Economic costs of benign prostatic hyperplasia in the private sector

PURPOSE: Several studies document the impact of benign prostatic hyperplasia (BPH) in working, aged men. Direct medical costs related to BPH treatment are largely borne by employees through higher premiums. However, indirect costs related to lost work are primarily borne by the employer. In this study we used claims data and absentee records from large employers to estimate the costs associated with BPH in working age males. MATERIALS AND METHODS: We used 2 data sources to examine direct and indirect costs associated with BPH in a privately insured, nonelderly population. Multivariate regression models were used to predict spending for persons with and without a medical claim for BPH, controlling for relevant covariates. Data on work loss were linked to medical claims to estimate work loss related to treatment for BPH. RESULTS: Mean annual expenditures were 4,193 dollars for men without a medical claim for BPH. In contrast, annual spending was 5,729 dollars for men with a claim for BPH. Thus, the incremental cost associated with a diagnosis of BPH was 1,536 dollars yearly. Overall the average employee with the condition missed 7.3 hours of work yearly related to BPH with approximately 10% reporting some work loss related to a health care encounter for BPH. CONCLUSIONS: Treatment of men with BPH places a significant burden on employees and their employers through direct medical costs as well as through lost work time. Direct and indirect costs to the private sector related to BPH treatment are estimated to be 3.9 billion dollars.     

Primary urethral reconstruction: the cost minimized approach to the bulbous urethral stricture

PURPOSE: Treatment for urethral stricture disease often requires a choice between readily available direct vision internal urethrotomy (DVIU) and highly efficacious but more technically complex open urethral reconstruction. Using the short segment bulbous urethral stricture as a model, we determined which strategy is less costly. MATERIALS AND METHODS: The costs of DVIU and open urethral reconstruction with stricture excision and primary anastomosis for a 2 cm bulbous urethral stricture were compared using a cost minimization decision analysis model. Clinical probability estimates for the DVIU treatment arm were the risk of bleeding, urinary tract infection and the risk of stricture recurrence. Estimates for the primary urethral reconstruction strategy were the risk of wound complications, complications of exaggerated lithotomy and the risk of treatment failure. Direct third party payer costs were determined in 2002 United States dollars. RESULTS: The model predicted that treatment with DVIU was more costly (17,747 dollars per patient) than immediate open urethral reconstruction (16,444 dollars per patient). This yielded an incremental cost savings of $1,304 per patient, favoring urethral reconstruction. Sensitivity analysis revealed that primary treatment with urethroplasty was economically advantageous within the range of clinically relevant events. Treatment with DVIU became more favorable when the long-term risk of stricture recurrence after DVIU was less than 60%. CONCLUSIONS: Treatment for short segment bulbous urethral strictures with primary reconstruction is less costly than treatment with DVIU. From a fiscal standpoint urethral reconstruction should be considered over DVIU in the majority of clinical circumstances.     

The acute medical care costs of fall-related injuries among the U.S. older adults

OBJECTIVES: Falls in the older adults are a major public health concern. The growing population of adults 65 years or older, advances in medical care and changes in the costs of care motivated our study of the acute health care costs of fall-related injuries among the older adults in the United States of America. DESIGN AND SETTINGS: The Market Scan Medicare Supplemental database 1998 was used to estimate reimbursed costs for hospital, emergency department (ED), and outpatient clinic treatments for unintentional falls among older adults. RESULTS: A fall on the same level due to slipping, tripping, or stumbling was the most common mechanism of injury (28%). Mean hospitalisation cost was 17,483 US dollars(S.D.: 22,426 US dollars) in 2004 US dollars. Femur fracture was the most expensive type of injury (18,638 US dollars, S.D.: 19,990 US dollars). The mean reimbursement cost of an ED visit was 236 US dollars and 412 US dollars for an outpatient clinic visit. CONCLUSION: The magnitude of the economic and social costs of falls in older adults underscores the need for active research in the field of falls prevention.     

