Biomedical subjects

Judith A O'Brien

Publications and source records attributed to Judith A O'Brien.

29 records · Page 2Linked to original sources

PubMed2005

Costs and medical care consequences associated with the diagnosis of peripheral arterial disease.

BACKGROUND: Peripheral arterial disease (PAD) is increasingly recognised as an indicator of disseminated atherothrombosis, but its impact on use of healthcare resources is not well understood. OBJECTIVE: To provide a quantitative description of the resource utilisation and costs incurred following PAD. METHODS: Hospitalisations, physician visits and the corresponding direct medical costs were examined in 16,440 patients with a diagnosis of PAD (1985--1995) in Saskatchewan, Canada, and compared with 15,590 reference patients with a diagnosis of myocardial infarction (MI) [1990--1995]. Medical history and patient characteristics were available retrospectively to January 1980 and follow-up to December 2000. Rates and timing of all-cause and cardiovascular hospitalisations and physician visits within discrete periods in the 10 years following PAD diagnosis, and 5 years following MI, were evaluated, as were lengths of stay and predictors of hospitalisation. RESULTS: Average follow-up was 5.9 years among patients with PAD and 3.6 years for MI. Half (55%) of patients with PAD were male versus 64% of reference patients. The mean ages were 67.3 and 66.9 years, respectively. Patients with PAD were hospitalised most frequently soon after diagnosis, with rates subsequently decreasing to 0.14 per month. These rates were similar in the reference group except for the period immediately following MI. The average 5-year cost post-diagnosis (2002 Can dollars) per patient was 41,968 Can dollars vs 48,578 Can dollars for the reference population. CONCLUSIONS: A diagnosis of PAD not only imposes a severe burden on patients and their families, but it also significantly increases the use of healthcare resources and the associated costs. By the end of year 1, this burden is comparable with a diagnosis of MI.

Aged↗

PubMed2003

Cost of managing an episode of relapse in multiple sclerosis in the United States.

BACKGROUND: The purpose of this study was to determine the direct medical US cost of managing multiple sclerosis relapses. METHODS: Direct data analysis and cost modeling were employed to derive typical resource use profiles and costs in 2002 US dollars, from the perspective of a third-party payer responsible for comprehensive health-care. The location and scope of health care services provided over a 90-day period were used to define three levels of relapse management. Hospitalization and resulting subsequent care was defined as high intensity management. A medium level of intervention was defined as either use of the emergency room, an observational unit, or administration of acute treatments, such as intravenous methylprednisolone in an outpatient or home setting. The lowest intensity of care comprised physician office visits and symptom-related medications. Data were obtained from many sources including all payer inpatient, ambulatory and emergency room databases from several states, fee schedules, government reports, and literature. All charges were adjusted using cost-to-charge ratios. RESULTS: Average cost per person for high management level was 12,870 dollars, based on analysis of 4,634 hospital cases (mean age 48 years, 73% female). Hospital care comprised 71% of that cost. At discharge, 36% required inpatient sub-acute care, rehabilitation or home care. The typical cost per moderate episode was 1,847 dollars and mild episode 243 dollars. CONCLUSIONS: Management strategies leading to a reduction in the frequency and severity of a relapse, less reliance on inpatient care, or increased access to steroid infusions in the home, would have a substantial impact on the economic consequences of managing relapses.

Adult↗

PubMed2003

Cost of managing complications resulting from type 2 diabetes mellitus in Canada.

BACKGROUND: Decision makers need to have Canadian-specific cost information in order to develop an accurate picture of diabetes management. The objective of this study is to estimate direct medical costs of managing complications of diabetes. Complication costs were estimated by applying unit costs to typical resource use profiles. For each complication, the event costs refer to those associated with the acute episode and subsequent care in the first year. State costs are the annual costs of continued management. Data were obtained from many Canadian sources, including the Ontario Case Cost Project, physician and laboratory fee schedules, formularies, reports, and literature. All costs are expressed in 2000 Canadian dollars. RESULTS: Major events (e.g., acute myocardial infarction: 18,635 dollars event cost; 1,193 dollars state cost), generate a greater financial burden than early stage complications (e.g., microalbuminuria: 62 dollars event cost; 10 dollars state cost). Yet, complications that are initially relatively low in cost (e.g., microalbuminuria) can progress to more costly advanced stages (e.g., end-stage renal disease, 63,045 dollars state cost). CONCLUSIONS: Macrovascular and microvascular complication costs should be included in any economic analysis of diabetes. This paper provides Canadian-based cost information needed to inform critical decisions about spending limited health care dollars on emerging new therapies and public health initiatives.

