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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.

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Adolescents who initiated SSRI/SNRI therapy earlier experienced lower risk of ER visits and had lower total costs compared to late initiators.

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The lack of a fully developed results-based financing model before implementation of a program in the health sector begins can lead to difficulty in communicating about the program to different actors involved and delay components of implementation.

OBJECTIVES: Compare direct and indirect (workloss) costs between privately-insured U.S. employees with hypogonadism (HG) and demographically matched controls without HG. METHODS: Male employees, ages 35-64, with Ն2 HG diagnoses (ICD-9-CM: 257.2x) or Ն1 HG diagnosis and Ն1 claim for testosterone therapy between 1/1/2005-3/31/2009 were identified from a privately-insured claims database (Nϳ12,000,000). The index date was defined as the most recent HG diagnosis with continuous eligibility Ն1 year before (baseline period) and 1 year after (study period). Employees with HG were matched 1:1 on age, region, employment status, and index year to controls without HG. Descriptive analyses compared demographic characteristics, comorbidities, resource utilization, direct costs (reimbursements to providers for medical services and prescription drugs) and indirect costs (disability and medically-related absenteeism) inflated to $2009. Multivariate analyses adjusting for baseline patient differences were used to estimate risk-adjusted costs. RESULTS: 4,269 HG employees, mean age 51, with matched controls met inclusion criteria. Compared with controls, HG employees had higher baseline comorbidity rates: hyperlipidemia (50.2% vs. 25.3%), hypertension (37.7% vs. 21.1%), back/neck pain (32.0% vs. 15.7%), and HIV/AIDS (7.1% vs. 0.3%) (all pϽ0.0001). HG employees had higher study period rates of inpatient stays (10.8% vs. 5.2%), Emergency Department visits (27.5% vs. 16.3%), outpatient visits (100.0% vs. 76.7%), prescription medication use (95.7% vs. 68.3%), and higher mean workloss days (19.3 vs. 8.8) (all pϽ0.0001). HG employees compared with controls had higher mean study period direct ($10,914 vs. $3,823) and indirect costs ($3,204 vs. $1,450); HG-related direct costs were $832. HG employees' costs remained higher after adjusting for baseline differences (direct: $9,291 vs. $5,248; indirect: $2,729 vs. $1,840) (all pϽ0.0001). CONCLUSIONS: Employees with HG had higher comorbidity rates and costs compared with demographically matched controls. Given the low HG-related costs, the main driver of overall costs among HG patients may be their comorbidity burden.

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