Alcohol interventions for trauma patients treated in emergency departments and hospitals: a cost benefit analysis

OBJECTIVE: To determine if brief alcohol interventions in trauma centers reduce health care costs. SUMMARY BACKGROUND DATA: Alcohol-use disorders are the leading cause of injury. Brief interventions in trauma patients reduce subsequent alcohol intake and injury recidivism but have not yet been widely implemented. METHODS: This was a cost-benefit analysis. The study population consisted of injured patients treated in an emergency department or admitted to a hospital. The analysis was restricted to direct injury-related medical costs only so that it would be most meaningful to hospitals, insurers, and government agencies responsible for health care costs. Underlying assumptions used to arrive at future benefits, including costs, injury rates, and intervention effectiveness, were derived from published nationwide databases, epidemiologic, and clinical trial data. Model parameters were examined with 1-way sensitivity analyses, and the cost-benefit ratio was calculated. Monte Carlo analysis was used to determine the strategy-selection confidence intervals. RESULTS: An estimated 27% of all injured adult patients are candidates for a brief alcohol intervention. The net cost savings of the intervention was 89 US dollars per patient screened, or 330 US dollars for each patient offered an intervention. The benefit in reduced health expenditures resulted in savings of 3.81 US dollars for every 1.00 US dollar spent on screening and intervention. This finding was robust to various assumptions regarding probability of accepting an intervention, cost of screening and intervention, and risk of injury recidivism. Monte Carlo simulations found that offering a brief intervention would save health care costs in 91.5% of simulated runs. If interventions were routinely offered to eligible injured adult patients nationwide, the potential net savings could approach 1.82 billion US dollars annually. CONCLUSIONS: Screening and brief intervention for alcohol problems in trauma patients is cost-effective and should be routinely implemented.     

Medical or surgical therapy for erosive reflux esophagitis: cost-utility analysis using a Markov model

OBJECTIVE: To compare the cost and utility of healing and maintenance regimens of omeprazole and laparoscopic Nissen fundoplication (LNF) in the framework of the Canadian medical system. SUMMARY BACKGROUND DATA: Medical therapy with proton pump inhibitors for endoscopically proven reflux esophagitis is a safe and effective treatment option. Of late, the surgical treatment of choice for this disease has become LNF. METHODS: The authors' base case was a 45-year-old man with erosive reflux esophagitis refractory to H2-blockers. A cost-utility analysis was performed comparing the two strategies. A two-stage Markov model (healing and maintenance phases) was used to estimate costs and utilities with a time horizon of 5 years. Discounted direct costs were estimated from the perspective of a provincial health ministry, and discounted quality-of-life estimates were derived from the medical literature. Sensitivity analyses were performed to test the robustness of the model to the authors' assumptions and to determine thresholds. A Monte Carlo simulation of 10,000 patients was used to estimate variances and 95% interpercentile ranges. RESULTS: For the 5-year period studied, LNF was less expensive than omeprazole (3519.89 dollars vs. 5464.87 dollars per patient) and became the more cost-effective option at 3.3 years of follow-up. The authors found that 20 mg/day omeprazole would have to cost less than 38.60 dollars per month before medical therapy became cost effective; conversely, the cost of LNF would have to be more than 5,273.70 dollars or the length of stay more than 4.2 days for medical therapy to be cost effective. Estimates of quality-adjusted life-years did not differ significantly between the two treatment options, and the incremental cost for medical therapy was 129,665 dollars per quality-adjusted life-years gained. CONCLUSIONS: For patients with severe esophagitis, LNF is a cost-effective alternative to long-term maintenance therapy with proton pump inhibitors.     

Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis

Despite the importance of hemodialysis vascular access, the cost of vascular access care has not been studied in detail. A prospective cost analysis was performed among incident hemodialysis patients to determine the cost of vascular access care overall and on the basis of access type. Detailed clinical and demographic information, as well as data on access type, was collected for all local incident hemodialysis patients between July 1, 1999, and November 1, 2001. A comprehensive measure of total vascular access costs, including surgery, radiology, hospitalization for access complications, physician costs, costs for management of outpatient bacteremia, and vascular access monitoring costs, was obtained. Costs are reported in 2002 Canadian dollars (1 CAN dollar = 0.69 US dollar). A total of 239 consecutive incident hemodialysis patients were identified, 49, 157, and 33 of whom were dialyzed exclusively with a catheter or had a native arteriovenous fistula or synthetic graft attempted, respectively. In year 1, 18.4% of all hospital admissions were for vascular access-related complications. The mean cost of all vascular access care in year 1 was 6890 CAN dollars(median 4020 dollars; interquartile range [IQR] 2440 dollars to 7540 dollars). The mean cost of access care per patient-year at risk for maintaining a catheter exclusively, attempting an arteriovenous fistula, or attempting a graft was 9180 dollars (median 3812 dollars; IQR 2250 dollars to 7762 dollars), 7989 dollars (median 4641 dollars ; IQR 3035 dollars to 8832 dollars), and 11,685 dollars (median 8152 dollars; IQR 3395 dollars to 12,908 dollars), respectively (P = 0.01). Vascular access care is responsible for a significant proportion of health care costs in the first year of hemodialysis. These results support clinical practice guidelines that recommend preferential placement of a native fistula.     

