The direct and indirect costs associated with endometriosis: a systematic literature review

Background: Stroke is not only a costly deadly disease, but also a leading cause of long-term disability. However, stroke associated indirect costs such as productivity loss and informal care cost have not been well studied. To better develop such studies and provide policy-relevant information, we conducted a literature review of indirect costs of stroke. Methods: We conducted a literature search using PubMed, MEDLINE and EconLit, complemented by Google Scholar search and cross-reference checking using key words of stroke, cerebrovascular disease, subarachnoid hemorrhage, intracerebral hemorrhage, cost of illness, productivity loss, indirect cost, economic burden, and informal caregiving. We identified original research articles published during 1990-2012 in English language peer reviewed journals for the review. Since the number of studies on indirect cost of stroke was small, we included cost-of-illness (COI) studies if they contained sufficient analyses of the indirect cost. We summarized the indirect costs by study type, cost categories, and study settings. Results: There were 31 original research articles investigating the indirect cost of stroke. Only 6 (19%) of these studies solely investigated the indirect cost; the other 25 (81%) studies were COI studies which included the indirect cost as a component. Of the 31 articles, six examined indirect costs in the US. Two of them focused solely on indirect costs. One study at a national level examined informal caregiving among elderly with stroke and estimated the annual cost of such care to be $6.1 billion in 1999. The other study for the State of California estimated lost productivity associated with stroke mortality in the State to be over $1 billion in 1991. The other four US studies suggested that the indirect costs will continue to increase in the coming decades, especially among African American and Hispanics, and that indirect costs might account for over 58% of the total cost of stroke. Due to diverse research methods, data, and cost definitions, the literature suggested a wide range of the indirect cost as a percentage of total stroke costs (2.6% - 71%) often with indirect cost as a significant cost component of stroke. Conclusions: While the literature indicated that the indirect cost accounted for a significant portion of the economic burden of stroke, there is a clear need to develop improved methods to study costs and to better use or establish relevant data sources for such studies. With the aging population and increasing survival rate of stroke, both direct and indirect costs of stroke are likely to increase greatly. Interventions for stroke prevention as well as for improving quality of life among stroke patients are needed to contain both direct and indirect costs associated with stroke. More research investigating the indirect costs will be helpful in guiding the development of such interventions to reduce the burden of stroke.

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Indirect Costs of Oral Versus Non-Oral Therapies in Hematologic Malignancies: A Systematic Literature Review

Blood ◽

10.1182/blood-2020-136773 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 30-31

Author(s):

Mir Sohail Fazeli ◽

Divya Pushkarna ◽

Ana Howarth ◽

Margaret Hux ◽

Mir-Masoud Pourrahmat ◽

...

Keyword(s):

Literature Review ◽

Indirect Cost ◽

Societal Perspective ◽

Systematic Literature Review ◽

Outcomes Research ◽

Cost Savings ◽

Indirect Costs ◽

Hematologic Malignancies ◽

The Usa ◽

American Society

Introduction: The treatment landscape for hematologic malignancies is evolving rapidly, and a range of therapeutic options with differing routes of administration is now available. The shifting dynamics of these novel therapies and increasing total treatment costs highlight the importance of value-based healthcare decisions that take patient, payer, and societal perspectives into account. It is therefore increasingly important to consider both direct and indirect costs when evaluating therapeutic options. Reducing healthcare visits for administration of non-oral therapies (injectable and/or mixed therapies) results in indirect cost savings and is of particular relevance during the current coronavirus disease (COVID-19) pandemic where there are distinct challenges with respect to visiting hospital settings. However, the indirect cost savings of utilizing oral versus non-oral treatments have yet to be fully assessed from a patient and societal perspective. The objective of this review was to assess the differences in indirect non-treatment-related costs between oral and non-oral therapies for hematologic malignancies. Methods: A systematic literature review (SLR) was conducted by searching the Embase®, MEDLINE®, EconLit, and Health Technology Assessment/National Health Service economic evaluation (HTA/NHS EED) databases from inception to June 2020. Additionally, literature searches of proceedings from the 2018-2020 American Society of Clinical Oncology (ASCO), American Society of Hematology (ASH), and The Professional Society for Health Economics and Outcomes Research (ISPOR) conferences were performed to capture recent studies not indexed in the main databases. A manual search of the reference list from all included study publications was also performed. Eligibility criteria for study identification were developed using the Population, Intervention, Comparator, and Outcome (PICO) framework. Eligible studies included cost models and observational studies reporting indirect costs from a patient and/or societal perspective for oral versus non-oral therapies. Results: A total of 4,012 records were identified by the searches. Following title/abstract screening, the full text of 25 publications was reviewed, and 5 studies conducted in the USA (n = 3), Italy (n = 1), and Finland (n = 1) were identified as eligible and selected for qualitative evidence synthesis (Table). Although the SLR protocol included all hematologic malignancies, only studies including patients with multiple myeloma (MM) were identified. The indirect costs reported across the selected studies varied and included costs such as loss of productivity, transportation, and patient and/or caregiver time. Among all 5 studies, total indirect costs for patients with MM were lower for oral versus non-oral regimens. In the USA-based studies, indirect costs were USD 70-1,202 per month for oral regimens versus USD 432-1,526 per month for non-oral regimens. In Europe-based studies, indirect cost estimates were EUR 1,800 versus EUR 17,000 per year for oral versus non-oral regimens (Italian study), and EUR 114 versus EUR 358 per 28-day cycle for oral versus non-oral regimens (Finnish study; averages calculated from ranges in Table). Conclusions: This SLR demonstrates a paucity of data on the indirect costs to patients and society of oral versus non-oral therapies for hematologic malignancies. The studies included in this review assessed differing types of indirect costs, including loss of productivity, transportation costs, and patient and/or caregiver time; however, all indicated that the administration of oral regimens is associated with lower indirect costs compared with non-oral regimens. This finding is compelling given the current global health crisis due to COVID-19, where prioritizing the concept of "value" means assessing more complex issues, such as indirect costs that may have a meaningful impact on patients and society. Disclosures Fazeli: Evidinno Outcomes Research Inc.: Current Employment. Pushkarna:Evidinno Outcomes Research Inc.: Current Employment. Howarth:Evidinno Outcomes Research Inc.: Current Employment. Hux:Evidinno Outcomes Research Inc.: Consultancy. Pourrahmat:Evidinno Outcomes Research Inc.: Current Employment. Chen:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company.

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