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PubMedDate not supplied

The economic value of childhood varicella vaccination in France and Germany.

OBJECTIVE: To determine the economic impact of childhood varicella vaccination in France and Germany. METHODS: A common methodology based on the use of a varicella transmission model was used for the two countries. Cost data (2002 per thousand) were derived from two previous studies. The analysis focused on a routine vaccination program for which three different coverage rates (CRs) were considered (90%, 70%, and 45%). Catch-up strategies were also analyzed. A societal perspective including both direct and indirect costs and a third-party payer perspective were considered (Social Security in France and Sickness Funds in Germany). RESULTS: A routine vaccination program has a clear positive impact on varicella-related morbidity in both countries. With a 90% CR, the number of varicella-related deaths was reduced by 87% in Germany and by 84% in France. In addition, with a CR of 90%, routine varicella vaccination induces savings in both countries from both societal (Germany 61%, France 60%) and third-party payer perspectives (Germany 51%, France 6.7%). For lower CRs, routine vaccination remains cost saving from a third-party payer perspective in Germany but not in France, where it is nevertheless cost-effective (cost per life-year gained of 6521 per thousand in the base case with a 45% CR). CONCLUSION: Considering the impact of vaccination on varicella morbidity and costs, a routine varicella vaccination program appears to be cost saving in Germany and France from both a societal and a third-party payer perspective. For France, routine varicella vaccination remains cost-effective in worst cases when a third-party payer perspective is adopted. Catch-up programs provide additional savings.

Age Distribution↗

PubMed2002

Cost perspectives for outpatient intravenous antimicrobial therapy.

Intravenous antimicrobial therapy often continues after a patient is discharged from the hospital or it begins in the outpatient setting. Reimbursement for this therapy varies by payer. The United States Outpatient Parenteral Antibiotic Therapy (OPAT) Outcomes Registry is a valuable resource for quantifying cost by payer, as well as for describing practice patterns and adverse events related to intravenous antimicrobial therapy. To describe the reimbursement structure and cost of intravenous vancomycin home care therapy for four different types of payers, a survey of home infusion companies was done. Also surveyed were infusion programs participating in the OPAT Outcomes Registry, representing four different types of payers, to determine the cost of outpatient intravenous therapy. A retrospective cohort study of these infusion programs was conducted to describe practice patterns and to identify adverse events that resulted from intravenous vancomycin. We found that the cost of outpatient therapy was substantial, although nonuniform, across payer types. Alternative outpatient therapies associated with lower risks for adverse events and lower costs should be considered.

Anti-Bacterial Agents↗

PubMed1999

Economic evaluation of ciprofloxacin compared with usual antibacterial care for the treatment of acute exacerbations of chronic bronchitis in patients followed for 1 year.

OBJECTIVE: To undertake a 1-year prospective economic evaluation of ciprofloxacin compared with usual antibacterial care (any antibacterial other than a quinolone) for the treatment of acute exacerbations of chronic bronchitis (AECB) in adults presenting with a type I or type II AECB. DESIGN: Patients entered the study with an initial AECB and were randomised to the ciprofloxacin group or the usual care group. The following measurements were taken at the end of each AECB and every 3 months: resource utilisation, St. George's Respiratory Questionnaire, Nottingham Health Profile and Health Utilities Index (HUI). The following additional measurements were taken after each AECB: AECB-symptom days and willingness to pay to avoid the AECB. Economic evaluations were performed from the societal viewpoint and the viewpoint of a major third-party payer. Cost-effectiveness analysis was based on cost per AECB-symptom day averted; cost-utility analysis (CUA) was based on cost per quality-adjusted life-year (QALY) gained using the HUI as the basis for calculating QALYs. Cost-benefit analysis was based on the willingness-to-pay (WTP) data. SETTING: This was a study of outpatients enrolled from 46 family physicians and 2 respirologists in Ontario (29 sites) and Québec (19 sites), Canada, between November 1993 and June 1994. PATIENTS AND PARTICIPANTS: 240 adult male and female patients aged > or = 18 years with chronic bronchitis. MAIN OUTCOME MEASURES AND RESULTS: WTP data did not pass scope tests for reasonableness. Ciprofloxacin was more costly and provided better outcomes compared with usual antibacterial care. The base-case results are as follows (1994/1995 values): the incremental annual cost was 578 Canadian dollars ($Can) from the societal viewpoint and $Can840 for the third-party payer; the cost-effectiveness ratio per AECB-symptom day averted was $Can209 from the societal viewpoint and $Can304 for the third-party payer; the cost-utility ratio per QALY gained was $Can18,600 from the societal viewpoint and $Can27,000 for the third-party payer. According to Laupacis criteria, these CUA results are strong evidence in favour of adoption from the societal viewpoint and moderate evidence in favour from the viewpoint of the third-party payer. A subgroup analysis suggests that ciprofloxacin may be particularly cost effective, even 'win-win', in patients with more severe disease. CONCLUSIONS: The sensitivity analyses indicate that the results are relatively robust. Nevertheless, the statistical uncertainty in the results is sufficient that the findings cannot be accepted unequivocally. A further study with a larger sample size would be useful to confirm (or deny) the findings of this study.

