Estimating the Cost of Thalassemia Care across the World: A Thalassemia International Federation Model.

Estimating the cost of thalassemia care is important for the optimization of care planning, resource allocation and the empowerment of patient advocacy. However, available evidence is heterogeneous, reflecting diverse healthcare systems and cost estimation methods. We sought to build a globally applicable cost model for thalassemia care. We followed a three-step approach, including (i) a targeted literature review to identify previous cost-of-illness studies on thalassemia; (ii) a generic model development based on the main determinants of cost in different countries emerged from a literature review and validated by a team of medical experts; (iii) a piloting of the model using data from two diverse countries. The literature review revealed studies focusing on the total costs of thalassemia care or the cost or cost-effectiveness of specific treatment or prevention modalities in high- and low-prevalence countries across the world. The resulting evidence was used to build a model that calculates total annual therapy cost based on entry of country-level and patient-level data, and data on healthcare modalities, indirect costs and prevention. Testing the model using published data from the UK, Iran, India and Malaysia, revealed an annual cost per patient of £81,796.00 for the UK, Iranian rial (IRR) 13,757.00 for Iran, Indian rupee (INR) 166,750.00 for India and Malyasian ringgit (or dollar) (MYR) 111,372.00 for Malaysia. A globally applicable model that calculates total annual cost of thalassemia care was built based on existing evidence. The model successfully predicted the annual cost of thalassemia care in the UK, Iran, India and Malaysia.

Exploring the current status of neuroendocrine tumours: a population-based analysis of epidemiology, management and use of resources.

BACKGROUND: Neuroendocrine tumours (NETs) are rare malignancies characterised by its capacity to synthesise and secrete monoamines, due to its neuroendocrine origin. Its varied locations and symptoms have traditionally been responsible for extended delays in their diagnosis. The interest of this study was to characterise the patient population diagnosed with NETs in Spain and to revise how the disease is managed, together with the hospitalisation costs of these patients. METHODS: The database included records of all patients diagnosed with a NET between 2010 and 2015. Admission records were used to evaluate hospitalisation, disease management data and costs, and single-patient files were used to characterise the population. RESULTS: Nine Thousand One Hundred Twenty patients were diagnosed with a neuroendocrine tumour between 2010 and 2015, with a 2 fold increase in the diagnosis rate over the study period. 42.25% of the patients were females, while 57.75% were males, and mean diagnosis age was 62.58 years (SD = 14.65). Considering all the registered neuroendocrine neoplasms, 46.86% of the patients had malignant well-differentiated NETs, 32.02% had a malignant poorly differentiated neuroendocrine carcinoma and 42.93% of patients developed metastatic NETs. In addition, 18.59% of patients were diagnosed with benign well-differentiated NETs. The most common tumour sites were the bronchus, lung and other sites, including pancreatic tumours; metastasis was found in the liver and distant lymph nodes. Pancreatic resection was the most common surgical procedure utilised in these patients, summing 19% of total expenses, the injection of an unspecified therapeutic substance (including targeted therapies) was registered in 11.40% of admissions, while chemotherapy was registered in only 6.85% of admissions. The annual healthcare cost of NETs was €15,373,961, corresponding to €9092 per patient. CONCLUSIONS: The implementation of standard diagnosis procedures should be prioritised, with a focus on the pancreas and lung, and taking into account that 42.93% of the patients develop a metastatic tumour. The presence of comorbidities and multimorbidities should be considered in order to develop more efficient disease management protocols.

The cost of lost productivity due to premature lung cancer-related mortality: results from Spain over a 10-year period.

BACKGROUND: Cancer mortality is one of the major causes of productivity loss; and within all cancer sites, malignant neoplasms of the lung continue to be the principal cancer-related cause of death in Spain, with a survival rate of only 10.7%. Thus its effects in labour productivity are a major concern and represent a great social impact. The objective of this study was to evaluate the productivity losses that occur as a result of premature deaths due to lung cancer in Spain. METHODS: The human capital approach was used to calculate the costs derived from the premature mortality due to lung cancer, via the extraction of data on mortality, reference salaries and unemployment rates. RESULTS: Deaths due to lung cancer represented the 28.90% and the 10.83% of all cancer-related deaths in 2017 in males and females respectively, with an increasing tendency in this last group. In addition, the YPPLL count increased in the study period among females. Lung cancer was responsible annually for 60,846 YPPLL, and productivity losses summed €13.1 billion over the 10 year period. CONCLUSIONS: The assessment of productivity losses due to lung cancer provides new information that may assist decision makers in the allocation of resources, reducing the burden it supposes in working-age individuals.