Analysis of hospitalizations comparing rifaximin versus lactulose in the management of hepatic encephalopathy

INTRODUCTION: Patients with end-stage liver disease often develop hepatic encephalopathy. The loss in cognitive abilities results in marked economic loss to the patient and health care community. We report hospital admission rates and economic impact of patients with end-stage liver disease suffering from hepatic encephalopathy. METHODS: The medical records were reviewed involving liver transplant patients started on lactulose or rifaximin therapy after presenting with stage 2 hepatic encephalopathy from January 2004 to November 2005. Information collected included demographics, hospitalizations required for hepatic encephalopathy, economic data, and Model for End-stage Liver Disease (MELD) score. RESULTS: Thirty-nine patients met study criteria: 24 patients treated with lactulose (group one) and 15 with rifaximin (group two). Group one included 18 men and six women of mean age 48 (range 39 to 58), average MELD 14 (range 10 to 19). Group two included 10 men and five women of mean age 47 (range 42 to 58), average MELD 15 (range 10 to 19). Group one patients required 19 hospitalizations overall: three patients with three hospitalizations, four patients with two hospitalizations, and two patients required one hospitalization. Total drug cost per month was 50 dollars(group one) and 620 dollars(group two). The average annual cost of hospitalization, emergency room visit, and drug per patient treated was 13,284.96 dollars for a total of 318,839 dollars (range 5005 dollars to 26,255 dollars, including drug cost and hospital care). Group two required three hospitalizations, all three with one visit. The average annual cost of hospitalization, emergency room visit, and drug per patient treated was 7958.13 dollars for a total of 119,372 dollars (range 6005 dollars to 19,255 dollars, including drug cost and hospital care). The total cost of therapy per patient per year was 13,285 dollars (group one) versus 7958 dollars (group two). The average length of stay was shorter in group two [3.5 days (range 3 to 4)] versus group 1 [5.0 days (range 3 to 10); P < .0001]. CONCLUSION: These pilot data demonstrate the marked difference in economic costs for the treatment of hepatic encephalopathy. The results also show that in comparative groups, the economic gains are quickly lost when using lactulose.     

Waiting for a liver--hidden costs of the organ shortage.

Discussion about the economics of end-stage liver disease has typically focused on the high cost of liver transplantation, but the management of complications in patients waiting for an organ can also be very expensive. Our research considered the hypothesis that an increase in the number of organ grafts would decrease health care costs in patients with liver disease by eliminating the cost of waiting for an organ. We examined treatment costs for a consecutive series of liver transplant candidates listed at our institution between November 1, 1996 and December 31, 1997. Costs were estimated for inpatient stays, outpatient visits, and posttransplant medications for 2 1/2 years from the date of listing. Of the 58 study patients, 26 (45%) received transplants, 7 of whom died within 2 1/2 years. A total of 11 patients (19%) died while waiting for an organ, and another 21 patients (36%) were still waiting after 2 1/2 years. Pretransplantation costs accounted for 41% of the total cost. Transplanting all 58 candidates without delay through a hypothetical increase in the supply of organs to meet demand would have more than doubled the number of transplantations while increasing costs in this cohort by only 37% (from 123,000 dollars to 169,000 dollars per patient). In conclusion, although an adequate supply of donor organs would not decrease total health care spending for patients with end-stage liver disease, so much money is currently spent on medical management during the waiting period that the savings achieved by transplanting all candidates without delay would offset a large portion of the cost of the additional transplants.     