Amputation, Surgical↗

PubMed2003

Estimates of direct medical costs for microvascular and macrovascular complications resulting from type 2 diabetes mellitus in the United States in 2000.

BACKGROUND: Diabetes mellitus is a chronic condition that affects the health of Americans and the US health care system on many levels. According to the American Diabetes Association, approximately 16 million Americans have diabetes mellitus. The onset of type 2 diabetes mellitus, which accounts for the vast majority (90%-95%) of cases, precedes diagnosis by a mean 7 years, with the disease typically manifesting during adulthood. It is not uncommon for people to first realize they have diabetes mellitus due to the appearance of a related complication. OBJECTIVE: The goal of this analysis was to estimate the direct medical costs of managing microvascular and macrovascular complications of type 2 diabetes mellitus in the United States in the year 2000. METHODS: Complication costs were estimated by applying unit costs to typical resource-use profiles. A combination of direct data analysis and cost modeling was used. For each complication, the event costs referred to those associated with the acute episode and subsequent care in the first year. State costs were the annual costs of continued management. Data were obtained from many sources, including inpatient, ambulatory, and emergency department care databases from several states; national physician and laboratory fee schedules; government reports; and literature. All costs were expressed in 2000 US dollars. RESULTS: Major events (eg, acute myocardial infarction--30,364 dollars event cost, 1678 dollars state cost) generated a greater financial burden than early-stage complica- tions (eg, microalbuminuria--63 dollars event cost, 15 dollars state cost). However, complications that were initially relatively low in cost (eg, microalbuminuria) can progress to more costly advanced stages (eg, end-stage renal disease--37,022 dollars state cost). CONCLUSIONS: Given the scope of diabetes mellitus in the United States and its impact on health care and budgets, it is important for policy makers to have up-to-date information about treatment outcomes and costs. The costs presented here provide essential components for any analysis examining the economic burden of the complications of diabetes mellitus.

Cost of Illness↗

PubMed2003

Economic evaluation of galantamine in the treatment of mild to moderate Alzheimer's disease in the United States.

BACKGROUND: Alzheimer's disease (AD) is estimated to affect up to 11% of those aged > or =65 years in the United States, and the number of patients with AD is predicted to increase over the next few decades as the population ages. The substantial social and economic burden associated with AD is well established, with the cost of management increasing as the disease progresses. OBJECTIVE: The aim of this study was to evaluate the economic impact of galantamine 16 and 24 mg/d relative to no pharmacologic treatment in the management of mild to moderate AD in the United States based on the concept of need for full-time care (FTC). METHODS: Calculations were made using the Assessment of Health Economics in Alzheimer's Disease model, which applies predictive equations to estimate the need for FTC and the associated costs. The predictive equations were developed from longitudinal data on patients with AD. Inputs to the equations were derived by analyzing the data from 2 randomized, placebo-controlled, galantamine clinical trials. Resource use (from a payer perspective) was estimated from US clinical trial data, and costs were estimated from several US databases. Analyses were carried out over 10 years, and costs and benefits were discounted at 3%. RESULTS: In the base case, 3.9 to 4.6 patients need to start treatment with galantamine to avoid 1 year of FTC, depending on dose. Treated patients spent 7% to 8% more time pre-FTC and 12% to 14% less time requiring FTC, resulting in savings of 2408 to 3601 US dollars. Time horizons below 3 years, very high discontinuation rates, or increased survival with galantamine reversed the savings. Conversely, limiting treatment to responders delayed FTC by 6 to 7 months, with savings of approximately 9097 to 11,578 US dollars. CONCLUSIONS: These results suggest that use of galantamine in patients with AD in the United States could reduce the use of costly resources such as formal home care and nursing homes, leading to cost savings over time.

Aged↗

PubMed2002

Cost effectiveness of tinzaparin sodium versus unfractionated heparin in the treatment of proximal deep vein thrombosis.

