Comparison of Costs, Re-Intervention Rates, and Length of Hospital Stay for Three Uterus Sparing Interventions for Uterine Fibroids: A 2-Year Retrospective Claims Analysis.

Purpose: To describe two-year post-operative outcomes, and healthcare utilization of three uterus-sparing interventions used to treat women with intramural and/or subserosal uterine fibroids. Subjects and Methods: This was a post-market, randomized, prospective, multi-center, longitudinal, interventional, and comparative clinical study to evaluate the costs and health outcomes of LAP-RFA vs the standard uterine conserving technologies (myomectomy and UAE) for the treatment of symptomatic uterine fibroids in women who desire uterine conservation. For this RCT study, 54 subjects were randomized on a 1:1 ratio across the three procedures and followed out to two years. Their results were compared to retrospective US insurance claims from the IBM MarketScan® Commercial Database from 2017-2020 for 96,854 women who underwent a uterus-sparing procedure for fibroids. Results: Mean ambulatory surgical center costs and the mean out-patient hospital costs were lowest for LAP-RFA ($13,134 and $14,428) and highest for UAE ($28,214 and $19,131). The total two-year re-intervention rate of any subsequent procedure (AM, LM, LAP-RFA, or UAE) was lowest in AM group (0%) followed by LM (4.2%), LAP-RFA (11%), and UAE (33%). Mean peri-operative reintervention costs and the mean reintervention total costs were $2429 and $5939 for LAP-RFA, $2122 and $8368 for LM, $4410 and $11,942 for AM, and $8113 and $46,692 for UAE subjects. In the RCT study, the average length of hospital stay was significantly less for the LAP-RFA group subjects (8.2 hours) in contrast to both the laparoscopic myomectomy group subjects (16.0 hours) and the abdominal myomectomy group subjects (33.6 hours). Despite the small numbers, two-year reintervention rates followed a similar pattern as the IBM MarketScan data. Conclusion: In comparing these three non-invasive approaches, LAP-RFA was associated with the lowest peri-operative cost, and UAE was associated with the highest peri-operative cost. Further studies are needed to assess the cost, effectiveness, and subject satisfaction with each procedure.

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.

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.

Estimating the cost due to resistance against antiretroviral therapies in individuals with HIV: Perspective of the Kingdom of Saudi Arabia.

Objectives: The emergence of resistance to antiretroviral therapy (ART) has an impact on the cost of HIV care. This study aimed to estimate the direct and indirect costs associated with the first episode of drug resistance in individuals with HIV receiving first-line ART. Methods: We developed a cost calculator to estimate the cost of drug resistance over a period of 12 months in the Kingdom of Saudi Arabia. The model inputs (estimated using expert opinion and publicly available sources) included costs associated with testing for resistance, adverse events of a new regimen, and indirect costs. Results: The direct and indirect medical expenses for the year resistance developed were 6980 Saudi Arabian riyal (SAR) and SAR 2862, respectively. The addition of the cost of new ARTs would increase the total annual costs (between SAR 5174 and SAR 34,265 per patient). One-way sensitivity analysis also reported significant impact of initial and switching therapies used after resistance develops on the total costs of resistance per year. Conclusions: There is a significant cost burden associated with drug resistance, which emphasizes the need to select an appropriate initial ART regimen that has a strong genetic barrier and conduct pre-treatment resistance tests (if possible).

A systematic literature review on the health-related quality of life and economic burden of Fabry disease.