Cost-utility analysis applied to the treatment of burn patients in a specialized center

OBJECTIVE: To discover the total costs and quality of life of burn patients in a specialist center classified by diagnosis-related groups (DRGs). DESIGN: Prospective study of 5-year follow-up from January 1, 1997, through December 31, 2001. SETTING: Burn Center of Valencia. PATIENTS: A total of 898 patients treated at the Burn Center of Valencia. MAIN OUTCOME MEASURES: Hospital, extrahospital, caregiving, labor, and social costs of the burn patients grouped by DRG (code 457: extensive burns without operating room procedure; code 458: nonextensive burns with skin graft; code 459: nonextensive burns with wound debridement or other operating room procedure; code 460: nonextensive burns without operating room procedure; or code 472: extensive burns with operating room procedure) were studied. The costs were compared with those that the DRG system assigns. The quality of life of the patients at the end of the follow-up period was also studied. To measure quality of life, the EuroQol 5-Dimensions survey was used. Utility calculations and cost-utility analysis were undertaken according to life expectancy. RESULTS: The number of quality-adjusted life-years produced by the center was 13 577, with a mean quality-of-life level on release from the study of 0.87. The mean cost per patient, including the social and labor costs, was $95 551, with health care costs amounting to only 10%. The mean cost per quality-adjusted life-year was $686. CONCLUSIONS: The labor costs were the most important and amounted to 56%; together with the social costs, these constituted 85% of the total costs. The DRG code 456 was an option dominated by the remaining DRG codes 458 through 460 and 472. Given the high costs of treating burn patients, a clear health care policy is urgently needed.     

Urologic diseases in america project: trends in resource use for urinary tract infections in men

PURPOSE: Various types of urinary tract infection (UTI) occur in men. In this study we examined health care use trends, including epidemiological and economic factors, for UTI in men in the United States. MATERIALS AND METHODS: The analytical methods used to generate these results have been described previously. RESULTS: Approximately 20% of all UTIs occur in men. Between 1988 and 1994 the overall lifetime prevalence of UTI was estimated to be 13,689/100,000 men. Orchitis rates, particularly in older men, are generally higher than those of cystitis or pyelonephritis. Approximately 10% of all inpatient care of men with UTI is for orchitis (12 to 14/100,000 population). Rates of outpatient hospital and physician office care for male UTI have increased in the last decade. Rates for emergency room care for UTI in elderly men (85 to 94 years old) were almost twice those in men younger than 85 years. The adjusted mean health care expenditure for privately insured men with UTI was 5,544 dollars in 1999 compared to 2,715 dollars for men without UTI. Total annual health care expenditures for men and women with UTI were 5,544 dollars and 5,407 dollars, respectively. Mean time lost from work was slightly higher for men. Based on composite data overall medical expenditures for men with UTI in the United States were estimated to be approximately 1.028 billion dollars in 2000. CONCLUSIONS: Health care use and economic data on UTIs in men revealed a number of intriguing trends. These results raise various important questions for future research.     

Drug Insight: oral phosphodiesterase type 5 inhibitors for erectile dysfunction

Erectile dysfunction (ED) is a common medical condition that affects the sexual life of millions of men. At present, first-line oral pharmacotherapy for most patients with ED is a phosphodiesterase type 5 (PDE-5) inhibitor, of which three are currently available worldwide. Sildenafil (Viagra, Pfizer) has a very satisfactory efficacy-safety profile in all patient categories. The first PDE-5 inhibitor to reach the market, it is now the most widely prescribed oral agent for ED. Tadalafil (Cialis, Lilly ICOS) and vardenafil (Levitra, Bayer/GlaxoSmithKline) were introduced to the European Union and the US in 2003 and 2004, respectively. These three PDE-5 inhibitors share many characteristics, but each has unique features. This review describes the chemical, pharmacologic and clinical features of sildenafil, vardenafil and tadalafil as oral first-line treatments for ED. First, we describe the physiology of penile erection and PDE-5 inhibitor pharmacology, including chemistry, PDE selectivity, pharmacokinetics, and possible drug interactions. We then summarize data on the efficacy and safety profiles of the three PDE-5 inhibitors for the treatment of ED in the general population, in patients with diabetes mellitus and in men that have undergone bilateral nerve-sparing retropubic radical prostatectomy.     

