insecurity (doubled up and residential instability), and parent's experience with homelessness. RESULTS: Sixteen percent of children lived in severe housing-cost burdened households and 14% experienced at least 4 ACEs. After adjusting for sociodemographic characteristics and social support, severe housing-cost burden was associated with an increase in the odds of each of the ACEs. CONCLUSIONS FOR PRACTICE: While further research is needed, findings highlight the need for policymakers to provide resources and support for housing-cost burdened children. Also, service providers should identify ACEs among housing cost-burdened children.

Cost, profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation.

STUDY DESIGN: Retrospective cost-of-illness study. INTRODUCTION: Injuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable. PURPOSE OF THE STUDY: To estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network. METHODS: Using 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway. RESULTS: Two hundred and twenty-six individuals (n 1/4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively. DISCUSSION: Findings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates. CONCLUSION: Surgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.

Economic-Burden Trajectories in Commercially Insured US Infants With Respiratory Syncytial Virus Infection.

BACKGROUND: This study evaluates the long-term respiratory syncytial virus (RSV) burden among preterm and full-term infants in the United States. METHODS: Infants with birth hospitalization claims and ≥24 months of continuous enrollment were retrospectively identified in the Truven MarketScan Commercial Claims and Encounters database for the period 1 January 2004-30 September 2015. Infants with RSV infection in the first year of life (n = 38 473) were matched to controls (n = 76 825), and remaining imbalances in the number of individuals in each group were adjusted using propensity score methods. All-cause, respiratory-related, and asthma/wheezing-related 5-year average cumulative costs were measured. RESULTS: Early premature (n = 213), premature (n = 397), late premature (n = 4446), and full-term (n = 33 417) RSV-infected infants were matched to 424, 791, 8875, and 66 735 controls, respectively. After 2 years since RSV diagnosis, all-cause cumulative costs for RSV-infected infants as compared to those for controls increased by $22 081 (95% confidence interval [CI], -$5800-$42 543) for early premature infants, by $14 034 (95% CI, $5095- $22 973) for premature infants, by $10 164 (95% CI, $8835-$11 493) for late premature infants, and by $5404 (95% CI, $5110-$5698) for full-term infants. The 5-year RSV burden increased to $39 490 (95% CI, $18 217-$60 764), $23 160 (95% CI, $13 002-$33 317),$13 755 (95% CI, $12 097-$15 414), and $6631 (95% CI, $6060-$7202), respectively. The RSV burden was higher when stratified by inpatient and outpatient setting and respiratory-related and asthma/wheezing-related costs. CONCLUSIONS: The RSV burden extends across cost domains and prematurity, with the greatest burden incurred by the second year of follow-up. Findings are useful in determining the cost-effectiveness of RSV therapies in development.

Healthcare Utilization and Comorbidities Associated with Anorectal Malformations in the United States.

OBJECTIVE: To determine nationwide prevalence and healthcare utilization in children with anorectal malformations and associated anomalies over a 6-year period. STUDY DESIGN: We used the Kids' Inpatient Database for the years 2006, 2009, and 2012 for data collection. International Classification of Diseases, Ninth Revision codes were used to identify patients with anorectal malformations and associated anomalies. RESULTS: A total of 2396 children <2 years of age with anorectal malformations were identified using weighted analysis; 54.3% of subjects were male. The ethnic subgroups were 40.1% white, 23.6% Hispanic, 9.3% African American, and 27% other ethnicity. Other congenital anomalies were reported in 80% of anorectal malformations and were closely associated with increased length of stay and costs. A genetic disorder was identified in 14.1% of the sample. Urogenital anomalies were present in 38.5%, heart anomalies in 21.2%, and 8.6% had vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula and/or esophageal atresia, renal anomalies, and limb defects association. Anorectal malformations with other anomalies including vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula and/or esophageal atresia, renal anomalies, and limb defects association incurred significant hospital charges when compared with anorectal malformations alone. The average annual healthcare expenditure for surgical correction of anorectal malformations and associated anomalies for the 3 years was US $45.5 million. CONCLUSIONS: This large, major nationally representative study shows that majority of children with anorectal malformations have additional congenital anomalies that deserve prompt recognition. The high complexity and need for lifelong multidisciplinary management is associated with substantial healthcare expenditure. This information complements future healthcare resource allocation and planning for management of children with anorectal malformations.

