Direct and indirect costs of rheumatoid arthritis to an employer.

This study is among the first to estimate the overall economic burden of rheumatoid arthritis (RA) from an employer perspective. The annual, per capita cost of RA was determined for beneficiaries of a major employer by analyzing medical, pharmaceutical, and disability claims data. The incremental costs related to RA were determined by matching RA patients to a case-control group of individuals with no recorded RA treatment. The utilization of health care services as well as the rate of disability among RA patients was substantially higher than among the controls. For example, annual, per capita employer expenditures for RA employees with disability were almost 3 times those for their controls ($17,822 vs $6131, respectively). Treatment to address not only the severity but also the progression of RA may substantially reduce overall employer expenditures for this disease.

Relationship of compliance with hormone replacement therapy to short-term healthcare utilization in a managed care population.

OBJECTIVE: To identify healthcare utilization characteristics that distinguish female members of a managed care organization (MCO) who remained compliant with hormone replacement therapy (HRT) from those who had poor compliance during an 18-month period and to estimate the cost of HRT to an MCO. STUDY DESIGN: A retrospective cohort design in a population of continuously enrolled female members of an MCO. METHODS: All female members of the Lovelace Health Plan 40 years of age or older who began HRT between January 1, 1993, and June 30, 1994 (n = 1158). Compliance was determined by calculating an estrogen medication possession ratio based on pharmacy fills over 18 months. "High compliers" (n = 427) were defined as those purchasing at least 80% of their recommended days supply, and "low compliers" (n = 269) as those purchasing less than 20%. Healthcare encounters and costs of high and low compliers were compared. RESULTS: High compliers were younger (P < 0.01), more likely to be non-Hispanic white than Hispanic (P < 0.0001), and had higher costs for obstetric/gynecologic care (P < 0.0001) and non-HRT prescriptions (P < 0.0001). Low compliers had higher point estimates of costs and encounters for all other categories of care, but differences were statistically significant only for emergency department visits (P < 0.001). CONCLUSIONS: The added cost of HRT did not result in higher total healthcare utilization and costs, as women who complied well with therapy had decreased utilization and costs in other categories of care. Differences in subcategories of healthcare utilization suggest that level of HRT compliance reflects differences in how women access healthcare.

Multiple opiate receptors: phylogenetic differences.

Both the levels and types of binding sites for opiates and enkephalins appear to be different between species. The most dramatic differences are seen between rats, which have significant levels of both high and low affinity sites, and goldfish, which have only low affinity sites. Binding to both high and low affinity sites is easily displaced by low concentrations of morphine and D-Ala2-D-Leu5-enkephalin, suggesting that both represent relevant receptor sites.