BACKGROUND: Fabry disease (FD) is a rare lysosomal storage disease associated with glycolipid accumulation that impacts multiple physiological systems. We conducted a systematic literature review (SLR) to characterize the humanistic (quality of life [QoL]) and economic burden of FD. METHODS: Searches were conducted in the Embase, MEDLINE®, and MEDLINE® In-Process databases from inception to January 19, 2022. Conference abstracts of specified congresses were manually searched. Additional searches were performed in the Cochrane and ProQuest databases for the humanistic SLR and the National Health Service Economic Evaluations Database for the economic SLR. Studies of patients with FD of any sex, race, and age, and published in the English language were included. There was no restriction on intervention or comparator. For the humanistic SLR, studies that reported utility data, database/registry-based studies, questionnaires/surveys, and cohort studies were included. For the economic SLR, studies reporting economic evaluations or assessing the cost of illness and resource use were included. RESULTS: Of the 1363 records identified in the humanistic search, 36 studies were included. The most commonly used QoL assessments were the 36-item Short-Form Health Survey (n = 16), EQ-5D questionnaire descriptive system or visual analog scale (n = 9), and the Brief Pain Inventory (n = 8). Reduced QoL was reported in patients with FD compared with healthy populations across multiple domains, including pain, physical functioning, and depressive symptoms. Multiple variables-including sex, age, disease severity, and treatment status-impacted QoL. Of the 711 records identified in the economic burden search, 18 studies were included. FD was associated with high cost and healthcare resource use. Contributors to the cost burden included enzyme replacement therapy, healthcare, and social care. In the seven studies that reported health utility values, lower utility scores were generally associated with more complications (including cardiac, renal, and cerebrovascular morbidities) and with classical disease in males. CONCLUSION: FD remains associated with a high cost and healthcare resource use burden, and reduced QoL compared with healthy populations. Integrating information from QoL and economic assessments may help to identify interventions that are likely to be of most value to patients with FD.

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.

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.

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

BACKGROUND: 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 (NIS) 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. FINDINGS: From 2011-2018, there were an estimated 1,710,164 (95% 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 9,336 (95% CI 8,813-9,857; 6.0%) resulted in in-hospital mortality. Variables associated with higher odds of OI-related hospitalizations (compared to without an OI) included younger age (Likelihood Ratio (LR) p < 0.001), male sex (LR p < 0.001), non-white race/ethnicity (LR p < 0.001) and being uninsured (LR p < 0.001). Higher OI-related mortality was associated with older age (LR p < 0.001), male sex (LR p = 0.001), Hispanic race/ethnicity (LR p < 0.001), and being uninsured (LR p = 0.009). The OI-related hospitalization rate fell from 2,725.3 (95% CI 2,266.9-3,183.7) per 100,000 PWH in 2011 to 1,647.3 (95% CI 1,492.5-1,802.1) in 2018 (p < 0.001), but the proportion of hospitalizations with mortality was stable (5.9% in 2011 and 2018). INTERPRETATION: 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.

Housing cost burden and external causes of mortality: Variations across housing regimes in high-income countries, 2010-2020.

OBJECTIVES: While comparative studies reported that generous welfare state improves population health, they did not take into account the roles of housing as a cornerstone of welfare state. To reduce knowledge gaps, this study aims to estimate (a) the link between housing affordability stress and mortality rate due to external causes and (b) the moderating effects of housing regime on such association. METHODS: Using country level panel data from the databases of the Organisation for Economic Co-operation and Development (OECD), fixed effects were performed to estimate the effects of housing costs to income ratio on mortality rates due to external causes (accidents, intentional self-harm, and assault). Also, we tested whether housing regimes moderate the association between housing cost burden and mortality rate. RESULTS: An increased level of housing cost burden predicted mortality rates due to accidents and intentional self-harm. Such association was pronounced for countries with higher rates of homeownership and limited access to market self-help. In addition, when homeownership rates and debt-to-income ratios are taken into account as time-varying variables, the elevated mortality risks associated with both increased housing cost burden and higher homeownership are mitigated in countries where debt relative to income increases. CONCLUSION: Our findings suggest that different housing systems shape divergent patterns of mortality risks associated with housing affordability stress. Future studies may wish to incorporate housing in macro comparative studies on population health.

Is removal and destruction of perfluoroalkyl and polyfluoroalkyl substances from wastewater effluent affordable?

