Health care utilization among COPD patients is approximately twice that of age- and sex-matched controls, with much of the difference attributable to smoking-related diseases. In this health maintenance organization, inpatient costs were similar to and outpatient costs were much higher than national averages for COPD patients covered by Medicare.

No abstract

Summary:Purpose: Previous studies have estimated medical care costs of epilepsy by applying unit costs to estimated utilization or by summing costs for (a) ambulatory care and hospitalizations coded as epilepsy and (b) procedures and drugs specifically associated with the diagnosis or treatment of epilepsy. These methods may underestimate the cost of medical care for epilepsy. Two methods for estimating the medical care costs of epilepsy ("epilepsy-attributable cost method" and "case-control cost method") were compared.Methods: The study population was 655 individuals with an epilepsy diagnosis enrolled in a managed care plan in the southwestern United States. The epilepsy-attributable costs were determined by summing costs for inpatient and outpatient encounters coded as epilepsy, procedures for the diagnosis or treatment of epilepsy, and drugs used to treat epilepsy. The case-control method determined costs by calculating the difference in total costs between cases and 1,965 age-and gendermatched controls.Results: The case-control epilepsy costs were $2,923 per case compared with epilepsy-attributable costs of $1,335 per case. The case-control method found statistically significant differences in costs between cases and controls for inpatient care, prescription drugs, and 8 of 11 categories of outpatient care. The largest contributors to the discrepancy between estimates were inpatient care, emergency department care, laboratory tests, and "other specialist" care.Conclusions: Epilepsy-attributable costs accounted for only 46% of the total difference in costs between epilepsy cases and controls. Persons with epilepsy use more medical services than controls, but a substantial portion of this care is not coded to epilepsy.

In 3 geographically diverse health plans, anticoagulation clinics provided a generally higher quality of control than previously reported in other observational studies. This study highlights the costs of obtaining this level of control.

No abstract

The economic consequences of chronic obstructive pulmonary disease (COPD) are considerable, although the factors that best predict costs are largely unknown. This study used a population-based cohort to identify the clinical factors during an index year that were most predictive of increased direct medical costs in the subsequent year, and to develop a predictive model that described the cost variations in COPD. The medical records of 2116 patients enrolled in one regional health system who had COPD and health-care resource utilisation data for 1998 and 1999, were abstracted for information about symptoms, smoking history, chronic illnesses, and pulmonary function data. All inpatient, outpatient and pharmacy utilisation data for each subject for 1999 were extracted from the database. Total costs for each individual were transformed to a log scale. Potential causes of cost variability (predictor variables) were defined and classified into sets (or domains). Multiple linear regression models were fitted for each domain. The study demonstrated that severity of airflow obstruction, as assessed by FEV(1)% predicted, is a significant but weak predictor of future health-care resource utilisation-prior hospitalisation and home oxygen use, the presence of comorbid conditions and symptoms of dyspnoea are better predictors of costs. Those interested in the economic benefits of new COPD treatments and disease management programs need to carefully account for these factors.

Acute liver failure or injury not clearly attributable to other known causes occurred on the order of 1 per 10,000 person-years among diabetic patients treated with oral hypoglycemic drugs or insulin.

Economic growth in developing countries and globalization of the food sector is leading to increasingly similar food consumption patterns worldwide. The aim of this study was to describe similarities and differences in the contributions of main food groups to energy and nutrient intakes in five developed countries across three continents. We obtained summary reports of national food consumption survey data from Australia, France, Denmark, the Netherlands, and the United States. Survey years spanned 2003–2012; sample size ranged from 1444 to 17,386. To mitigate heterogeneity of food groups across countries, we recategorized each survey’s reported food groups and subgroups into eight main food groups and, for three countries, a ninth “mixed dishes” group. We determined the percent contribution of each food group to mean daily intakes of energy, saturated fat, sodium, fiber, and ten vitamins and minerals that are commonly under-consumed. Differences in findings from surveys utilizing a foods-as-consumed versus a disaggregated or ingredients approach to food group composition and contributions from the milk and milk products group, a source of several under-consumed nutrients, were explored. Patterns of food group contributions to energy and nutrient intakes were generally similar across countries. Some differences were attributable to the analytical approach used by the surveys. For the meat/protein, milk and milk products, vegetables, and fruit groups, percent contributions to key nutrient intakes exceeded percent contributions to energy intake. The mixed dishes group provided 10%–20% of total daily energy and a similar 10%–25% of the daily intake of several nutrients. This descriptive study contributes to an understanding of food group consumption patterns in developed countries.