Adult↗

PubMed1993

Hospital pricing: cost shifting and competition.

The issue of cost shifting has taken on enormous policy implications. It is estimated that unsponsored and undercompensated hospital costs--one measure of cost shifting--has totaled $21.5 billion in 1991. The health services research literature indicates that hospitals set different prices for different payers. However, the empirical evidence on hospitals' ability to raise prices to one payer to make up for unsponsored care or lower payments by other payers is mixed at best. No study has concluded that hospitals have raised prices to fully adjust for such actions. The extent of cost shifting is limited by the market. When a hospital has market power, it is able to set prices above marginal costs. However, when a buyer has enough patient/subscribers and a willingness to direct them to particular providers based on price considerations, hospitals have less flexibility in raising prices above costs. Thus, the extent of cost shifting is limited by the market. Cost shifting is not as easy as it may have been in the past because the nature of hospital and insurer competition has changed radically in the last decade. While hospital quality, services, and amenities still matter, some buyers are increasingly concerned about the price they pay. Evidence from studies of PPO and HMO negotiations with hospitals suggests that hospitals' market power is eroding, at least in some areas. In areas with relatively few hospital competitors and little PPO or HMO activity, Medicaid and Medicare price reductions and uncompensated care burdens will be partially absorbed by higher prices paid by private payers. In more price sensitive markets and in markets in which prices to private payers have risen to those commensurate with the market power of local hospitals, such cost shifting will not occur. A market-based approach in hospital pricing requires an explicit policy for the uninsured. In a competitive market, a hospital that traditionally cared for the uninsured by spending some of its profits on them will be unable to do so, at least to the same extent as it did in the past. Increased competition in health care without consideration of the uninsured will decrease the uninsured's access to care.

Contract Services↗

PubMed1994

Managing orthopedics and neurosciences costs through standard treatment protocols.