The cost of oropharyngeal cancer in England: A retrospective hospital data analysis.

OBJECTIVES: To estimate the total costs of treating head and neck cancers, specifically oropharyngeal, laryngeal and oral cavity cancer, in secondary care facilities in England during the period 2006/2007 to 2010/2011. DESIGN: Patient records were extracted from an English hospital database to estimate the number of patients treated for oropharyngeal, laryngeal and oral cavity cancer in England. Identified resource use was linked to published United Kingdom cost estimates to quantify the reimbursement of treatment through the Payment by Results system. SETTING: Retrospective hospital data analysis. PARTICIPANTS: From the hospital data, patient records of patients treated for oropharyngeal, laryngeal and oral cavity cancer were selected. MAIN OUTCOME MEASURES: Annual total costs of treatment, stratified by inpatient and outpatient setting and by male and female patients. RESULTS: From 2006/2007 to 2010/2011, total costs of treatment across the three head and neck cancer sites were estimated to be approximately £309 million, with 90% attributable to inpatient care (bundled costs). Oropharyngeal cancer accounted for 37% of total costs. Costs and patient numbers increased over time, largely due to a rise in oropharyngeal cancer, where total costs increased from £17.21 million to £30.32 million, with over 1400 (52%) more inpatients treated in 2010/11 compared to 2006/07. CONCLUSIONS: In 4 years, the number of patients with oropharyngeal cancer receiving some form of inpatient care increased by more than half, and associated costs increased by three quarters. This reinforces the case for prevention and early detection strategies to help contain this epidemiological and economic burden.

Who bears the cost of NICE public health recommendations?

BACKGROUND: In the UK, NICE issues guidance on public health initiatives. Failure to report which sectors of the economy are affected by their implementation precludes the appropriate accounting for the full opportunity costs, and has the potential to result in erroneous decision making and inefficient budgetary planning. SOURCES OF DATA: We reviewed all NICE public health guidances available at the time of research, categorizing the sector on which the cost burden of the public health initiatives fall and the extent to which this burden was estimated. AREAS OF AGREEMENT: The majority of guidances were determined to be associated with a cost burden on the NHS (n = 48) and local authorities' public health spend (n = 47). AREAS OF CONTROVERSY: Explicit identification and quantification of cost burden by sector of the economy was reported for only eight guidances. GROWING POINTS: Increasing numbers of research studies are developing methods to robustly consider the implications of cross sector budget impacts. AREAS TIMELY FOR DEVELOPING RESEARCH: Future NICE guidance should report disaggregated costs across the sectors where they fall. Further research is needed to conceptualize the opportunity cost of financial burdens falling on non-health budgets before optimal decision making in public health is possible.

Short-term costs of preeclampsia to the United States health care system.

BACKGROUND: Preeclampsia is a leading cause of maternal morbidity and mortality and adverse neonatal outcomes. Little is known about the extent of the health and cost burden of preeclampsia in the United States. OBJECTIVE: This study sought to quantify the annual epidemiological and health care cost burden of preeclampsia to both mothers and infants in the United States in 2012. STUDY DESIGN: We used epidemiological and econometric methods to assess the annual cost of preeclampsia in the United States using a combination of population-based and administrative data sets: the National Center for Health Statistics Vital Statistics on Births, the California Perinatal Quality Care Collaborative Databases, the US Health Care Cost and Utilization Project database, and a commercial claims data set. RESULTS: Preeclampsia increased the probability of an adverse event from 4.6% to 10.1% for mothers and from 7.8% to 15.4% for infants while lowering gestational age by 1.7 weeks (P < .001). Overall, the total cost burden of preeclampsia during the first 12 months after birth was $1.03 billion for mothers and $1.15 billion for infants. The cost burden per infant is dependent on gestational age, ranging from $150,000 at 26 weeks gestational age to $1311 at 36 weeks gestational age. CONCLUSION: In 2012, the cost of preeclampsia within the first 12 months of delivery was $2.18 billion in the United States ($1.03 billion for mothers and $1.15 billion for infants), and was disproportionately borne by births of low gestational age.

