Health Care Costs Associated With Muscle Weakness: A UK Population-Based Estimate.

Sarcopenia and muscle weakness are responsible for considerable health care expenditure but little is known about these costs in the UK. To address this, we estimated the excess economic burden for individuals with muscle weakness regarding the provision of health and social care among 442 men and women (aged 71-80 years) who participated in the Hertfordshire Cohort Study (UK). Muscle weakness, characterised by low grip strength, was defined according to the Foundation for the National Institutes of Health criteria (men < 26 kg, women < 16 kg). Costs associated with primary care consultations and visits, outpatient and inpatient secondary care, medications, and formal (paid) as well as informal care for each participant were calculated. Mean total costs per person and their corresponding components were compared between groups with and without muscle weakness. Prevalence of muscle weakness in the sample was 11%. Mean total annual costs for participants with muscle weakness were £4592 (CI £2962-£6221), with informal care, inpatient secondary care and primary care accounting for the majority of total costs (38%, 23% and 19%, respectively). For participants without muscle weakness, total annual costs were £1885 (CI £1542-£2228) and their three highest cost categories were informal care (26%), primary care (23%) and formal care (20%). Total excess costs associated with muscle weakness were £2707 per person per year, with informal care costs accounting for 46% of this difference. This results in an estimated annual excess cost in the UK of £2.5 billion.

The increase in health care costs associated with muscle weakness in older people without long-term illnesses in the Czech Republic: results from the Survey of Health, Ageing and Retirement in Europe (SHARE).

Muscle weakness and associated diseases are likely to place a considerable economic burden on government health care expenditure. Therefore, our aim for this study was to estimate the direct and indirect costs associated with muscle weakness in the Czech Republic. We applied a cost-of-illness approach using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Six hundred and eighty-nine participants aged 70 years and over and without any long-term illnesses were included in our study. A generalized linear model with gamma distribution was used, and odds ratio (OR) was calculated in order to explore the effect of muscle weakness on direct and indirect costs. For both genders, muscle weakness had a statistically significant impact on direct costs (OR =2.11), but did not have a statistically significant impact on indirect costs (OR =1.08) or on total cost (OR =1.51). Muscle weakness had the greatest statistically significant impact on direct costs in females (OR =2.75). In conclusion, our study has shown that muscle weakness may lead to increased direct costs, and consequently place a burden on health care expenditure. Therefore, the results of this study could lead to greater interest in the prevention of muscle weakness among older people in the Czech Republic.

Clinical and economic characteristics of total hip replacement patients with high health care costs and high health care use.

OBJECTIVE: The aims of this study were to confirm whether total hip arthroplasty (THA) patients with muscle atrophy/weakness (MAW) have high health care costs and resource use and to identify the characteristics that contribute to these high costs and use. DESIGN: This study analyzed claims from United States patients who underwent THA identified from commercial (n = 25,249) and Medicare (n = 22,472) insurance databases to compare demographics, health care costs, and resource use among patients with or without MAW. The patients were classified into three separate cohorts: pre-MAW (having MAW during the 12 mos before THA), post-MAW (having MAW during the 12 mos after THA, and no-MAW (no MAW claim). Characteristics of the THA patients associated with high health care costs were examined by multiple logistic regression, and subgroups of patients with high cost and high resource use were identified by classification and regression tree analyses. RESULTS: Health care use and costs were significantly higher for the THA patients with MAW, who had greater likelihood of inpatient and emergency department use and stays at skilled nursing facilities than the no-MAW patients. Classification and regression tree identified subgroups of high-cost patients as those with MAW having extended hospital stays and more outpatient visits. CONCLUSIONS: THA patients with MAW are at greater risk for high health care costs and resource consumption, including longer hospital stays, increased outpatient visits, and stays at skilled nursing and inpatient rehabilitation facilities.

Characteristics of hip fracture patients with and without muscle atrophy/weakness: predictors of negative economic outcomes.