Economic evaluation of propofol for sedation of patients admitted to intensive care units.

BACKGROUND: The goal of the current study was to evaluate the economic impact of propofol as compared with midazolam for sedating patients in the intensive care unit (ICU). METHODS: A randomized, unblinded, multicenter pharmacoeconomic trial captured health resource utilization and outcome measurements associated with sedation and treatment of patients in four ICUs across Canada. Statistical analysis was performed to investigate the difference in sedation quality, ICU length of stay, and other health resources used. The authors compared the costs (1997 Canadian dollars) associated with the two treatments. Two types of sensitivity analyses were performed. RESULTS: Although overall sedation duration was similar, propofol patients spent more time at adequately sedated status (60.2% vs. 44%; P = 0.01) and were extubated faster (median extubation time, 2.5 vs. 7.1 h; P = 0.001). The ICU length of stay and health resource utilization did not differ. The total cost per patient, including drug cost and ICU stay cost, did not differ between groups (median, $5,718 for propofol vs. $5,950 for midazolam; P = 0.94). The first sensitivity analysis suggested that the incremental cost (per patient) of propofol varies from an extra cost of $114 to a savings of $2,709. Based on a hypothetical model, the second sensitivity analysis showed a potential saving of $479 per patient as a result of improved discharge planning. CONCLUSION: The analysis demonstrated that using propofol resulted in a reduction of time to extubation and higher sedative regimen costs. There was no difference in intensity of resource use or ICU length of stay and hence in costs. Issues regarding discharge delay among propofol-treated patients remain to be explored.     

Sexual functions of men with obstructive sleep apnoea syndrome and hypogonadism may improve upon testosterone administration: a pilot study

This study examined 72 patients with obstructive sleep apnoea syndrome (OSAS), confirmed by polysomnography. Thirty-two patients were suffering from erectile dysfunction (ED) assessed by IIEF-5 questionnaires and confirmed by nocturnal penile tumescence examination. Their testosterone levels were measured. Eight patients had normal testosterone levels and were treated with a PDE-5 inhibitor (vardenafil) only; after 6 months of treatment, 6 of these patients (75%) showed significant improvement in erectile function. The remaining 24 patients with OSAS, ED and hypogonadism (total testosterone <12 nmol l⁻¹), were divided into two groups based on the indication for continuous positive airway pressure (CPAP) therapy: five patients received CPAP therapy (group 1) and 19 patients did not (group 2). The patients of group 2 received only a PDE-5 inhibitor (vardenafil 20 mg) for ED; and eight patients (42%) showed an improvement after 3 months of treatment. The five patients receiving CPAP therapy were treated with a combination of parenteral testosterone undecanoate and a PDE-5 inhibitor (vardenafil) and all had normal erectile function after 3 months of therapy. The results suggest positive effects of addition of testosterone to treatment with PDE-5 inhibitors in hypogonadal men with OSAS, which should be confirmed in larger controlled studies.     

Nondialysis (home) medication utilization and cost in diabetic and nondiabetic hemodialysis patients

Hemodialysis patients take an average 12 medications (10 at home, 2 in clinic). Cost associated with clinic medications is estimated at 8,429 dollars per patient year at risk, but the medication cost associated with home medications is unknown. Our objective was to determine an estimate of the cost of home medications in the hemodialysis population. Point-prevalent patient medication use data (Jan. 1, 2003) from the Dialysis Clinic Inc. (DCI) national database was used for the study. All patients were classified as patients with diabetes (DM) or patients without diabetes (nonDM), and medication orders were divided into home and in-clinic medications. Home medications were classified as brand (B), generic (G), or brand that could be generic (BG). All home medications were further subcategorized into 12 therapeutic classes. National average medication cost for brand (76.29 dollars) and generic (22.79 dollars) medications were applied to the orders. The medication profiles of 10,230 HD patients were surveyed. Overall, patients were on a mean of 10.1 +/- 4.6 home medications. Currently, 53.4% of the health care dollar is spent on cardiac, gastrointestinal, and phosphate binding medications. DM patients spent significantly more on cardiac, gastrointestinal, and endocrine/hormonal agents (all p < 0.001) whereas nonDM patients spent more on anti-infective agents, analgesics, and phosphate binders (all p < 0.05). Medications for HD patients cost 16,000 dollars per patient per year. Health care providers should be aware of the medication cost burden in HD patients. Efforts to decrease this burden, whether through pharmaceutical care, generic prescribing, or sampling programs, should be considered.     