OBJECTIVE: To evaluate economic and health implications of tinzaparin sodium, a once a day low-molecular-weight heparin (LMWH), versus unfractionated heparin (UFH) in the treatment of acute deep vein thrombosis (DVT) from a US healthcare payer perspective. STUDY DESIGN: An economic model, composed of two submodules, was created: A short-term module based on clinical trial data covering the first 3 months and a long-term module that projects trial results based on published data for up to 50 years. METHODS: Clinical trial results were combined with data from long-term follow-up studies of DVT in a model that estimates the health and economic consequences of treatment. Both short- and long-term costs with tinzaparin sodium were compared with UFH, as were health outcomes and quality-adjusted life-years (QALYs). RESULTS: Patients treated with tinzaparin sodium are estimated to live a mean of 0.9 years longer on average (0.6 discounted), resulting in an increase of 0.8 QALYs (0.5 discounted). At the same time, lifetime savings are US dollars 621 per patient (1999 values), even when all patients receiving tinzapirin sodium are treated as inpatients. Early discharge of patients receiving tinzaparin sodium, or outpatient treatment, would save between US dollars 3000 and US dollars 5000 per patient. CONCLUSION: Tinzaparin sodium leads to better health outcomes and substantial economic savings compared with UFH treatment when all management costs are considered.

Ambulatory Care↗

PubMed2002

Direct medical cost of managing deep vein thrombosis according to the occurrence of complications.

BACKGROUND: Management of deep vein thrombosis (DVT) has evolved from hospitalisation for intravenous heparin therapy to treatment options that include acute management as an outpatient. While efficacy and safety remain the principal basis for choosing a therapy, the economic consequences of that choice should be considered as well. OBJECTIVE: To estimate the average cost of various DVT management options from the perspective of US health payers. DESIGN: Inpatient and outpatient management strategies were examined. Inpatient cases were identified by International Classification of Diseases, 9(th) Edition, Clinical Modification codes and were classified into subgroups according to complication status. A cost estimate was developed by applying unit costs to the corresponding course of treatment. Cost estimates included initial acute care and that occurring in the following 6 months. Resource use profiles and unit costs were derived from several statewide inpatient, emergency room and ambulatory care databases supplemented by national fee schedules, published reports and peer-reviewed literature. All costs are reported in 1999 US dollars. RESULTS: The mean 6-month treatment costs for inpatient management ranged from US dollars 3906 to US dollars 17,168, depending on complication status. For outpatient management, the cost ranged from US dollars 2394 to US dollars 3369, depending on frequency of low molecular weight heparin (LMWH) injection and need for professional assistance. CONCLUSIONS: The management strategy selected for DVT has an important economic impact. Self-administered LMWH in a homecare setting results in the lowest cost. However, as some patients either cannot, or will not, be treated this way, it is important for decision makers to consider the costs of other strategies.

Ambulatory Care↗

PubMed2002

Lifetime costs of complications resulting from type 2 diabetes in the U.S.

OBJECTIVE: To model the lifetime costs associated with complications of type 2 diabetes. RESEARCH DESIGN AND METHODS: A cohort of 10,000 patients with diabetes was simulated using a model based on existing epidemiological studies. Complication rates were estimated for various stages of macrovascular disease, nephropathy, retinopathy, neuropathy, and hypoglycemia. At the beginning of the simulation, patients were assumed to have been treated for 5 years and have a mean HbA1c of 8.4. From the U.K. Prospective Diabetes Study, it was estimated that on current therapies, the HbA1c would drift upward on average 0.15% per year. Direct medical costs of managing each complication were estimated (in 2000 U.S. dollars) from all-payor databases, surveys, and literature. RESULTS: Macrovascular disease was estimated to be the largest cost component, accounting for 85% of cumulative costs of complications over the first 5 years. The costs of complications were estimated to be $47,240 per patient over 30 years, on average. The management of macrovascular disease is estimated to be the largest cost component, accounting for 52% of the costs; nephropathy accounts for 21%, neuropathy accounts for 17%, and retinopathy accounts for 10% of the costs of complications. CONCLUSIONS: The complications of diabetes account for substantial costs, with management of macrovascular disease being the largest and earliest. If improving glycemic control prevents complications, it will reduce these costs.

Adult↗

PubMedDate not supplied

Modeling the efficiency of reaching a target intermediate end point: a case study in type 2 diabetes in the United States.

