Medical costs, direct

Few papers have looked at the economic implications of bipolar affective disorder. Most of the published studies look at direct medical costs over the course of a year. Industry-sponsored studies focus on the benefits of a new treatment over older treatments. However, factors individual to a particular patient are likely to be more important than the average cost of a particular treatment. These include selection of patients who are likely to respond to a particular treatment, and psychoeducation coupled with encouragement during follow-up and carefial monitoring, to avoid such expensive outcomes as ftill-blown relapse, serious toxicity or suicide. 

COPD is the fourth leading cause of death in the United States in 2000,119,000 adults died from the disease.3 In 2002, COPD was estimated to cost the United States 32.1 billion, with direct medical costs accounting for 18 billion of the total.3 Morbidity, mortality, and costs are all expected to increase over the next decade. 

Direct costs include both medical and nonmedical expenditures for the detection, treatment, and prevention of disease. Direct medical costs reflect resources consumed in the "production" of health care, such as pharmaceutical products and services, physician visits, and hospital care. Direct nonmedical costs reflect expenditures for products and services that are not directly related to disease treatment but are still related to patient care. Examples of direct nonmedical costs include transportation to a pharmacy or physician s office and housekeeping during the illness period. Indirect costs account for changes in productivity of an individual because of illness. The monetary value of lost or altered productivity is typically used as a measure of indirect costs. Intangible costs and consequences are nonmonetary in nature and reflect the impact of disease and its treatment on the individual s social and emotional functioning and quality of life. Table 12.2 provides examples of these types of costs and consequences. 

The direct medical costs of care usually are associated with monetary transactions and represent costs that are incurred during the provision of care. Examples of direct medical costs include payments for purchasing a pharmaceutical product, payments for physicians fees, salaries of allied health professionals, or purchases of diagnostic tests. Because the charge for medical care may not accurately reflect the resources consumed, accounting or statistical techniques may be needed to determine direct costs. 

Monetary transactions undertaken as a result of illness or health care to detect, prevent, or treat disease are not limited to direct medical costs. There is another type of cost that often is overlooked - direct nonmedical costs. These costs are incurred because of illness or the need to seek medical care. They include the cost of transportation to the hospital or physician s office, the cost of special clothing needed because of the illness, the cost of accommodations for receiving medical treatment at a distant medical facility, and the cost of special housing (e.g., the cost of modification of a home to accommodate an ill individual). Direct nonmedical costs, which are generally paid out of pocket by patients and their families, are just as much direct medical costs as are expenses that are more usually covered by third-party insurance plans. 

The results of the application of this model are, among others, that. differences m clinical outcomes exist between levodcpa alone and entacapone phis levodcpa, entacapone substantially improved the amount of time spent with 25% OFF tune, hvmg with 25% OFF time pier day was increased by 0.63 years (or 7.6 months) ova the 5-year time period, and the costs per QALY gained were 9221 and 20986 for total and direct medical costs, respectively. 

Tobacco use has the highest cost to society of any substance of abuse, with the possible exception of alcohol. The American Lung Association estimated in the year 2000 that direct medical costs of tobacco-caused illness were approximately 50 billion. However, this cost is well below the total medical costs to society because... 

The first published direct medical cost of sleep apnea was 275 million in 1990 by the National Commission on Sleep Disorders Research. (47). More recently, groups in Manitoba, Canada and Puget Sound, Washington published direct medical cost analyses. Health care utilization by children with OSAS has also been studied in Israel. 

There are different ways to look at outcomes. One method, the ECHO model, purports three basic types of outcomes economic, clinical, and humanistic (Kozma et al., 1993). Economic outcomes include direct costs and consequences, both medical and nonmedical, and indirect costs and consequences. For example, when assessing outcomes from a patient perspective, a medication copayment would be a direct medication cost, whereas gas money to pick up the medication from the pharmacy would represent a nonmedical direct cost. Lost wages from missed work could be regarded as an indirect cost. 

Direct costs are the resources consumed in the prevention, detection, or treatment of a disease or illness. These costs can be divided into direct medical and direct nonmedical costs. Direct medical costs are specific monetary transactions associated with paying for medical care, such as hospitalizations, drugs, medical supplies, and physician visits. Direct nonmedical costs involve monetary transactions for required items or services that do not involve purchase of medical care. Examples include transportation to medical facilities, special foods, and the time that family members miss work to care for others. 

Direct Medical Costs Direct Nonmedical Costs... 

In economic evaluations, there is a need to make assumptions about the variables in the analysis. For instance, assumptions that are made commonly include the incidence of adverse effects, the drug s efficacy (in clinical trials) and effectiveness (use in actual practice), and the costs of drugs or other direct medical costs. It is important to keep in mind that assumptions are simply predictions about what a researcher thinks might happen as a result of a program or intervention. To account for the variety of outcomes that may arise in any intervention, researchers should use a technique known as... 

The latest and most convincing economic study is available from the Asheville Project. In patients with diabetes who received ongoing pharmaceutical care services, not only were improvements maintained in hemoglobin AlC levels over the 5-year study time frame, but also days of sick time decreased every year and estimated increases in productivity were 18,000 annually. In addition, total mean direct medical costs in the Asheville project decreased by 1200 to 1872 per patient per year compared with the baseline. ... 