Economic Evaluation of Propofol for Sedation of Patients Admitted to Intensive Care Units

Background: The goal of the current study was to evaluate the economic impact of propofol as compared with midazolam for sedating patients in the intensive care unit (ICU).

Methods: A randomized, unblinded, multicenter pharmacoeconomic trial captured health resource utilization and outcome measurements associated with sedation and treatment of patients in four ICUs across Canada. Statistical analysis was performed to investigate the difference in sedation quality, ICU length of stay, and other health resources used. The authors compared the costs (1997 Canadian dollars) associated with the two treatments. Two types of sensitivity analyses were performed.

Results: Although overall sedation duration was similar, propofol patients spent more time at adequately sedated status (60.2%vs. 44%;P = 0.01) and were extubated faster (median extubation time, 2.5 vs. 7.1 h;P = 0.001). The ICU length of stay and health resource utilization did not differ. The total cost per patient, including drug cost and ICU stay cost, did not differ between groups (median, $5,718 for propofol vs. $5,950 for midazolam;P = 0.94). The first sensitivity analysis suggested that the incremental cost (per patient) of propofol varies from an extra cost of $114 to a savings of $2,709. Based on a hypothetical model, the second sensitivity analysis showed a potential saving of $479 per patient as a result of improved discharge planning.     

Inpatient costs of fire-related injuries in Finland

The aim of this study was to approximate the direct health care costs of fire-related injuries in inpatient care in Finland.Using the PERFECT costing method, cost data from both Finnish burn centres were linked to the fire-related injury patient data from the Finnish National Hospital Discharge Register (FHDR, 2001–2009). Additionally, a sample of 168 patients from the Helsinki Burn Centre was linked to the FHDR to examine the relation of %TBSA.Burn was involved in approximately 77% of the cases, the remainder consisting mainly of combustion gas poisonings. Burns were generally much more expensive to treat. Fire-related injuries incurred EUR 6.2 million per year in inpatient costs for the whole country. Mean cost per burn patient was EUR 25,000 and for combustion gas poisoning it was EUR 3600. As expected there was a strong relationship between %TBSA and cost. Older age had a strong effect on costs. The most severe injuries cost over EUR 400,000 to treat. Approximately 7–8% of the most expensive cases constitute 50% of the total costs. Successful prevention of extreme cases would yield considerable savings in relation to total annual inpatient care costs. However, a cost–benefit analysis would be needed.     

Urologic diseases in America project: urinary incontinence in males--demographics and economic burden

PURPOSE: We quantified and describe the demographics and economic burden of male urinary incontinence in the United States of America. MATERIALS AND METHODS: The analytic methods used to generate these results have been described previously. RESULTS: Urinary incontinence (UI) affects men of all ages, including 17% of males older than 60 years in the United States, which is an estimated 3.4 million men. There is a strong trend toward an increasing prevalence of UI with increasing age as well as an increase in the prevalence of UI in males with time. Ethnicity has less of a role in prevalence estimates in men than in women. The largest impact of UI in elderly men is in physician office visits, followed by outpatient services and surgeries. Resource use is greatest in the nursing home setting, where more than half of men have UI and require assistance with toileting. The overall economic burden for male UI is estimated at 18.8 billion dollars in direct medical costs in 1998/1999 dollars. Medical expenditures for UI for male Medicare beneficiaries 65 years and older have doubled since 1992. Compared to persons without UI the presence of UI increases the annual expenditures per person yearly from 3,204 dollars to 7,702 dollars. CONCLUSIONS: The direct and indirect costs of male UI increased throughout the 1990s with annual expenditures per person yearly in men with UI more than double that in men without UI. Given the aging population and staggering impact of UI in nursing home settings, there is a compelling need for further research into effective prevention, treatment and management strategies.     