OBJECTIVE: Hip fractures have negative humanistic and economic consequences. Predictors and sub-groups of negative post-fracture outcomes (high costs and extensive healthcare utilization) were identified in patients with and without muscle atrophy/weakness (MAW). METHODS: Truven Health MarketScan data identified patients ≥50 years old with inpatient hospitalizations for hip fracture. Patients had ≥12 months of continuous healthcare insurance prior to and following index hospitalization and no hip fracture diagnoses between 7 days and 1 year prior to admission. Predictors and sub-groups of negative outcomes were identified via multiple logistic regression analyses and classification and regression tree (CART) analyses, respectively. RESULTS: Post-fracture 1-year all-cause healthcare costs (USD$31,430) were higher than costs for the prior year ($18,091; p < 0.0001). Patients with MAW had greater post-fracture healthcare utilization and costs than those without MAW (p < 0.05). Greater post-fracture costs were associated with a higher number of prior hospitalizations and emergency room visits, length of index hospitalization, Charlson Comorbidity Index (CCI), and discharge status; diagnosis of rheumatoid arthritis, osteoarthritis, or osteoporosis; and prior use of antidepressants, anticonvulsants, muscle relaxants, benzodiazepines, opioids, and oral corticosteroids (all p < 0.009). High-cost patient sub-groups included those with MAW and high CCI scores. CONCLUSIONS: Negative post-fracture outcomes were associated with MAW vs no MAW, prior hospitalizations, comorbidities, and medications.

Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. A cohort study and propensity-matched analysis.

RATIONALE: Intensive care unit (ICU)-acquired weakness is a frequent complication of critical illness. It is unclear whether it is a marker or mediator of poor outcomes. OBJECTIVES: To determine acute outcomes, 1-year mortality, and costs of ICU-acquired weakness among long-stay (≥8 d) ICU patients and to assess the impact of recovery of weakness at ICU discharge. METHODS: Data were prospectively collected during a randomized controlled trial. Impact of weakness on outcomes and costs was analyzed with a one-to-one propensity-score-matching for baseline characteristics, illness severity, and risk factor exposure before assessment. Among weak patients, impact of persistent weakness at ICU discharge on risk of death after 1 year was examined with multivariable Cox proportional hazards analysis. MEASUREMENTS AND MAIN RESULTS: A total of 78.6% were admitted to the surgical ICU; 227 of 415 (55%) long-stay assessable ICU patients were weak; 122 weak patients were matched to 122 not-weak patients. As compared with matched not-weak patients, weak patients had a lower likelihood for live weaning from mechanical ventilation (hazard ratio [HR], 0.709 [0.549-0.888]; P = 0.009), live ICU (HR, 0.698 [0.553-0.861]; P = 0.008) and hospital discharge (HR, 0.680 [0.514-0.871]; P = 0.007). In-hospital costs per patient (+30.5%, +5,443 Euro per patient; P = 0.04) and 1-year mortality (30.6% vs. 17.2%; P = 0.015) were also higher. The 105 of 227 (46%) weak patients not matchable to not-weak patients had even worse prognosis and higher costs. The 1-year risk of death was further increased if weakness persisted and was more severe as compared with recovery of weakness at ICU discharge (P < 0.001). CONCLUSIONS: After careful matching the data suggest that ICU-acquired weakness worsens acute morbidity and increases healthcare-related costs and 1-year mortality. Persistence and severity of weakness at ICU discharge further increased 1-year mortality. Clinical trial registered with www.clinicaltrials.gov (NCT 00512122).

Malnutrition in the UK.

Malnutrition is estimated to cost the UK twice that of obesity every year, but it is still an often overlooked problem. Dr Mabel Blades, a freelance Registered Dietician and Nutritionist, looks at the problems that malnutrition presents and the solutions that we can use to combat it.

Clinical and economic characteristics of hip fracture patients with and without muscle atrophy/weakness in the United States.

UNLABELLED: This retrospective analysis of hip fracture patients with and without muscle atrophy/weakness (MAW) revealed that those with MAW had significantly higher healthcare utilization and costs compared with hip fracture patients without MAW. PURPOSE: Examine the demographics, clinical characteristics, and healthcare resource utilization and costs of hip fracture patients with and without MAW. METHODS: Using a large US claims database, individuals who were newly hospitalized for hip fracture between 1 Jan 2006 and 30 September 2009 were identified. Patients aged 50-64 years with commercial insurance (Commercial) or 65+ years with Medicare supplemental insurance (Medicare) were included. The first hospitalization for hip fracture was defined as the index stay. Patients were categorized into three cohorts: patients with medical claims associated with MAW over the 12 months before the index stay (pre-MAW), patients whose first MAW claim occurred during or over the 12 months after the index stay (post-MAW), and patients without any MAW claim (no-MAW). Multivariate regressions were performed to assess the association between MAW and healthcare costs over the 12-month post-index period, as well as the probability of re-hospitalization. RESULTS: There were 26,122 Medicare (pre-MAW, 839; post-MAW, 2,761; no-MAW, 22,522) and 5,100 Commercial (pre-MAW, 132; post-MAW, 394; no-MAW, 4,574) hip fracture patients included in this study. Controlling for cross-cohort differences, both the pre-MAW and post-MAW cohorts had significantly higher total healthcare costs (Medicare, $7,308 and $18,753 higher; Commercial, $18,679 and $25,495 higher) than the no-MAW cohort (all p < 0.05) over the 12-month post-index period. The post-MAW cohort in both populations was also more likely to have any all-cause or fracture-related re-hospitalization during the 12-month post-index period. CONCLUSIONS: Among US patients with hip fractures, those with MAW had higher healthcare utilization and costs than patients without MAW.