Disability-adjusted-life-years losses in postmenopausal women with osteoporosis: a burden of illness study.

BACKGROUND: To estimate the disability-adjusted life years (DALY) in a nationwide representative sample of postmenopausal women with osteoporosis. The effects of drug-based therapy and risk factors for osteoporotic bone fractures on DALY losses were also explored. METHODS: DALY were estimated based on participant's clinical characteristics and Health-Related Quality-of-Life (HRQoL) data obtained from a cross-sectional, epidemiological one-visit study (the GINERISK study). The study enrolled postmenopausal women (at least 12-months after their last menstrual period) with osteoporosis, above 18-years old, who attended Spanish outpatient Gynaecology clinics. HRQoL was assessed using the generic SF-12v2 questionnaire, which was used to derive disutility values. Mortality rates were extracted from the Spanish national statistics database. Factors explored to be associated with DALY losses were examined using ANOVA, ANCOVA and MANCOVA models. RESULTS: DALY could be computed in 2,782 (67%) out of 4,157 postmenopausal women, with a mean (95% CI) age of 61.0 (60.7-61.2) years. Overall individual undiscounted DALY per woman were 6.1 (5.9-6.2), resulting to be significantly higher in women with severe osteoporosis with prior bone fracture; 7.8 (7.2-8.4) compared to osteoporotic women [5.8 (5.6-6.0)] or postmenopausal women with a BMD > -2.5 T-score that received a drug-based therapy [6.2 (5.8-6.5)]; F = 27.0 (P < 0.01). Models explaining the variation in the levels of health based on the use of a selective estrogen receptor modulator (SERM) or possession of risk factors for osteoporotic BF were found (P < 0.05). CONCLUSIONS: DALY losses were considerable amongst postmenopausal women with osteoporosis. Not having a prior bone fracture, being older, using a SERM and having less osteoporotic risk factors were all linked to less DALY losses.

Prostate cancer in Spain: A retrospective database analysis of hospital incidence and the direct medical costs.

INTRODUCTION: The goal of this study is to determine the medical costs, comorbidity profile, and health care resources use of patients diagnosed with prostate cancer who have been treated in Spanish hospitals. METHODS: The admission records of the patients diagnosed with prostate cancer used in the study were registered between January 2016 and December 2020. These records have been collected from a Spanish hospital discharge database and have been evaluated in a retrospective multicenter analysis. RESULTS: 8218 patients from the database met the criteria and were thus analyzed. The median aged of the diagnosed patients was 71.68 years. The median Charlson comorbidity index (CCI) score was 4, and the updated median CCI was 3. Hypertension was diagnosed in the 49.76% of the individuals, 37.03% had chronic obstructive pulmonary disease and 34.51% had hyperlipidaemia. The mortality rate was 9.30%. The most common medical procedure was prostate resection with percutaneous endoscopic approach (31.18%). The mean annual cost per admission was 5212.98€ €. CONCLUSIONS: Technologies, such as the prostate-specific antigen (PSA) testing for screening has helped in the diagnosis in the past decades, enhancing a decrease in the mortality rate of the patients throughout the years.

Incidence and medical costs of lupus in Spanish hospitals: a retrospective database analysis.

BACKGROUND: This study aimed to assess the comorbidity profile, use of healthcare resources and medical costs of patients with systemic lupus erythematosus (SLE) and cutaneous lupus erythematosus (CLE) treated at the hospital level in Spain. METHODS: Admission records of patients with SLE and CLE that were registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS: 329 patients met the criteria; 64.44% were female and 35.56% were male, with a median age of 54.65 years. Mean Charlson comorbidity index (CCI) was 2.75 in the index admission. 31.61% of the patients suffered essential hypertension, 21.96% suffered asthma and 19.76% suffered hyperlipidemia. Mortality rate was 3.95%. The most common medical procedure was heart ultrasound (19.45%) and introduction in peripheral vein of anti-inflammatory with a percutaneous approach (17.93%). Mean admission cost was €6355.99. CONCLUSIONS: Lupus patients showed a higher incidence and prevalence in the female population, with associated cardiac diseases as the main secondary conditions.

A simulation model to estimate 10-year risk of coronary heart disease events in patients with schizophrenia spectrum disorders treated with second-generation antipsychotic drugs.