High-cost, high-volume specialty programs such as orthopedics and neurosciences find themselves in a position of evaluating the costs and in some cases the appropriateness of medical practices in response to payer scrutiny and provider selection processes. Orthopedics and neurosciences programs are at a stage of development analogous to that of cardiovascular care several years ago. Many of the same trends have come into play, such as payer "carve-outs" for orthopedic services, payer selection of centers of excellence based on cost and quality, reduction of Medicare reimbursement, greater use of high-cost technology, the decline of profitability due to "older, sicker, and tougher" patients, and the recent emergence of national orthopedic specialty networks oriented to national contracts for care. In an era in which payers demand value on both sides of the cost-plus-quality equation, programs are challenged to maximize the return on a patient population rife with "no-win" situations. In the orthopedic service line these include a high proportion of Medicare patients and chronic conditions such as workers' compensation medical back cases or repetitive motion injuries, which can be elusive to diagnose and expensive to treat. Many hospitals continue to lose money on joint replacement surgeries, the largest-volume orthopedic inpatient service, primarily because of the high Medicare population and the cost of implants. Neuroservices, while still relatively well reimbursed, face a rising proportion of Medicare payments as patients live longer and develop chronic, degenerative conditions. Inpatient days are decreasing due to payer pressures to limit hospital stays and to shift inpatient care to outpatient services. Some hospitals "have lost interest in (the orthopedic) service line during the last five years because of recent trends in orthopedic-related inpatient volume and payment." But by managing costs strategically, both the neurosciences and orthopedics service lines can provide substantial revenue as well as the opportunity to achieve a "center of excellence" competitive position in a managed care environment. This Special Report outlines the process and advantages of managing costs and quality of care strategically, that is, in a manner which helps these programs meet internal cost and clinical goals while responding to market situations. The hospital, physicians, and patients all benefit as costs are reduced, quality is enhanced, and the service line's competitive position is strengthened.

Cost Control↗

PubMed1988

The cost of treating persons with AIDS in four hospitals in metropolitan New York in 1985.

From hospital accounting data on 402 patients, this study calculated annual, lifetime and perdiem cost, assessed the relationship to cost risk group, diagnosis, payer, and DRG, and estimated how the cost burden was shared between hospitals and third-party payers. Conclusions were as follows: Annual impatient hospital cost for adults with AIDS averaged +22,300, incurred during an average of 38 hospital days. Lifetime inpatient hospital costs averaged +38,200, incurred during an average of 62 hospital days. Patients with AIDS did not make more intensive use of hospital ancillary services than the average medical/surgical patient. They incurred exceptional per diem costs for laboratory and pharmacy services, but this was offset by lower operating room costs. Cost did not bear a statistically significant relationship to risk group in adult patients, but hospital utilization, and thus annual cost, ws very different for pediatric patients. There was limited evidence of a relationship between cost and diagnosis and between cost and payer. Eighty-two percent of the total cost was reimbursed by third-party payers: Medicaid (28 percent), Blue Cross (26 percent), Medicare (3 percent) and commercial insurance and other payers (25 percent). We estimate that self-pay patients paid 13 percent of the cost, and that 5 percent was unreimbursed.

Acquired Immunodeficiency Syndrome↗

PubMed2000

Does managed care more efficiently allocate resources to older patients in critical care settings?

OBJECTIVE: To evaluate resource utilization by elderly patients with respiratory failure in order to compare the efficiency of managed care and non-managed care payers. DESIGN: Regression analysis is applied to predict survival rate and the payments per life saved as a function of managed care participation, sociodemographics, and clinical risk factors. SETTING: Acute care hospitals in New York State. PATIENTS: Patients discharged under DRG 483 during 1992-1996. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Predicted payments were compared to the value of extending life for each payer subset, with and without quality of life adjustments, in order to determine when net benefits were maximized. Payments per life saved increased steadily for both groups (managed care and non-managed care) with age, with the non-managed care payments increasing more rapidly than managed care payments. Benefits equaled costs in the same age ranges for both payer groups, although the age at which benefits equaled costs was 93 for managed care patients and 91 for non-managed care patients. Resources are allocated efficiently for most patients regardless of payer. CONCLUSIONS: Managed care patients with DRG483 had higher rates of survival. Resource utilization efficiency was not affected by payer source.

Adolescent↗

PubMedDate not supplied

Processing dental claims electronically.