Myelin protein zero Arg36Gly mutation with very late onset and rapidly progressive painful neuropathy.

Mutations in myelin protein zero (MPZ) protein result in a wide spectrum of peripheral neuropathies, from congenital hypomyelinating to late onset sensory and motor axonal forms. In some patients, neuropathic pain can be a prominent symptom, making the diagnosis challenging mainly in those with other risk factors for neuropathy. We describe a 77-year-old woman with impaired glucose tolerance presenting with rapidly progressive axonal neuropathy leading to excruciating pain and severe weakness of lower limbs within 2 years from the onset. Her son abruptly complained of similar painful symptoms at the age of 47 years. Molecular analysis revealed a novel heterozygous missense mutation (c.106A>G) in MPZ exon 2, causing the substitution of arginine-36 with glycine in the extracellular domain. Our observation suggests that MPZ-related neuropathy should be considered in the diagnostic work up of patients with painful axonal neuropathy even presenting with rapid progression and at a very late age of onset.

Use of physical therapy in patients hospitalized with a diagnosis of generalized weakness: a retrospective study.

In a retrospective analysis of data from a national database, we observed and compared the presence of complications, lengths of stay, inflation-adjusted charges, and discharge statuses of two groups of patients hospitalized with a primary diagnosis of generalized weakness who did or did not receive physical therapy (PT) services. From a sample of patients (n = 38,991 cumulative from 1988 through 2003) from the Nationwide Inpatient Sample (NIS), 2.3% of patients admitted to the hospital with generalized weakness received PT intervention. Patients hospitalized with a primary diagnosis of generalized weakness who received PT services were sicker, had more selected secondary complications, and were demographically and socioeconomically dissimilar from patients who did not receive PT services. Quantitative analyses indicate that PT patients had longer inpatient hospital stays, more nonroutine discharges, and higher inflation-adjusted charges. The results are consistent with the interpretation that outcomes such as those examined here (nonroutine discharge, length of stay, and charges at discharge) are related to referral patterns in which only the most serious comorbidities qualify patients for referral for PT intervention services.

Economic impact of prolonged motor weakness complicating neuromuscular blockade in the intensive care unit.

OBJECTIVE: We compared a case-series of ten patients who developed prolonged neuromuscular weakness after continuous, nondepolarizing, neuromuscular blockade with a group of controls without neuromuscular weakness to determine the economic impact of the neuromuscular weakness. DESIGN: Frequency-matched case control trial. SETTING: Medical and surgical intensive care units of a 937-bed tertiary care, university-affiliated teaching hospital. PATIENTS: Ten patients developed prolonged neuromuscular weakness after continuous administration of nondepolarizing neuromuscular blockers. Ten patients from a 1994 drug utilization database who did not develop motor weakness after paralysis were identified to serve as controls. MEASUREMENTS AND MAIN RESULTS: The medical and accounting records of the patients were retrospectively reviewed. Charge data were obtained from patient accounts. Institutional ratios to convert charges to full costs and marginal costs were obtained from the Hospital Finance Department of Henry Ford Hospital. The economic impact of the diagnosis and recovery of the motor weakness was estimated for the intensive care unit (ICU) and hospital stays and compared with those values for control patients. Median hospital charges (excluding rehabilitation), totaling $91,476, were attributed to the patients who developed neuromuscular weakness and included charges for neuromuscular blocking agents, continuous mechanical ventilation, ICU and hospital beds, neurologic studies, and physical therapy services. In the control patients, median charges were $22,191 (p = .001). The total median cost differential for a patient in the neuromuscular weakness group was in excess of $66,713 (95% confidence interval $23,485 to $189,214, p = .001). Significant differences were also found for patient charges, full costs, and marginal costs for mechanical ventilation (p = .002), neurologic studies (p = .014), as well as ICU (p = .002) and hospital (p = .001) stays. CONCLUSIONS: The development of motor weakness was associated with an increase in ICU and hospital stays, continued mechanical ventilation, and disproportionate healthcare expenditures in excess of $66,000 per patient. A prospective evaluation of the true prevalence of neuromuscular weakness after neuromuscular blockade and of the costs to the healthcare system is needed.