scholarly journals Economic burden of cirrhosis in Catalonia: a population-based analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018012 ◽  
Author(s):  
Mireia Miquel ◽  
Montserrat Clèries ◽  
Mercedes Vergara ◽  
Emili Vela
Keyword(s):  
Resource Use ◽  
Healthcare Resource ◽  
Population Level ◽  
Population Based ◽  
Point Prevalence ◽  
Receiver Operating Curve ◽  
High Morbidity ◽  
Healthcare Resource Use ◽  
Healthcare Budget ◽  
Comorbidity Burden

BackgroundCirrhosis is a chronic disease with high morbidity and mortality. Few studies have evaluated healthcare resource use in patients with cirrhosis.ObjectiveWe aimed to describe the point prevalence of cirrhosis on 31 December 2012 and the population-level distribution of healthcare resource use and expenditures in a non-selected population of patients with cirrhosis, stratified by whether their disease was compensated or decompensated, and by comorbidity burden.MethodsThis population study included all known patients aged >18 years with cirrhosis (according to International Classification of Diseases, ninth revision) in Catalonia, Spain, on 31 December 2012. We evaluated healthcare resource use and expenditure during 2013, taking into account the presence of decompensation before or during 2012.ResultsWe documented 34 740 patients diagnosed with cirrhosis (58.7% men; mean age 61.8±14 years), yielding a point prevalence of 460 per 100 000 inhabitants on 31 December 2012. Annual mortality was 9.1%. During 2013, healthcare expenditures on patients with cirrhosis totalled €142.1 million (€4234 per patient), representing 1.8% of the total 2013 healthcare budget of Catalonia. Hospitalisation costs accounted for 35.1% of the total expenditure and outpatient care accounted for 22.4%. MultivariateMultivariate logistic regression identified morbidity burden, HIV infection, hospitalisation and emergency room visits during 2012 as independent predictors of expenditure above the 85th centile (area under the receiver operating curve, 0.88 (95% CI 0.883 to 0.893, P<0.001)).ConclusionsCirrhosis accounts for a high proportion of healthcare resource usage and expenditures; hospitalisation accounted for the highest expenditures.

scholarly journals The direct costs of overdiagnosed asthma in a longitudinal population-based study

2018 ◽  
Author(s):  
Bryan C. Ng ◽  
Mohsen Sadatsafavi ◽  
Abdollah Safari ◽  
J. Mark FitzGerald ◽  
Kate M. Johnson
Keyword(s):  
Resource Use ◽  
Healthcare Costs ◽  
Healthcare Resource ◽  
Medication Use ◽  
Population Based ◽  
Healthcare Resource Use ◽  
Asthma Diagnosis ◽  
Physician Visits ◽  
Direct Healthcare Costs ◽  
Physician Diagnosis

ABSTRACTObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and evaluate strategies to reduce this burden. We assessed the difference in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out.DesignPopulation-based prospective cohort study.SettingParticipants were recruited through random-digit dialling of both landlines and mobile phones in BC, Canada.ParticipantsWe included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma which was confirmed by a bronchodilator reversibility or methacholine challenge test at the end of the 12-month follow-up.Primary and secondary outcome measuresSelf-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits, and medication use from the Canadian healthcare system perspective.ResultsAsthma was ruled out in 86 (24.9%) participants. Average annual asthma-related direct healthcare costs for participants with confirmed asthma were $497.9 (SD $677.9), and $307.7 (SD $424.1) for participants with asthma ruled out. In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (Relative Ratio [RR]=1.60, 95%CI 1.14-2.22), increased rate of specialist visits (RR=2.41, 95%CI 1.05-5.40) and reliever medication use (RR=1.62, 95%CI 1.09-2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11).ConclusionsA quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.Strengths and limitations of this studyParticipants were recruited through random sampling of the general population in the province of British Columbia.Asthma diagnosis was confirmed or ruled out using sequential guideline-recommended objective airway tests.Healthcare resource use was self-reported, potential recall bias may have led to reduced accuracy.The study was unable to evaluate the indirect costs of overdiagnosis or the cost-savings from correcting the diagnosis.The generalizability of the results may be limited by regional differences in medical costs and practices.

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