A reduction of healthcare costs is an important part of the reform our society is demanding. We cannot ignore this. Lowering administrative costs is a particularly good way to reduce health care expenditures since this decreases the cost without compromising the quality of services. Implementing an EDI structure for submitting claims and receiving claim remittance advice is one way to significantly reduce the cost of health care by lowering administrative costs. EDI allows the consumer to receive the same level of health care at a lower cost. To accomplish this goal, the industry must accept some standardization. While providers, dental software vendors, and clearinghouses request an electronic claims system that is uniform-payers (insurance companies, State-administered Medicaid programs, etc.) often insist on proprietary formats that fit their own requirements. This impedes the implementation of a successful electronic interchange of data. Under the leadership of the Canadian Dental Association, payers and dentists in Canada were able to create a superior electronic claim processing network, CDAnet. Providers and payers using CDAnet agree that the system works very well. The Canadian dentist does not pay for this service, and insurance companies benefit significantly. Dentists in the USA do not have a universal electronic claim processing network. A USA dentist who wants to send claims electronically has limited selections and often pays additional fees. Organized dentistry has the best opportunity of establishing electronic data interchange between providers and payers in the USA. The first step is creating a universal electronic claim processing system. This system must protect confidentiality by maintaining data that keeps anonymous provider and patient data. It is the dentist who produces the claim. Dentists must become involved in the decisions affecting electronic claim processing. The proper guidance from organized dentistry will enable providers, payers, software vendors, and clearinghouses to cooperate together in creating a cost effective electronic communication network.

Canada↗

PubMed2006

National trends in bariatric surgery, 1996-2002.

BACKGROUND: Surgical therapy for the long-term treatment of obesity ("bariatric surgery") in individuals whose body mass index (calculated as weight in kilograms divided by the square of height in meters) is 40 or higher or in those who have significant obesity-related comorbidities and a body mass index of 35 or higher is one of few interventions shown to be effective. Many aspects of recent national bariatric surgery trends are unclear, including the ages of individuals undergoing such procedures and the economic burden borne by public vs private payers. HYPOTHESIS: Population-adjusted rates of bariatric surgery are rapidly increasing and have economic implications that differ for private vs public payers. DESIGN AND SETTING: We examined hospitalization and charge data from the Nationwide Inpatient Sample from 1996 through 2002, representative of national patterns for children and adults. We derived nationally weighted estimates of population-adjusted hospitalization rates and inflation-adjusted charges for bariatric surgery. We also examined the relative economic burden for public vs private payers for bariatric surgery discharges. RESULTS: Population-adjusted rates of bariatric surgery in the overall sample increased more than 7-fold in the study period, from 3.5 per 100 000 US population in 1996 to 24.0 per 100 000 in 2002. During this period, among youth (<20 years old), rates increased from 0.23 per 100 000 to 0.73 per 100 000; and among elderly persons (>65 years old), rates increased from 0.30 per 100 000 to 1.69 per 100 000. The rate increased most dramatically among those aged 20 to 65 years, who composed 97% or more of bariatric surgery discharges annually. Increases in bariatric surgical volume corresponded with increasing economic consequences overall, exceeding USD $2 billion in annual charges by 2002 (mean, USD $29,107 per discharge). Since 2000, private payers have been charged for more than 80% of the national total; annual charges to Medicare and Medicaid have been comparatively modest, but each exceeded USD $100 million by 2002. CONCLUSIONS: National rates of bariatric surgery have increased markedly among children and adults, with attendant economic consequences, principally for private insurers. This trend may reflect the dearth of effective primary care and preventive interventions to address the obesity epidemic.

Adult↗

PubMed1995

Assessing patient outcomes with higher hematocrit levels.

Quality improvement theory teaches that, as providers of health care, physicians must determine and then meet the needs of their primary customers, the patients and payers. The needs of patients and payers are met and measured by the outcome of services and treatments delivered by providers to patients. In general, outcomes fall into three main categories: clinical, financial, and patient based. All parties within the end-stage renal disease (ESRD) community seek the best value (quality/cost) when receiving, delivering, or paying for ESRD services. Because there is not yet a consensus on the definition(s) of quality in the care of ESRD patients, a determination of value remains largely cost dependent. Thus payers, who have no easy or reliable way to compare the quality of providers, based many of their decisions on the best available price. Patient-based outcomes include the assessment of patient satisfaction and health status (health-related quality of life). These outcomes broaden the perspective on quality of care beyond the clinical and laboratory measures traditionally used in the ESRD Program. The assessment of these outcomes can give providers additional insights into the burdens of renal failure and its treatment on the lives of their patients. This information then can be used to design or modify the services provided. Physicians are required to provide high-quality, effective, appropriate, and cost-efficient services. How to meet the often conflicting outcome needs of payers and patients remains a significant challenge. It is essential that all within the ESRD community reach some agreement on the operational definition(s) of quality process and outcome indicators.(ABSTRACT TRUNCATED AT 250 WORDS)