Several jurisdictions are currently evaluating regulatory standards for perfluoroalkyl and polyfluoroalkyl substances (PFAS) in municipal water resource recovery facility (WRRF) effluent. Effective and responsible implementation of PFAS effluent limits should consider the costs and capabilities of currently available technologies, because the costs of meeting WRRF PFAS limits could disproportionally fall to ratepayers. Cost curves were developed for currently available PFAS separation and destruction options, assuming effluent treatment targets near current analytical detection limits. Removing and destroying PFAS from municipal WRRF effluent is estimated to increase costs per household by a factor of between 2 and 210, using Minnesota-specific data as an example. Estimated costs per household would increase more for residents of smaller communities, averaging 33% of median household income (MHHI) in communities smaller than 1000 people. This exceeds the U.S. Environmental Protection Agency (EPA)-developed affordability index of 2% of MHHI by a factor of 16. Estimated costs per household to remove and destroy PFAS varied among locations, primarily based on WRRF and community size, median income, rural versus urban, and type of wastewater treatment processes currently used. PRACTITIONER POINTS: Required tertiary treatment before WRRF effluent PFAS separation, using currently available technologies, is a significant portion (~40-80%) of estimated costs. Adding PFAS separation, destruction, and pre-treatment would make Minnesota wastewater rates unaffordable (defined by EPA affordability guidance) without external funding. The estimated cost per household is higher for smaller communities and would require substantial external funding to maintain rate affordability. Design and operating uncertainties remain for full-scale WRRF retrofits to consistently remove and destroy effluent PFAS with limited full-scale applications.

National and Local Direct Medical Cost Burden of COPD in the United States From 2016 to 2019 and Projections Through 2029.

BACKGROUND: Despite the significant burden posed by COPD to health care systems, there is a lack of up-to-date information quantifying the general COPD burden, costs, and long-term projections to various stakeholders in the United States. RESEARCH QUESTION: What are the updated state-specific and nationwide estimates of the COPD disease burden and direct costs in 2019, along with projections of COPD-attributable medical costs through 2029? STUDY DESIGN AND METHODS: A cross-sectional, retrospective study design using the 2016 to 2019 Medical Expenditure Panel Survey, 2019 American Community Survey, and 2019 Behavioral Risk Factor Surveillance System data was applied to generate COPD-attributable expenditure estimates. Cost projections for the years 2020 to 2029 were based on 2017 national population projections reported by the US Census Bureau, and all costs were adjusted to 2019 US dollars. RESULTS: In total, 4,135 people living with COPD were included; a higher proportion had other concurrent conditions such as cardiovascular-related conditions compared with people without COPD (n = 86,021). Overall, in 2019, COPD-attributable medical costs after adjusting for demographic characteristics and 19 concurrent conditions (including COPD-related and non-COPD-related conditions) were estimated at $31.3 billion, with state-specific cost estimates reporting wide variation, from $44.8 million in Alaska to $3.1 billion in Florida. Nationwide COPD-attributable medical costs borne by payer type were as follows: private insurance, $11.4 billion; Medicare, $10.8 billion; and Medicaid, $3.0 billion. Projections of national medical costs attributable to COPD are reported to increase to $60.5 billion in 2029. INTERPRETATION: Understanding the current disease and economic burden of COPD in the United States, along with the projected costs attributable to COPD in the next decade, will highlight unmet needs and gaps in care that help inform health care decision-makers in planning future actions to alleviate this disease burden.

Measuring the burden of cystic fibrosis: A scoping review.

BACKGROUND: Cystic fibrosis (CF) contributes a significant economic burden on individuals, healthcare systems, and society. Understanding the economic impact of CF is crucial for planning resource allocation. METHODS: We conducted a scoping review of literature published between 1990 and 2022 that reported the cost of illness, and/or economic burden of CF. Costs were adjusted for inflation and reported as United States dollars. RESULTS: A total of 39 studies were included. Direct healthcare costs (e.g., medications, inpatient and outpatient care) were the most frequently reported. Most studies estimated the cost of CF using a prevalence-based (n = 18, 46.2 %), bottom-up approach (n = 23, 59 %). Direct non-healthcare costs and indirect costs were seldom included. The most frequently reported direct cost components were medications (n = 34, 87.2 %), inpatient care (n = 33, 84.6 %), and outpatient care (n = 31, 79.5 %). Twenty-eight percent (n = 11) of studies reported the burden of CF from all three perspectives (healthcare system (payer), individual, and society). Indirect costs of CF were reported in approximately 20 % of studies (n = 8). The reported total cost of CF varied widely, ranging from $451 to $160,000 per person per year (2022 US$). The total cost depended on the number of domains and perspectives included in each study. CONCLUSIONS: Most studies only reported costs to the healthcare system (i.e., hospitalizations and healthcare encounters) which likely underestimates the total costs of CF. The wide range of costs reported highlights the importance of standardizing perspectives, domains and costs when estimating the economic burden of CF.

