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BackgroundThe rising prevalence of overweight and obesity places a financial burden on health services and on the wider economy. Health service and societal costs of overweight and obesity are typically estimated by top-down approaches which derive population attributable fractions for a range of conditions associated with increased body fat or bottom-up methods based on analyses of cross-sectional or longitudinal datasets. The evidence base of cost of obesity studies is continually expanding, however, the scope of these studies varies widely and a lack of standardised methods limits comparisons nationally and internationally. The objective of this review is to contribute to this knowledge pool by examining direct costs and indirect (lost productivity) costs of both overweight and obesity to provide comparable estimates. This review was undertaken as part of the introductory work for the Irish cost of overweight and obesity study and examines inconsistencies in the methodologies of cost of overweight and obesity studies. Studies which evaluated the direct costs and indirect costs of both overweight and obesity were included.MethodsA computerised search of English language studies addressing direct and indirect costs of overweight and obesity in adults between 2001 and 2011 was conducted. Reference lists of reports, articles and earlier reviews were scanned to identify additional studies.ResultsFive published articles were deemed eligible for inclusion. Despite the limited scope of this review there was considerable heterogeneity in methodological approaches and findings. In the four studies which presented separate estimates for direct and indirect costs of overweight and obesity, the indirect costs were higher, accounting for between 54% and 59% of the estimated total costs.ConclusionA gradient exists between increasing BMI and direct healthcare costs and indirect costs due to reduced productivity and early premature mortality. Determining precise estimates for the increases is mired by the large presence of heterogeneity among the available cost estimation literature. To improve the availability of quality evidence an international consensus on standardised methods for cost of obesity studies is warranted. Analyses of nationally representative cross-sectional datasets augmented by data from primary care are likely to provide the best data for international comparisons.

Severe refractory asthma poses a substantial burden in terms of healthcare costs but relatively little is known about the factors which drive these costs. This study uses data from the British Thoracic Society Difficult Asthma Registry (n=596) to estimate direct healthcare treatment costs from an National Health Service perspective and examines factors that explain variations in costs. Annual mean treatment costs among severe refractory asthma patients were £2912 (SD £2212) to £4217 (SD £2449). Significant predictors of costs were FEV1% predicted, location of care, maintenance oral corticosteroid treatment and body mass index. Treating individuals with severe refractory asthma presents a substantial cost to the health service.

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These findings provide an argument for adoption and remuneration of the PAS model in the community pharmacy (primary healthcare) setting.

Objective/Hypothesis: The aim of this study was to explore the cost-utility of pediatric cochlear implantation, incorporating savings associated with ed· ucation into the analysis. Methods: The costs of pedi· atric cochlear implantation were based on the full costs levied to purchasers, inclusive of complications and maintenance, by a large pediatric cochlear im· plant program in the United Kingdom. After implantation, profoundJy hearing-impaired children have been found to develop hearing threshold levels equiv· alent to severely hearing-impaired children who wear hearing aids. An independent study calculated the educational costs for severely hearing-impaired and profoundJy hearing-impaired children. From this study, savings in ducational costs that would result from enabling the profoundly hearing-impaired to function as severely bearing-impaired were deter· mined. Cost-utility was established conservatively by applying to children the known gains in utility re· ported by adults with cochlear implants. Results: The discounted costs of creating a pediatric cochlear im· plant user and of maintaining the child over the first 12 years were £48,757 ($78,011). The discounted differ· ence in education costs associated with a profoundJy hearing-impaired child (IIL >95 dB) as compared with a sever ly hearing-impaired child over the same period was £26, 781 ($42,850). These rep· r sent the potential savings in educational costs asso· ciated with pediatric cochlear implantation. Assum· ing implantation at age 4 years, the discounted net average cost of pediatric cochlear implantation over compulsory chool years (ages 4-16) was £21,976 ($35,162). Cochlear implants have been shown to improve the quaJity of life in adults by 0.23 points per annum (where quality of life is rated on a scale from 0 to 1). Applying this weight to children r ceiving im· plantation at age 4 years, and assuming a life expectancy of 74 years, the quality-adjusted life-year (QALY) 156 gain is calculated to be 16.33. The cost per undis· counted QALY gain was estimated to b e £1,345.70 ($2153.12) and per discounted QALY gain to be £10,341 ($16,545.60). Conclusion: This study provides evidence, based on conservative assumptions, to support the view that pediatric cochlear implantation is a cost-effective health care intervention in profoundJy hearing-impaired young children.

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Chronic kidney disease (CKD) affects over 10% of the global population and poses significant challenges for societies and health care systems worldwide. To illustrate these challenges and inform cost-effectiveness analyses, we undertook a comprehensive systematic scoping review that explored costs, health-related quality of life (HRQoL) and life expectancy (LE) amongst individuals with CKD. Costs were examined from a health system and societal perspective, and HRQoL was assessed from a societal and patient perspective. Papers published in English from 2015 onward found through a systematic search strategy formed the basis of the review. All costs were adjusted for inflation and expressed in US$ after correcting for purchasing power parity. From the health system perspective, progression from CKD stages 1-2 to CKD stages 3a-3b was associated with a 1.1-1.7 fold increase in per patient mean annual health care cost. The progression from CKD stage 3 to CKD stages 4-5 was associated with a 1.3-4.2 fold increase in costs, with the highest costs associated with end-stage renal disease at $20,110 to $100,593 per patient. Mean EuroQol-5D index scores ranged from 0.80 to 0.86 for CKD stages 1-3, and decreased to 0.73-0.79 for CKD stages 4-5. For treatment with renal replacement therapy, transplant recipients incurred lower costs and demonstrated higher HRQoL scores with longer LE compared to dialysis patients. The study has provided a comprehensive updated overview of the burden associated with different CKD stages and renal replacement therapy modalities across developed countries. These data will be useful for the assessment of new renal services/ therapies in terms of cost-effectiveness.