BACKGROUND: The risk for cardiovascular (CV) events has been shown to be considerably higher among schizophrenia patients than the general population. OBJECTIVE: The aim of this study was to describe a general stochastic simulation model for the treatment of schizophrenia related to CV-associated risks of second-generation antipsychotics (SGAs). METHODS: A model to simulate the expected 10-year incidence of all types of coronary heart disease (CHD) events in patients treated with SGAs was developed from the Cardiovascular, Lipid and Metabolic Outcomes Research in Schizophrenia (CLAMORS) study to reproduce baseline conditions. The CHD event risk was estimated through a locally adjusted Framingham risk function using the expected mean change in the CV risk factors from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE) study. RESULTS: The 10-year CHD event rate after treatment with SGAs was 0.181, 0.179, 0.176, and 0.172 for olanzapine, quetiapine, risperidone, and ziprasidone, respectively. Relative risk was calculated relative to no treatment, and values were as follows: olanzapine, 1.03 ± 1.05 (95% CI, 0.74 to 1.42), quetiapine, 1.02 ± 1.05 (95% CI, 0.74 to 1.41), risperidone, 1.00 ± 0.99 (95% CI, 0.73 to 1.36), and ziprasidone, 0.97 ± 0.95 (95% CI, 0.72 to 1.31). There were approximately 25,269 CHD events over a 10-year period in schizophrenia patients treated with olanzapine, 25,157 events with quetiapine, 24,883 with risperidone, and 24,514 events with ziprasidone. CONCLUSIONS: The estimated outcomes suggest that each SGA shows a different level of CV event risk, with ziprasidone showing the lowest rate without any association for increased risk of CHD.

Incidence and medical costs of chronic obstructive respiratory disease in Spanish hospitals: a retrospective database analysis.

OBJECTIVE: This study aimed to assess the comorbidity profile, use of health care resources and medical costs of patients with chronic obstructive pulmonary disease (COPD) treated at the hospital level in Spain. METHODS: Admission records of patients with COPD and at least two admissions registered between January 2016 and December 2020 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS: 95,140 patients met the inclusion criteria; 69.1% were males with a median age of 75 years. Mean Charlson comorbidity index (CCI) was 1.9 in the index admission, increasing to 2.1 during the follow-up period. An acute exacerbation of COPD was registered in 93.6% of patients in the index admission; other secondary diagnoses included respiratory failure (56.8%), essential hypertension (36.9%), hypercholesterolemia (26.7%) and diabetes (26.3%). The age-adjusted incidence rate of COPD was 22.6 per 10,000 persons over the study period, decreasing significantly in the year 2020. Mortality rate was 4.1% for COPD patients, increasing to 6.6% in the year 2020. The year 2020, 191 patients registered a COVID-19 infection, with a mortality rate of 23.0%. Length of hospital stay, and intensive care unit (ICU) stay increased in the follow-up period versus the index admission, similar to admission costs. Mean admission cost was €3212 in the index admission, with cost increases being associated with age, length of stay, ICU stay and CCI. CONCLUSIONS: Patients' condition worsened significantly over the follow-up period, in terms of comorbidity and dependence on respirator, with an increased mortality rate and higher admission costs.

Direct medical costs of non-alcoholic fatty liver disease in Catalonia at the hospital level: a retrospective multicenter study.

BACKGROUND: The prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing worldwide, which is expected to correlate with significant medical and social costs. This study aimed to evaluate the clinical and economic burden of NAFLD in Catalonia at the hospital level. METHODS: Records of all patients diagnosed with NAFLD and treated in Catalan hospitals between the year 2007 and 2018 were extracted from a patient-level healthcare database. RESULTS: Admission files of 24,172 individual patients were obtained. High comorbidity rates were found across age groups, with a mean Charlson Comorbidity Index of 5.1. In-hospital mortality rate increased over the study period, and was associated to a higher comorbidity rate. Disease complexity was increased in this patient group, which is associated with larger medical costs. The mean annual cost per patient was €4073, with a total annual direct medical cost of €27,370,827. The greatest portion of costs was attributed to surgical interventions (€14,429,336). CONCLUSIONS: The high level of comorbidity and disease complexity in this patient group versus the general population is expected to correlate with a more intensive use of medical resources and costs. This study provides novel data to inform resource allocation and disease management decisions at the regional level.

Burden of ischemic heart disease in Spain: incidence, hospital mortality and costs of hospital care.