Hematocrit↗

PubMed2006

Colorectal cancer screening differential costs for younger versus older Americans.

BACKGROUND: Colorectal cancer (CRC) incidence rises with age, and most CRC arises from adenomatous polyps. It was therefore hypothesized that increased use of CRC screening and polypectomy in younger persons might yield CRC-related savings later in life for payers such as Medicare. METHODS: Using a decision analytic Markov model, the impact of increased CRC screening uptake on healthcare payers for younger Americans versus payers for older Americans, such as Medicare, was projected. RESULTS: As screening uptake increased, CRC incidence and mortality decreased, and annual costs related to CRC care and testing increased for younger persons, but decreased for older persons. Compared with current screening uptake of 40%, screening 75% of the U.S. population aged 50 to 80 increased annual costs related to CRC care and testing from 3.6 billion US dollars to 5.0 billion US dollars for 50- to 64-year-olds, but decreased annual costs from 5.9 billion US dollars to 5.6 billion US dollars for those aged 65 years and older. Sensitivity analyses suggest that future costs for other diseases could offset CRC care savings in older Americans that are attributable to screening. However, even without net cost savings for any age group, screening remained relatively cost-effective. CONCLUSIONS: Investments in screening and polypectomy in younger persons may decrease CRC-related costs, including screening and surveillance, for healthcare payers for older Americans, including Medicare. While these savings could potentially be offset by future health costs for other diseases, screening would still be cost-effective. Widespread CRC screening beginning at age 50 must remain a national priority.

Age Factors↗

PubMedDate not supplied

Cost of renal transplant in Belgium.

The objective of this study was to analyze 1-year direct medical costs of kidney transplantation in Belgium. The analysis included the last 150 patients who received a kidney transplant, were treated with cyclosporine, and had 1 year follow-up data. All patient were adults (>18 years) at the time of transplantation. Patient files were retrospectively analyzed. Key clinical events, such as primary hospitalization for transplantation; immunosuppressive drug use; patient survival; graft survival; acute rejection; CMV infection; adverse events and serious complications; treatment of adverse events; treatment of complications; repeat hospitalization; and follow-up hospital consultations were recorded. Total length of stay in the hospital was also recorded. For each patient, information up to 1 year following renal transplantation (or until death if death occurred before 1 year posttransplantation) was collected. Cost information was obtained from anonymous hospital bills that provided amounts paid by the health care payer and patient. Two perspectives are considered in this study: health care payer (INAMI/RIZIV) perspective and patient perspective. For the whole population (n = 143), 7 patients with graft failure were excluded. The mean direct medical costs from the health care payer's perspective, and patient's perspective were 37,792 Euro, and 2,034 Euro, respectively. During this 1-year period, patients were hospitalized for an average of 29 days. One-year direct medical costs of kidney transplantation are substantial. In Belgium, most of the direct medical costs are borne by the health care payer.

Adult↗

PubMed2002

Development of a continuous renal replacement program in critically ill patients.