Migraine is an intense, often debilitating type of headache. Migraines affect as many as 24 million people in the United States, and are responsible for billions of dollars in lost work, poor job performance, and direct medical costs. Approximately 18% of women and 6% of men experience at least one migraine attack per year. More than three million women and one million men have... 

The role of the clinical pharmacist in long-term care, also called a consultant pharmacist, continues to expand with the recognition of drug-related problems that affect the quality of life of seniors. In addition to the potential adverse outcomes associated with medication-related problems, the cost of these problems is staggering. In fact, the total annual direct medical cost of medication-related problems in nursing homes exceeds 7 billion. ... 

The impact of tick-borne diseases in the USA is enormous, not only in direct medical costs, which have been reported as high as S50 000 a year for treatment, but also in peripheral issues such as lost work time and even reduced real estate values in infested areas. Some estimates indicate that tick-borne diseases cost society more than US 1 billion a year (D.L. Weld, personal communication),... 

Direct medical costs Medications Supplies Laboratory tests Health care professionals time Hospitalization... 

Direct medical costs are the costs incurred for medical products and services used to prevent, detect, and/or treat a disease. Direct medical costs are the fundamental transactions associated with medical care that contribute to the portion of gross national product spent on health care. Examples of these costs include drugs, medical supplies and equipment, laboratory and diagnostic tests, hospitalizations, and physician visits. Direct medical costs can be subdivided into fixed and variable costs. Fixed costs are essentially overhead costs (e.g., heat, rent, electricity) that are not readily influenced at the treatment level and thus remain relatively constant. For this reason, they are often not included in most pharmacoeconomic analyses. Variable costs, which change as a function of volume, include medications, fees for professional services, and supphes. As more services are used, more funding must be used to provide them. 

The true incidence of VTE in the general population is unknown because a substantial portion of patients, perhaps greater than 50%, have cLinicaUy silent disease. An estimated 2 million people in the United States develop VTE each year 600,000 are hospitalized, and 60,000 die. The estimated annual direct medical costs of managing the disease are well over 1 billion and growing. The best available data indicate the age-adjusted annual incidence of symptomatic VTE in Caucasians to be 117 per 100,000. The incidence of VTE nearly doubles in each decade of life over the age of 50 and is slightly higher... 

Of the estimated 12.6 billion cost of asthma in the United States in 1998, direct medical expenditure accounted for 58% of the total, with emergency care (emergency department and inpatient hospital care) reaching 2.5 billion and prescription medications ( 3.2 billion) as the single largest direct medical expenditure. A cost-of-iUness approach takes in all measurable costs both indirect costs or costs to society and direct medical costs are considered. Using this approach, the cost per patient per year in 1994 in the United States was 756, a slight decrease in inflation-adjusted expenditures over the past 10 years. Indirect costs such as lost work and death accounted for two-thirds of these expenditures. 

Studies with agents other than cholinesterase inhibitors are rare but should increase in number as the understanding of AD and its potential treatments improve. A 28-week placebo-controlled trial with memantine reported cost savings and a lower incidence of institutionalization than in the placebo group. Caregiver costs decreased by 824/month and societal costs by 1090/month with memantine therapy. However, direct medical costs to the patient treated with memantine were higher than placebo due to cost of the medication. 

The direct medical costs associated with smoking total more than 75 billion per year, and the costs associated with lost productivity are estimated to be 80 billion. About 14% of all Medicaid expenditures are for smoking-related illnesses. This estimate does not include the costs of smoking-related neonatal disorders. 

Although the direct medical costs of anemia are unknown, the direct costs of drug treatment must be weighed with the indirect costs associated with anemia. The costs of laboratory tests used to diagnose anemia, the role of screening for anemia, and the prevention of anemia are aU components that necessitate consideration in the phar-macoeconomic analysis. Anemia practice guidelines within medical subspecialties must take pharmacoeconomics into consideration as they are developed. Additionally, the frequency of blood transfusions must be considered, as it impacts cost and therapeutic decision making in patients. 

An important characteristic of microbial biofilms is their innate resistance to immune system and antibiotic killing (89, 90). This has made microbial biofilms a common and difficult-to-treat cause of medical infections (87,91,92). It has recently been estimated that over 60% of the bacterial infections currently treated in hospitals are caused by bacterial biofilms (91). Several ehronic infections (e.g. respiratory infections caused by Pseudomonas aeruginosa in the cystic fibrosis lung. Staphylococcal lesions in endocarditis, and bacterial prostatitis, primarily caused by Escherichia coli) have been shown to be mediated by biofilms (93). More notably, biofilms (particularly of Staphylococcus aureus, P. aeruginosa, and E. coli) are also a major cause of infections associated with medical implants (94, 95). The number of implant-associated infections approaches 1 million per year in the United States alone, and their direct medical costs exceed 3 billion annually (96). Thus, there is an urgent need to find novel approaches to eradicate biofilms. 

The Netherlands government (Ministry of Social Affairs and Employment 1997) published a report about the cost of work-related diseases and injuries. The direct medical costs, i.e., not the costs in terms of loss of income, loss of productivity etc, due to work related skin diseases was, for the year 1995, estimated to be 92 million NL guilders. This is about 42 million Euro for the Netherlands population of about 15 million inhabitants. 

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