BACKGROUND: Ischemic heart disease (IHD) is the leading global cause of death and is assumed to entail a significant social and economic burden globally. This study aimed to evaluate incidence and mortality trends of IHD in Spain and to estimate direct medical costs. METHODS: Admission files corresponding to patients with IHD registered between 2011 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective study. RESULTS: Admission data corresponding to 814,740 patients with IHD was analyzed. The majority of patients were males, and about half of the hospitalizations were due to an acute myocardial infarction. Incidence decreased significantly in most age groups over time, while hospital mortality rate remained stable (4.4%). Additionally, mortality rate was significantly higher among females (6.6%). Median admission cost was €5175; the higher costs per admission were found in patients with an acute myocardial infarction and in admissions with an ICU stay. The annual cost of hospital care was €693.8 million. CONCLUSIONS: Despite the decreasing trends described in the general population, hospital mortality rate was constant among hospitalized patients during the study period. The higher hospital mortality rate described among females should be considered in further studies and protocol revisions.

Hospital incidence and medical costs of polycythemia vera in Spain: a retrospective database analysis.

BACKGROUND: Polycythemia vera (PV) is one of the most common chronic myeloproliferative neoplasms, yet, little data is available on the epidemiology of PV in Spain and the costs of its management. This study aimed to evaluate the hospital incidence and mortality rate of PV in Spain, and to estimate hospital medical costs. METHODS: Hospital admission records of patients with PV registered between 2005 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS: Admission files of 490 patients were reviewed. Median age was 74 years; patients presented numerous conditions associated to age, namely hypertension, diabetes or anemia. Hospital mortality rate was associated to pulmonary heart disease, respiratory conditions and kidney disease. Most of the files analyzed corresponded to inpatient admissions; hospital incidence decreased over the study period in patients over 60 years. Median admission cost was €5580, increasing in patients deceased during the hospitalization. Admission cost increased significantly between 2006 and 2011. CONCLUSIONS: This study provides an evaluation of hospital management and costs of PV in Spain. Future studies should focus on the revision of disease management in the country and measuring total medical costs, which could be higher than global estimations.

Hospital incidence and costs of congenital hydrocephalus in Spain: a multicenter retrospective study.

METHODS: Records of hospital admissions of patients with congenital hydrocephalus between 2010 and 2019 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS: A third of the patients included in the study were perinatal patients, however, the hospitalization rate in this group was higher to that in patients over 1 year of age. Perinatal patients required more ICU admissions and longer hospital stays, with more frequent surgical interventions and mechanical ventilation. The mean medical cost associated to congenital hydrocephalus was €9610 per admission, with significantly higher costs found in perinatal patients. CONCLUSIONS: This study provides novel data on the hospital costs of congenital hydrocephalus in Spain. The hospital medical costs of this disorder have decreased over the past decade for perinatal patients but not in those aged 1 year and older, which should be considered in upcoming healthcare plans and resource allocation decisions.

Economic Implications of Endometriosis: A Review.

Endometriosis is a chronic inflammatory disease that can have serious physical and emotional consequences for patients in terms of pain, quality of life, and infertility. Despite affecting about 10% of women, the pathophysiology and economic impact of the disease are not fully understood. This study aimed to review and summarize research articles quantifying the direct and indirect costs of endometriosis in the context of current national and international treatment guidelines. A search including the terms 'endometriosis' AND 'costs' OR 'cost of illness' OR 'cost analysis' OR 'economic burden' was performed, focusing on studies published between January 2000 and May 2022. Total costs, costs of primary and secondary care, productivity losses, and indirect costs were reported. The medical costs of endometriosis were principally registered in secondary care settings, where surgery was the main cost driver. There was considerable variability of populations and study settings, with the overall direct medical cost range of endometriosis from US$1459 to US$20,239 (2022) per patient per year. An increasing trend has been reported in secondary care costs over time; however, not enough data were available at this time to evaluate inpatient and outpatient costs versus treatment strategies. Similarly, further research is required to evaluate the costs and potential savings associated with new therapies. Numerous studies have evaluated the indirect costs of endometriosis in recent years, finding costs between US$4572 and US$14,079 (2022). Currently, limited data are available on the economic burden of the disease at the patient level.

Ambulatory and hospital care of glaucoma in Spain and associated medical costs.

