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Based on comorbidities and healthcare resources used, patients with TRD appeared to represent a clinically complex subgroup of individuals with MDD. TRD was associated with significant cost burden.

In this study, DMD adherence was associated with a significantly lower rate of severe relapse and lower total costs over 2 years. Causality cannot be inferred because adherence and outcomes were measured over the same period. The study was subject to limitations associated with use of claims data and the absence of clinical measures.

Objective To assess basal insulin persistence, associated factors, and economic outcomes for insulin-na€ ıve people with type 2 diabetes mellitus (T2DM) in the US. Research design and methods People aged 18 years diagnosed with T2DM initiating basal insulin between April 2006 and March 2012 (index date), no prior insulin use, and continuous insurance coverage for 6 months before (baseline) and 24 months after index date (follow-up period) were selected using de-identified administrative claims data in the US. Based on whether there were 30 day gaps in basal insulin use in the first year post-index, patients were classified as continuers (no gap), interrupters (1 prescription after gap), and discontinuers (no prescription after gap). Main outcome measures Factors associated with persistence -assessed using multinomial logistic regression model; annual healthcare resource use and costs during follow-up period -compared separately between continuers and interrupters, and continuers and discontinuers. Results Of the 19,110 people included in the sample (mean age: 59 years, 60% male), 20% continued to use basal insulin, 62% had 1 interruption, and 18% discontinued therapy in the year after initiation. Older age, multiple antihyperglycemic drug use, and injectable antihyperglycemic use during baseline were associated with significantly higher likelihoods of continuing basal insulin. Relative to interrupters and discontinuers, continuers had fewer emergency department visits, shorter hospital stays, and lower medical costs (continuers: $10,890, interrupters: $13,674, discontinuers: $13,021), but higher pharmacy costs (continuers: $7449, interrupters: $5239, discontinuers: $4857) in the first year post-index (p < 0.05 for all comparisons). Total healthcare costs were similar across the three cohorts. Findings for the second year post-index were similar. Conclusions The majority of people in this study interrupted or discontinued basal insulin treatment in the year after initiation; and incurred higher medical resource use and costs than continuers. The findings are limited to the commercially insured population in the US. In addition, persistence patterns were assessed using administrative claims as opposed to actual medicationtaking behavior and did not account for measures of glycemic control. Further research is needed to understand the reasons behind basal insulin persistence and the implications thereof, to help clinicians manage care for T2DM more effectively. ARTICLE HISTORY

Patients with PAH had substantially higher costs and co-morbidity than controls, with circulatory/respiratory system-related costs accounting for 40% of excess costs. The high burden of illness suggests opportunities for savings from improved management.

Studies have not previously reported the indirect cost burden of multiple sclerosis (MS) from an employer perspective. To compare annual indirect costs between privately insured US employees with MS and matched employee controls. A retrospective analysis of a privately insured claims database containing disability data from 17 US companies was conducted. Employees with >/=1 MS diagnosis (ICD-9-CM: 340.x) after 1 January 2002, aged 18-64 years, were selected. Employees with MS were matched by age and sex to employee controls without MS. All were required to have continuous health coverage 3 months before MS diagnosis (baseline) and 12 months after (study period). Main outcomes measures included study period annual indirect (disability and medically related absenteeism) costs. For completeness, we also included measures of direct (medical and drug) costs. Chi-squared tests were used to compare baseline co-morbidities and differences in indirect resource use (disability and medically related absenteeism) between employees with MS and controls. Wilcoxon rank-sum tests were used for univariate comparisons of disability and medically related absenteeism days and associated annual indirect and direct costs between employees with MS and controls. Generalized linear models, controlling for differences in baseline characteristics, were used to estimate risk-adjusted annual costs for employees with MS and controls. Employees with MS (n = 989) averaged 44 years of age, and 66% were female. Compared with employee controls, employees with MS had significantly higher rates of mental health disorders, other neurological disorders and physical disorders measured by the Charlson Co-morbidity Index. Employees with MS were more likely to have short-term or long-term disability than employee controls (21.4% vs 5.2%, respectively; p< 0.0001), resulting in a higher mean number of disability days per year (29.8 vs 4.5; p < 0.0001). Employees with MS also had a higher rate of medically related absenteeism and associated absenteeism days than employee controls. On average, annual costs (year 2006 values) for disability were significantly higher for employees with MS ($US3868) than employee controls ($US414; p < 0.0001). Annual medically related absenteeism costs were also higher for employees with MS than for controls ($US1901 vs $US1003, respectively; p < 0.0001). On average, total annual indirect costs for employees with MS were $US5769 compared with $US1417 for controls (p < 0.0001). MS is a chronic and debilitating disease that poses a substantial employer burden in terms of medically related absenteeism and disability costs. Indirect costs of employees with MS were >4 times those of employee controls.

Summary Purpose:  Compare annual direct and indirect costs between privately insured U.S. patients with epileptic partial onset seizures (POS) and matched controls. Methods:  One thousand eight hundred fifty‐nine patients (including a subset of 758 employees) with ≥1 (POS) diagnosis (ICD‐9‐CM: 345.4.x–345.7.x), 1999–2004, ages 16–64 years, were identified from a privately insured claims database. Control group was an age‐ and gender‐matched cohort of randomly chosen beneficiaries without epilepsy (ICD‐9‐CM: 345.x). All were required to have continuous health coverage during 2004 (baseline) and 2005 (study period). Chi‐square tests were used to compare baseline comorbidities. Univariate and multivariate analyses were used for comparisons of annual direct (medical and pharmaceutical) and indirect costs during the study period. Results:  Patients with POS were on average 42 years of age, and 57% were women. Patients with POS had significantly higher rates of mental health disorders, migraine, and other neurologic disorders, and higher Charlson comorbidity index (CCI) compared with controls. On average, direct annual costs were significantly higher for POS patients ($11,276) compared with controls ($4,087), p < 0.001; difference of $7,190. Epilepsy‐related costs (i.e., costs for antiepileptic drugs, claims with epilepsy or convulsions diagnoses) accounted for $3,290 (29% of direct costs). Employees with POS had substantial and significantly higher indirect (disability‐ and medically related absenteeism) costs compared with controls ($3,431 vs. $1,511, p < 0.001). Multivariate analyses supported the matched‐control univariate findings. Conclusion:  Patients with POS had significantly higher costs compared with matched controls. Epilepsy‐related costs underestimate the excess costs of patients with partial onset seizures.