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.

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.

First Line of Defense: The Vital Role of Family Medicine Physicians in Preventing Acute Mesenteric Ischemia in High-Risk Patients.

Acute mesenteric ischemia (AMI) is a life-threatening condition with a high mortality rate despite surgical interventions. Morbidity and mortality are especially high in those with risk factors, which include diabetes mellitus (DM), hypertension (HTN), coronary artery disease, recent myocardial infarction, and rheumatic autoimmune diseases, among others. We present the case of a 70-year-old Caucasian woman diagnosed with AMI. The patient presented acutely to the emergency department after nine episodes of vomiting and was admitted to the surgical floor the same day for an emergent exploratory laparotomy. She presented acutely with an atypical presentation and without any progressive symptoms, despite various comorbidities. This patient was classified as "very high risk", but she had not been on any medications or monitored for any of her comorbidities. We highlight the essential and multifaceted role of family medicine physicians, also known as primary care physicians (PCPs), in the prevention of bowel ischemia and recommend the use of routine outpatient monitoring with clinical examination, blood testing, and imaging. These, along with a high index of suspicion, have clinical utility in preventing hospitalization, surgical intervention (bowel resection), and other serious sequelae of AMI. Timely detection, management, and specialist referrals from a family medicine physician can lower the overall burden on healthcare resources and personnel.

Psychosocial Support and Cost Burden of Cancer Among Patients Attending Tertiary Oncology Clinics in Lagos State, Nigeria.

BACKGROUND: Cancer management brings about changes in patients' paths of life, in their daily activities, work, relationships, and family roles, and it is associated with a high level of patient psychological stress and financial toxicity. The objective of this study was to assess the psychosocial support and financial burden of cancer patients and determine socioeconomic factors that impact them. Methodology and Methods: This was a descriptive cross-sectional study among 240 cancer patients in Lagos University Teaching Hospital (LUTH) and Lagos State University Teaching Hospital (LASUTH) in Nigeria. The respondents were recruited consecutively and data was collected using structured, adapted, interviewer administered questionnaires. The data was analyzed using epi info software version 7.1 with chi-square used to test for associations and the level of significance was set at p<0.05. RESULTS: Overall, 74.6% of respondents had perceived psychosocial support scores higher than 50 out of 100. The family was the most common source of support across the emotional, financial and tangible support dimension's (91.7%, 83.8% and 85.4%) while healthcare professionals (60%) were the commonest for informational support. Overall, 69.6% had COST scores less than 50% indicating worse financial toxicity. Statistical associations were found between cost burden and cancer type (p=0.01), age (p<0.0001) and financial support (p<0.0001). Older patients, those who had financial support, and those with gynecological cancers had a decreased financial burden For psychosocial support associations were seen with employment status (p=0.02), and treatment (p<0.0001). Higher psychosocial support for patients who were employed and had begun treatment. CONCLUSION: The majority of respondents experienced high levels of financial toxicity but adequate psychosocial support. More research is needed, as well as the inclusion of support groups into clinics and the availability of loans to help with the initial costs.

Atrial flutter-related health care use and costs: An analysis of a nationally representative administrative claims database in the United States.

Background: Atrial flutter (AFL) is a common arrhythmia associated with significant morbidity, yet the incremental burden of this condition has not been well documented. Objective: Using real-world data, we sought to evaluate the healthcare use and cost burden of incident AFL in the United States. Methods: From 2017 to 2020, persons with an incident diagnosis of AFL were identified through Optum Clinformatics, a nationally representative administrative claims database of commercially insured individuals in the United States. We constructed 2 cohorts (AFL patient; non-AFL comparator) and used a matching weights method to balance covariates between cohorts. Using logistic regression and general linear models, 12-month all-cause and cardiovascular (CV)-related health care use (inpatient, outpatient, emergency room [ER] visits, and other) as well as medical expenditures were compared between the matched cohorts. Results: The matching weight sample sizes were 13,270 for AFL and 13,683 for the non-AFL cohorts. In the AFL cohort, ∼71% were at least 70 years of age, 62% identified as male, and 78% identified as White. The AFL cohort had significantly higher health care use, including all-cause (relative risk [RR] 1.14; 95% confidence interval [CI] 1.11-1.18) and CV-related ER visits (RR 1.60; 95% CI 1.52-1.70) compared with the non-AFL cohort. Mean total health care costs (per patient annually) were almost $21,783 (95% CI $18,967-$24,599) higher among patients with AFL compared to those without AFL ($71,201 vs $49,418, respectively; P <.001). Conclusion: Amidst the backdrop of an aging population, findings from this study draw attention to the importance of timely and adequate treatment of AFL.