OBJECTIVES: This study aimed to analyze the impact of glaucoma in ambulatory centers and hospitals in Spain over the past decade, in terms of incidence and medical costs. METHODS: Administrative data of glaucoma patients from ambulatory centers and hospitals in Spain and registered between 2011 and 2020 was obtained from a Spanish National discharge database. Medical costs obtained were based on the diagnosis-related group-based hospital payment systems, determined by the Spanish Ministry of Health. RESULTS: Data from 100,734 ambulatory care visits and 11,408 hospital admissions related to glaucoma were obtained from the database. Most of the cases were registered in patients over 65 years of age. The incidence of glaucoma in ambulatory centers was 2.2 per 10,000 persons over the study period; in hospitals, the incidence was 0.2 per 10,000 persons. The incidence of glaucoma in ambulatory settings increased significantly over the study period, while the incidence in hospitals decreased over the same period. Most ambulatory visits and hospital admissions were programmed or non-urgent. The mean cost per ambulatory visit was €954, €5.5 million in total annually; the mean cost per hospital admission was €3,727, €4.1 million in total annually. The annual cost of ambulatory care increased significantly over the study period, while the annual cost of hospital care decreased significantly. CONCLUSIONS: The medical costs of glaucoma in Spanish hospitals decreased over the study period, while the costs of ambulatory care increased. This shift in the management of glaucoma should be considered in future resource allocation decisions.

Chronic inflammatory demyelinating polyneuropathy in Spain: a retrospective analysis of hospital incidence and medical costs.

BACKGROUND: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare disorder that usually involves long-term impairment. Despite the chronic health-care needs that are often associated, research evaluating the economic burden of this disorder is still scarce. This study aimed to assess the characteristics of patients admitted with CIDP in Spanish hospitals and to determine the associated medical costs. METHODS: A retrospective multicenter study was designed analyzing records of hospital and ambulatory visits of patients with CIDP in Spanish hospitals between 2004 and 2018. Medical costs registered in hospital facilities were evaluated. RESULTS: Admission files corresponding to 2805 patients diagnosed with CIDP were extracted from the database: 64.7% of patients were males, and median age was 60 years. Patients presented comorbidities that included essential hypertension, hypercholesterolemia, and diabetes mellitus. The raw number of admissions for CIDP increased significantly over the study period, similarly to mean admission costs for all age groups. Consequently, total hospital medical costs associated with CIDP increased over the study period. The mean medical cost per admission was €3953. CONCLUSIONS: The increasing number of hospital cases of CIDP is associated with rising medical costs. Further research will be required to fully evaluate the medical and societal burdens of this disorder.

Hospital care of endometriosis in Spain: a retrospective multicenter analysis of patient characteristics and costs.

BACKGROUND: Despite the potential serious outcomes associated with endometriosis, few data is available describing the real clinical practice and costs. The aim of this study was to evaluate the characteristics of patients diagnosed with endometriosis in Spain, to measure incidences within the hospital setting and the associated medical costs.Methods: Admission records of patients with endometriosis registered between 2009 and 2018 were obtained from a Spanish hospital discharge database and analyzed in a retrospective multicenter study. RESULTS: Data corresponded primarily to inpatient admissions, with a median length of stay of 3 days. Length of stay correlated with patients' age. Admissions were mainly associated with surgical procedures, namely local excision or destruction of lesions. The majority of secondary diagnoses registered corresponded to inflammatory disease of female pelvic organs; 9.2% of patients presented neoplasms of uterus and only 0.9% registered ovarian neoplasms. Mean admission cost was €3566 over the study period. CONCLUSIONS: The majority of admissions reviewed in this study corresponded to the removal of ovarian lesions, although data suggested a decrease in the number of cases that were treated as hospital inpatient admissions over the study period. Older patients, surgical procedures, and lengthier admissions were associated with higher medical costs.

Hospital care and medical costs of septic arthritis in Spain: a retrospective multicenter analysis.

OBJECTIVES: This study aimed to review the characteristics of patients admitted with septic arthritis in Spanish hospitals and to measure the associated direct medical costs. METHODS: Hospital admission records of patients with septic arthritis as a primary diagnosis registered between 2010 and 2019 were evaluated in a retrospective study. Admission cost in the database is based on the diagnosis-related group-based hospital payment systems, determined by the Spanish Ministry of Health. RESULTS: Files from 16,438 patients were evaluated; median age was 56 years and 62.8% of patients were males. Staphylococcus was the most frequently registered pathogen, and 2.7% of admissions registered an antibiotic-resistant infection. Median hospitalization time was 14 days for adult patients and 8 days for children, with an in-hospital mortality rate of 3.7% for adult patients, and no deaths registered in children. The median length of intensive care unit (ICU) stay was 3 days. The mean admission cost was €6,382 per patient, with no significant differences between age groups. Admission costs increased significantly with the length of hospital stay. The total medical cost reached 12.7 million euros per year, considering all patients in the database. CONCLUSIONS: This study provides new data on the medical costs of septic arthritis in Spain, providing a basis for the revision of resource allocation decisions in order to reduce the burden of this condition at the healthcare system level. Further research will be required to quantify the total burden associated with this condition.