BACKGROUND: Critically ill patients encounter many obstacles, such as acute renal failure, that increases length of stay as well as hospital cost. Dialysis in these patients is often ineffective thereby prolonging the inevitable and significantly increasing the cost of care. A dialysis program that could improve patient care, potentially improve outcome and be "revenue neutral" would be ideal. METHODS: A continuous renal replacement therapy (CRRT) program was developed to significantly impact the care of critically ill patients Using the latest CRRT equipment along with an innovative hands-on CRRT training program, a specialized CRRT team was created. Working in conjunction with the hospital business office, new revenue charge codes were created and existing codes were updated. Patients who underwent CRRT had their financial records reviewed for: hospital cost to perform CRRT, total hospital billing to the payer, CRRT revenue 881 (billing units) charged to the payer, total charges and reimbursement for the account, percentage of reimbursement, collected revenue, and payer. RESULTS: From April 2000 to February 2002, 39 critically ill patients underwent CRRT. Initial set-up cost was US$79,622.80 and the cost of CRRT was US$222,323.98. The hospital billed for US$656,090.63 and assuming 100% reimbursement, the potential profit was US$427,678.50. However, loss of revenue, mainly from noncompliance with charge capture resulted in the hospital billing only US$386,794.32 with a total reimbursement of US$165,779.86. The 21 burn patients who underwent CRRT yielded a net profit of US$10,294.12, with the highest reimbursement from workman's compensation and private payers. The overall mortality rate was 59% and 65% for the burn patients; significantly lower than published national averages. CONCLUSIONS: An in-house CRRT program improved patient care by providing dialysis in patients who normally would not tolerate the procedure. Although there was a loss of revenue, CRRT in the burn patients appeared "revenue neutral." Although not specifically studied in this review, based on published data, mortality rates in this population were lower than expected especially in critically ill burn patients.

Continuity of Patient Care↗

PubMed1989

Financial risk and hospital cost in stratified, peripheral vascular surgical DRGs without complications and comorbidities.

The purpose of this study was to analyze hospital resource consumption in any of the nine non-complicating conditions covered under stratified, peripheral vascular surgical Diagnosis-Related Groups (DRGs) using the new DRG prospective All Payer System in effect in New York. There is significant health policy debate at the level of the United States Congress regarding the improvement of the equity of DRG hospital payment. Although there have been a number of recommendations by federal advisory bodies to further stratify DRGs by complications and comorbidities, no major revision of DRGs along these lines has been implemented. The all payer system uses the DRG format to pay for all patients. We analyzed 788 peripheral vascular surgical patients by payer (Medicare, Medicaid, Blue Cross and commercial insurance) in these stratified, peripheral vascular surgical DRGs with no complications or comorbidities for a three year period. Our study demonstrated that patients within each DRG with more complications and comorbidities generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, financial risk under DRG payment, more outliers, and a higher mortality, compared to patients in these same DRGs with fewer complications and comorbidities. These findings suggest that new, prospective DRG all payer systems may be inequitable to certain groups of patients or types of hospitals in these stratified peripheral vascular surgical DRGs with no complication or comorbidities. This analysis suggests that these peripheral vascular surgical DRGs should be stratified by the numbers and types of complications and comorbidities to more equitably reimburse hospitals under DRGs.(ABSTRACT TRUNCATED AT 250 WORDS)

Costs and Cost Analysis↗

PubMed1998

Strategies for Reporting Evidence-Based Clinical Studies Involving Positron Imaging.

The objective of this investigation was to determine whether publications on positron imaging for lung cancer adhered to basic principles of data reporting and analysis according to the requirements established by payer organizations. The study sample consisted of 26 articles retrieved from the published literature for the interval 1980 to 1998. These articles were reviewed to assess the use and reporting of eight fundamental principles covering evidence-based data analysis that were formulated from payer-sponsored technology assessment program evaluations. These principles were derived from reviewing payer-sponsored assessments and reimbursement recommendations concerning diagnostic imaging technologies. The overall adherence to these basic principles was poor. The median number of principles to which articles adhered was two. In particular, the literature did not adequately include information about the role of imaging results in overall patient care, and, therefore, made any recommendations concerning the role of positron imaging in lung cancer patient management problematic. Strategies for publishing the results of positron imaging studies in the medical literature should include appropriate information that is required by payers for establishing reimbursement and clinical policies.

Journal Article↗

PubMed1998

Psychiatric hospitalization characteristics associated with insurance type.