Healthcare utilization and direct medical costs of Huntington's disease among Medicaid beneficiaries in the United States.

AIMS: To provide more recent estimates of healthcare utilization and costs in Huntington's disease (HD) in the Medicaid population. MATERIALS AND METHODS: This retrospective analysis used administrative claims data for HD beneficiaries (≥1 HD claim; ICD-9-CM 333.4) from Medicaid Analytic eXtract data files from 1 January 2010-31 December 2014. The date of the first HD claim during the identification period (1 January 2011-31 December 2013) was assigned as the index date. If a beneficiary had multiple HD claims during the identification period, one was randomly chosen as the index date. Beneficiaries were required to be continuously enrolled in fee-for-service plans during the 1-year pre-index and post-index periods. Medicaid beneficiaries without HD were drawn from a 100% random sample and matched (3:1) to those with HD. Beneficiaries were classified by disease stage (early/middle/late). All-cause and HD-related (any utilization related to HD diagnosis or symptoms associated with HD) healthcare utilization and costs were reported. RESULTS: A total of 1,785 beneficiaries without HD were matched to 595 beneficiaries with HD (139 early-, 78 middle-, and 378 late-stage). The mean (SD) annual total costs were higher for beneficiaries with HD than beneficiaries without HD ($73,087 [$75,140] vs. $26,834 [$47,659], p <.001) and driven by inpatient costs ($45,190 [$48,185] vs. $13,808 [$39,596], p <.001). Total healthcare costs were highest among beneficiaries with late-stage HD (mean [SD] cost: $22,797 [$31,683] for early-stage HD vs. $55,294 [$129,290] for middle-stage HD vs. $95,251 [$60,197] for late-stage HD; p <.001). LIMITATIONS: Administrative claims are intended for billing purposes and subject to coding errors. This study did not address functional status, which may provide further insight to late-stage and end-of-life burden of HD, and indirect costs. CONCLUSIONS: Medicaid beneficiaries with HD have higher acute healthcare utilization and costs compared to beneficiaries without HD, which tend to increase with disease progression, indicating that HD beneficiaries at later disease stages have greater burden.

Huntington's disease (HD) is a degenerative genetic disorder marked by progressive decline in cognitive and motor functions, leading to severe disability and loss of independence. The median and mean survival time after a diagnosis of HD is 15 years. Little is known about the kinds of health services used or costs associated with HD in the United States (US) in the Medicaid population. The study objective was to estimate healthcare utilization and direct medical spending among Medicaid beneficiaries with HD. The mean annual total costs were higher for beneficiaries with HD than beneficiaries without HD ($73,087 vs. $26,834). Mean total healthcare costs were highest among beneficiaries with late-stage HD ($22,797 for early-stage HD vs. $55,294 for middle-stage HD vs. $95,251 for late-stage HD). Medicaid beneficiaries with HD have higher acute healthcare utilization and costs compared to beneficiaries without HD, with utilization and costs increasing with disease progression, indicating that HD beneficiaries at later disease stages have greater burden.

Atypical Presentation of Diverticulitis in a Young Hispanic Male: A Case Report.

Diverticulitis is a significant contributor to the number of hospital admissions and healthcare costs in Western societies. The authors present the case of an otherwise healthy 33-year-old Hispanic male presenting to the emergency department with complaints of abdominal pain, pneumaturia, and hematochezia. The patient had no underlying risk factors, substantial prior medical history, or typical symptoms of diverticulitis. He was diagnosed with acute diverticulitis with a presumed colovesical fistula. The unique clinical presentation and the intraoperative findings are discussed. The objective of this case report is to make clinicians aware of atypical presentations of acute diverticulitis and guide the appropriate diagnostic workup for young Hispanic males presenting to the emergency departments with complaints of abdominal pain.

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.