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Media Coverage of Recent BHE Research
Artificial Cervical Disc Surgery Cheaper Than Fusion
Migraine Sufferers Report Substantial Health Impairment
Forthcoming Peer-Reviewed Journal Articles
Menzin J, Boulanger L, Marton J, Guadagno L, Dastani H, Dirani R, Phillips A, Shah H. The economic burden of chronic obstructive pulmonary disease (COPD) in a US Medicare population. Respir Med. 2008; [forthcoming].
RATIONALE: Although the economic burden of COPD has gained attention in recent years, data on the costs of COPD among U.S. Medicare beneficiaries are lacking.
METHODS: This study used administrative claims and eligibility records from a large U.S. multi-state Medicare managed care database. Study patients were 65+ years of age with paid claims during 2004. The COPD cohort comprised patients with 1+ inpatient/ER claims or 2+ outpatient claims (>30 days apart) for COPD (ICD-9-CM codes 491.xx, 492.x, 496). The comparison cohort included patients without COPD matched 3:1 to the COPD cohort on age, sex, enrollment months, and Medicare plan. Excess costs of COPD were estimated as the difference in overall health plan payments between the two cohorts during 2004. Attributable costs were calculated using medical claims with listed diagnoses of COPD or other respiratory-related conditions and pharmacy claims for respiratory medications.
RESULTS: 8,370 patients were included in the COPD cohort and were matched to 25,110 comparison cohort patients. For both groups, mean (SD) age was 78 (8) years, 54% were female, and duration of eligibility was 11 (2) months. COPD patients were more likely to utilize healthcare services and had excess total healthcare costs about $20,500 higher (P<0.0001) than the comparison cohort. Comorbidities were high in the COPD cohort, accounting for 46% of the observed excess cost. The attributable cost of COPD averaged about $6,300; other respiratory-related costs averaged about $4,400.
CONCLUSION: In this U.S. Medicare managed care population, COPD posed a substantial burden in terms of both respiratory-related and total healthcare costs. A comparison of these cost-of-illness estimates to those for elderly COPD patients in other countries would be of great interest, given the increasing age of populations in most Western countries.
Recently Published Articles
Brown JS, Neumann PJ, Papadopoulos G, Ruoff G, Diamond M, Menzin J. Migraine Frequency and Health Utilities: Findings from a Multi-Site Survey. Value Health. 2008;11(2), 315–321.
Patients aged ≥18 years diagnosed with episodic migraine were enrolled at 3 U.S. sites representing varied models of health care delivery. All subjects completed a questionnaire that included demographic and clinical information, a migraine-specific disability questionnaire, and the Health Utilities Index Mark 3 (HUI3). The HUI3 is a generic health status and health-related quality-of-life measure. HUI3 health status data are translated into utility scores anchored by 0 (dead) and 1 (perfect health). The study enrolled 150 patients. The mean age was 44 years and 87% were female. Mean (±SD) monthly migraine frequency was 4.4 ±3.6, with 34% reporting ≤2 migraines per month and 20% reporting > 6 migraines per month. The mean (±SD) HUI3 score was 0.62 ± 0.26. After controlling for study center, demographics, comorbidities, migraine characteristics, and level of migraine disruptiveness, migraine frequency was found to be significantly (p <0.05) and negatively associated with HUI3 scores. Subjects with >6 migraines per month had an adjusted mean HUI3 score of 0.41; the corresponding mean for those reporting ≤2 migraines per month was 0.67. Migraine frequency was positively associated with higher levels of disability for the emotion, cognition, and pain components of the HUI3. Among this group of care-seeking patients, migraineurs’ health utilities were inversely related to headache frequency. Although these data may not be generalizable to the entire migraine population, they may be useful in assessing the comparative cost-effectiveness of preventive migraine therapies.
Menzin J, Lines L, Manning LN. The Economics of Squamous Cell Carcinoma of the Head and Neck. Curr Opin Otolaryngol Head Neck Surg. 2007; 15: 58-73.
This review presents a brief overview of the recent literature on the costs of squamous cell cancer of the head and neck (SCCHN), one of the most common forms of cancer. SCCHN is a relatively deadly disease. Approximately 50% of patients survive to 5 years, and surgery and chemoradiotherapy can leave survivors with pain, disfigurement, and disability that further add to the burden of the disease.
Earlier diagnosis of SCCHN increases the likelihood of treating with a single modality, lowers the risk of mortality, decreases medical expenditures, and improves patients’ quality of life. Unfortunately, more than half of new cases of oral cancer are diagnosed at an advanced stage. Patients with SCCHN have been shown to use significantly more healthcare resources than similar patients without SCCHN, with resource use varying by cancer stage.
Although there have been a number of treatment innovations for SCCHN in the last five years, the lack of economic data complicates the task of evaluating these new interventions. In this time of mounting concerns over health-care costs, more emphasis on economic data is clearly warranted.