A comparative study of resource use and costs of renal, liver and heart transplantation

Organ transplantations are among the most expensive surgical treatments performed today, but estimates of the costs of organ transplantations vary widely between settings. The aim of this study is to estimate the costs of renal, liver and heart transplantation in a university hospital, adopting a similar costing methodology for all the three kinds of transplantation. Resource use data were collected from 803 patients transplanted between January 1995 and August 2001. Data about the time physicians and other hospital employees spent per transplantation were based on interviews. All costs from pretransplantation screening up to 3 years post-transplantation were taken into account and divided into costs of patient care and programme-related costs. Mean cost of renal transplantation varied from 70,723 Euros for cadaveric donor transplantations to 76,577 Euros for living donor transplantations. Mean costs of liver transplantation were 141,510 Euros and the mean costs of heart transplantation were 17, 828 Euros. Direct costs of patient care contributed to 79%, 87% and 92% of the costs of renal, liver and heart transplantation respectively. Inpatient hospital days were the largest contributor to the costs of patient care. The mean number of inpatient hospital days from pretransplantation screening to 3 years post-transplantation varied from 46 days for renal transplantation from a living donor to 58 days for renal transplantation from cadaveric donors, 83 days for heart transplantation and 108 days for liver transplantation. In conclusion, costs of liver and heart transplantation were approximately 2.0 and 2.5 times higher than the cost of renal transplantation. Length of inpatient hospital stay for transplantation did not change substantially over time between 1995 and 2001.     

The current and future burden and cost of overactive bladder in five European countries

OBJECTIVE: To estimate and compare the current and future direct cost of overactive bladder (OAB) to the health care systems of five European countries. METHOD: A health economic model was created to estimate the number of people currently affected by OAB symptoms, the expected number to be affected in the future, and the resultant economic burden on health care systems in Germany, Italy, Spain, Sweden, and the United Kingdom. RESULTS: The model estimated that in 2000, 20.2 million people over age 40 in the five countries experienced the symptoms of OAB; 7 million of these had urgency with urge incontinence. This figure is expected to rise to 25.5 million by 2020, including 9 million who will have urgency with urge incontinence. Average annual direct costs of OAB management ranged from euro269 to euro706 per patient per year. The largest cost was the use of incontinence pads, accounting for an average of 63% of the annual per patient cost of OAB management. Total cost to health care systems across all five countries was estimated at euro4.2 billion in 2000, and by 2020, the expected total cost was estimated to be euro5.2 billion, an increase of euro1 billion (26%). CONCLUSION: OAB is prevalent, with a substantial direct cost that is anticipated to increase in the future in line with aging populations. The overall burden, including indirect costs, may be considerably larger, and will fall predominantly on the elderly OAB population with urge incontinence. Recommended medical treatments could help manage those costs and should be evaluated.     

Are men with erectile dysfunction more likely to have hypertension than men without erectile dysfunction? A naturalistic national cohort study

PURPOSE:: We examined whether men with erectile dysfunction (ED) are more likely to have hypertension than men without ED in a managed care setting. MATERIALS AND METHODS:: We used a naturalistic cohort design to compare hypertension prevalence rates in 285,436 men with ED to that in 1,584,230 men without ED from 1995 through 2001. We also used a logistic regression model to isolate the effect of ED on the likelihood of hypertension after controlling for subject age, census regions and 9 concurrent diseases. The ED and the nonED cohort came from a nationally representative, managed care claims database that covers 51 health plans and 28 million members in the United States. Finally, the prevalence rate difference between members with and without ED, and the OR of having hypertension were calculated. RESULTS:: The hypertension prevalence rate was 41.2% in men with ED and 19.2% in men without ED. After controlling for subject age, census region and 9 concurrent diseases the OR was 1.383 (p <0.0001), which implies that the odds for men with ED to have hypertension were 38.3% higher than the odds for men without ED. CONCLUSIONS:: Men with ED were more likely to have hypertension than men without ED. This evidence supports the hypothesis that ED shares common risk factors with hypertension. It also suggests that men with ED and clinicians could use ED as an alerting signal to detect and treat undiagnosed hypertension earlier.