This study examines the relationship among types of insurance and characteristics of inpatient psychiatric treatment. Data include 46,998 adult psychiatric or substance abuse cases from all 1991-1992 Washington State discharges from short-stay general hospitals. Large and significant differences among payers exist in treatment characteristics, controlling for diagnosis and patient age. For example, length of stay is longest among commercial and Medicare payers. Emergency admissions are more common among public payers, and elective admissions are more common among private payers, including HMOs. Results and discussed in light of policy and administration issues that will arise as financing for mental health services comes under greater capitation.

Adult↗

PubMed2002

Cost of atopic dermatitis and eczema in the United States.

BACKGROUND: Atopic dermatitis/eczema (AD/E) is a common disease. Few studies have attempted to quantify the cost to third-party payers. OBJECTIVE: Our purpose was to identify the annual cost of medical services and prescription drugs for the treatment of AD/E to private insurance and Medicaid payers in the United States. METHODS: We used a retrospective study design employing claims data from 1997 and 1998 from a private insurer and a state Medicaid program to analyze costs incurred. Beneficiaries were considered to have AD/E if they had at least one claim in 1997 with a primary or secondary listing of 1 of 3 diagnosis codes: 691.8, other atopic dermatitis and related conditions; 692.9, contact dermatitis and other eczema when no cause is specified; or 373.3, noninfectious dermatoses of eyelid. Patients who did not meet the diagnosis criteria served as a control group in each payer for comparisons of expenditures with the AD/E group. RESULTS: Disease prevalence was 2.4% (private insurer) to 2.6% (Medicaid) of all eligible beneficiaries, and 3.5% to 4.1% of patients submitted at least one health care claim during the study period. Medicaid-insured patients used outpatient hospital visits and hospitalizations at a greater rate than did privately insured patients; neither used emergency departments extensively. The third-party payer cost of illness for AD/E ranged from $0.9 billion to $3.8 billion when projected across the total number of persons younger than 65 years insured by private insurers and Medicaid in the United States. More than one fourth of all health care costs for patients with AD/E may be attributed to AD/E and co-morbid conditions. CONCLUSIONS: Annual costs of AD/E are similar to those of other diseases such as emphysema, psoriasis, and epilepsy. Patients incur significant costs associated with AD/E and co-morbid conditions.

Cost of Illness↗

PubMed2003

Prophylaxis against respiratory syncytial virus (RSV), varicella, and pneumococcal infections: Economic-based decision-making.

OBJECTIVE: To compare costs and health benefits of three prophylactic interventions recommended by the American Academy of Pediatrics (AAP) and to help quantify the impact of illness and enhance the physicians' ability to make informed decisions. STUDY DESIGN: Medline search was conducted of English-language cost-effectiveness studies of varicella and pneumococcal conjugate vaccination recommended for all healthy infants and of respiratory syncytial virus (RSV) prophylaxis with palivizumab (Synagis) for infants at high risk for severe RSV infection. Data were collected on cost-effectiveness, burden of illness, and efficacy and analyzed from the societal and payer perspective. Results were discounted by 5% and costs inflated to year 2002 dollars. RESULTS: From the societal perspective, estimates of cost per life-years saved were money savings for varicella, 175,300 US dollars for pneumococcal conjugate vaccination, and 66,200 US dollars for palivizumab prophylaxis; from the payer perspective, estimates were 28,100, 338,400, and 66,400 US dollars, respectively. CONCLUSIONS: Cost-effectiveness estimates for varicella and pneumococcal conjugate vaccination demonstrate that evaluating economic benefits from the societal rather than the payer perspective makes universal prophylaxis very financially attractive. By comparison, this same differential does not exist for the cost-effectiveness estimates of palivizumab from the societal and payer perspectives because its use is in a well-defined high-risk target population. From a societal perspective, prophylaxis is a rational public policy decision, although in target populations, incidence of serious illness and the primary cost components driving the cost offsets vary across prophylactic measures studied.

Antibodies, Monoclonal↗