Burden of Hodgkin and non-Hodgkin lymphoma in Spain over a 10-year period: productivity losses due to premature mortality.

Background: Cancer is annually responsible for millions of deaths in Europe and billions of euros in productivity losses; the estimated mortality rate of lymphoma was of 7.07 per 100,000 individuals in Spain in 2018. This study aimed to evaluate the burden that lymphoma mortality represents for the Spanish society. Methods: The human capital approach was used to estimate the costs derived from premature mortality due to lymphoma between 2008 and 2017. Results: The number of deaths attributable to lymphoma increased steadily over the study period; the major number of deaths occurred among males aged 80 to 84 years. During the study period, 97,069 years of productive life were lost, a parameter that decreased noticeably over time due to the reduction in the number of deaths at working age. Productivity losses decreased accordingly. Lymphoma represented the 45.36% of losses due to hematological malignancies, generating €121 million in losses the year 2017. Hodgkin lymphoma was, among hematological malignancies, the malignancy accounting for the highest portion of losses per individual. Conclusions: Lymphoma represents a significant burden that can be reduced with the implementation of improved diagnosis and treatment methods, which must be taken into account in resource allocation and management policies.

Atopic dermatitis in specialized centers in Spain: a retrospective analysis of incidence and costs (2000-2017).

BACKGROUND: Atopic dermatitis is a chronic inflammatory skin disease that has substantial effects on patients' quality of life, with a prevalence between 2.2% and 17.6% worldwide. This study aimed to evaluate the use of specialized care resources generated by children and adults with atopic dermatitis, and the associated direct medical costs. METHODS: Admission details from patients admitted in specialized healthcare centers (inpatient and outpatient care) in Spain between 1 January 2000 and 31 December 2017 were analyzed in a retrospective multicentre study. RESULTS: Records corresponded to 3036 patients, 1266 aged 5 years or younger. Comorbid conditions corresponded to skin infections and respiratory difficulties (asthma, bronchiectasis). Hospital incidence of atopic dermatitis was 5.8 per 100,000 persons, stable over the study period, and 30.0 per 100,000 in those aged 5 years and younger. Mean annual direct medical cost per patient was €2469. Overall, direct medical costs per patient increased significantly over the study period (p < 0.0001). CONCLUSION: Hospital incidence of atopic dermatitis remained stable over the study period, which is in contrast with the increasing incidence reported by the Spanish government in primary care centers. The increase in direct medical costs of specialized care responded to the increase in treatment costs.

Economic impact of dry eye disease in Spain: A multicentre retrospective insurance claims database analysis.

PURPOSE: To analyse the occurrence and cost of dry eye disease in Spain in the recent years. METHODS: A cross-sectional analysis based on anonymised data from an insurance claims database that includes data from 1997 to 2015 from public and private hospitals and healthcare centres; 36,081 patients were eligible for the study after duplicate elimination. Five ICD9 codes associated with dry eye were used for patient selection, including vitamin A deficiency with xerophthalmic scars of cornea, xerophthalmia due to vitamin A deficiency, keratoconjunctivitis sicca not specified as Sjögren's, dry eye syndrome and keratoconjunctivitis sicca Sjögren's disease. RESULTS: Over 88% of the patients were female, and the mean age was 66 years. Patients with keratoconjunctivitis sicca Sjögren's disease represented more than 89% of all patients and had the highest percentage of women. Both the annual number of patients and the number of admissions have increased exponentially since 1997 raising from 1079 to 3097 and from 1344 to 5938, respectively. The in-hospital length of stay was 9.6 (standard deviation = 11.6) days where more than 65% of the admissions were due to emergencies. Total costs were found to increase from €4.9 to €30.3 million during the study period; in parallel, there was an increase in the mean annual cost per patient, which was on average €7379. CONCLUSION: Disease incidence is likely to increase due to the influence of modern-day workplace, and it is important to take into account the high economic burden and the large decrease in quality of life in regards to Spanish society and health policies.