OBJECTIVE: The objective of this study was to describe an approach to modeling the efficiency of an intervention by focusing on an established intermediate end point directly. A case study addresses the economic efficiency of obtaining dual glycemic control over time, according to initial choice of treatment. METHODS: From the perspective of a payer in the United States, instead of the usual approach of basing the model on projecting long-term diabetic complications from glycemic control, this model focuses directly on glycemic control. Treatment changes and associated health-care utilization needed to address postprandial glucose. After assigning each of 10000 drug-naïve patients, HbA1c, age, race, and sex based on distributions from a randomized clinical trial, the model applies the efficacy of nateglinide compared to metformin. Sensitivity analyses were carried out for all parameters. Costs are reported in year 2000 US dollars and discounted at 3%. RESULTS: In the base case, starting on nateglinide and increasing the time in dual glycemic control over 3 years by 2.4 months led to savings of US dollars 295 compared to starting on metformin. Savings increased with stricter treatment criteria but decreased if glycemic control was better initially. CONCLUSIONS: This study illustrates the use of an efficiency model that focuses directly on the relevant short-term end point: glycemic control. Starting patients with nateglinide is shown to be an efficient way of obtaining dual glycemic control during the first 3 years of treatment.

Adult↗

PubMedDate not supplied

Health and economic consequences of sevelamer use for hyperphosphatemia in patients on hemodialysis.

OBJECTIVES: The safety and efficacy of sevelamer hydrochloride in binding phosphate in patients with end-stage renal disease and its ability to attenuate the progression of cardiac calcification have been well documented but not the longer-term health and economic implications. Thus, a model of the predicted long-term consequences of sevelamer compared with calcium-based binders (acetate and carbonate) was developed. METHODS: Long-term cardiovascular implications of 1 year of treatment with phosphate binders in patients on hemodialysis are estimated based on the patient's demographics, comorbidities, and physiologic and renal parameters. The initial calcification score and expected changes over 1 year are derived using regression equations developed from the Treat-to-Goal study and translated to cardiovascular disease risk based on equations developed from a long-term cohort study. In this article, the implications of cardiovascular disease for life expectancy and medical costs are accounted for from a US payer perspective. RESULTS: The cardioprotective effect of sevelamer over 1 year is estimated to result in a 12% reduction in cardiovascular events compared with calcium acetate. In a population of 100 patients, the savings of 205,600 dollars accrued due to avoiding nine cardiovascular events with sevelamer, largely offset the increased binder costs, leading to a favorable cost-effectiveness ratio of about 2200 dollars per (discounted) life-year gained. CONCLUSIONS: Although both binders provide equivalent phosphate binding capacity, the results indicate that the advantage of 1 year of treatment with sevelamer in attenuating the progression of calcification has important clinical and economic consequences, suggesting that this provides good value for money.

Acetates↗

PubMedDate not supplied

Managing meningococcal disease in the United States: Hospital case characteristics and costs by age.

OBJECTIVE: Meningococcal disease occurs worldwide. Approximately 1400 to 2800 cases are reported in the United States annually. The goal of this analysis was to examine hospitalized cases of meningitis and meningococcemia to identify case characteristics, resource use, and inpatient care costs. METHODS: International Classification of Diseases-9th Revision-Clinical Modification diagnosis codes 036.0-036.9 were used to identify cases from roughly 1000 hospitals in four all payer state discharge databases. Multiyear data (1999-2001) were examined to identify demographics, admission month, health service utilization, and hospital costs by age group: infant (<1 years), children (1-10 years), adolescent (11-17 years), young adult (18-22 years), adults (23-49 years), and adults (> or =50 years). Cost estimates include accommodations, ancillary and physician services, reported in 2003 US dollars. RESULTS: Of 1654 cases of meningococcal disease identified, meningococcemia was coded for 51%. Adults accounted for 33% of the cases. The highest rate of admissions occurred from January through March and 62% were admitted via the Emergency Department. Inpatient case fatality rate was 6.4%; 71% of those who died had meningococcemia. The mean length of stay was 9 days. Of survivors, 91% were discharged home (1% with intravenous medications and 11% with other home health-care services) while 7% required further subacute inpatient care. The average cost per hospitalization was estimated at 23,294 dollars per patient. Infants had the lowest average cost per stay (16,793 dollars) and adolescents had the highest (28,202 dollars). CONCLUSIONS: The presence of meningococcemia results in a greater death rate, longer length of stay, and increased care costs. Meningococcal disease has substantial economic, as well as profound clinical consequences for patients of all ages.

Adolescent↗