Clinical Outcomes and 90-Day Costs Following Hemiarthroplasty or Total Hip Arthroplasty for Hip Fracture.

BACKGROUND: In the era of bundled payments, many hospitals are responsible for costs from admission through 90 days postdischarge. Although bundled episodes for hip fracture will have a separate target price for the bundle, little is known about the 90-day resource use burden for this patient population. METHODS: Using Medicare 100% Standard Analytic Files (2010-2014), we identified patients undergoing hemiarthroplasty or total hip arthroplasty (THA). Patients were aged 65 and older with admitting diagnosis of closed hip fracture, no concurrent fractures of the lower limb, and no history of hip surgery in the prior 12 months baseline. Continuous Medicare-only enrollment was required. Complications, resource use, and mortality from admission through 90 days following discharge (follow-up) were summarized. RESULTS: Four cohorts met selection criteria for analysis: (1) hemiarthroplasty diagnosis-related group (DRG) 469 (N = 19,634), (2) hemiarthroplasty DRG 470 (N = 77,744), (3) THA DRG 469 (N = 1686), and (4) THA DRG 470 (N = 9314). All-cause mortality during the study period was 51.6%, 29.5%, 48.1%, and 24.9% with mean 90-day costs of $28,952, $19,243, $29,763, and $18,561, respectively. Most of the patients waited 1 day from admission to surgery (41%-51%). Incidence of an all-cause complication was approximately 70% in each DRG 469 cohort and 14%-16% in each DRG 470 cohort. CONCLUSION: This study confirms patients with hip fracture are a costly subpopulation. Tailored care pathways to minimize post-acute care resource use are warranted for these patients.

Addressing obesity in the management of knee and hip osteoarthritis - weighing in from an economic perspective.

BACKGROUND: Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA). So there is increasing interest from a public health perspective in addressing obesity in the management of OA. While evidence of the efficacy of intereventions designed to address obesity in OA populations continues to grow, little is known about their economic credentials. The aim of this study is to conduct a scoping review of: (i) the published economic evidence assessing the economic impact of obesity in OA populations; (ii) economic evaluations of interventions designed to explicitly address obesity in the prevention and management of OA in order to determine which represent value for money. Besides describing the current state of the literature, the study highlights research gaps and identifies future research priorities. METHODS: In July 2014, a search of the peer reviewed literature, published in English, was undertaken for the period January 1975 - July 2014 using Medline Complete (Ebscohost), Embase, Econlit, Global Health, Health Economics Evaluation Database (HEED), all Cochrane Library databases as well as the grey literature using Google and reference lists of relevant studies. A combination of key search terms was used to identify papers assessing the economic impact of obesity in OA or economic evaluations conducted to assess the efficiency of obesity interventions for the prevention or management of OA. RESULTS: 14 studes were identified; 13 were cost burden studies assessing the impact of obesity as a predictor for higher costs in Total Joint Arthroplasty (TJA) patients and one a cost-effectiveness study of an intervention designed to address obesity in the managment of mild to moderate OA patients. CONCLUSION: The majority of the economic studies conducted are cost burden studies. While there is some evidence of the association between severe obesity and excess hospital costs for TJA patients, heterogeneity in studies precludes definitive statements about the strength of the association. With only one economic evaluation to inform policy and practice, there is a need for future research into the cost-effectiveness of obesity interventions designed both for prevention or management of OA along the disease spectrum and over the life course.