Economic burden of amyotrophic lateral sclerosis in the United Kingdom

Abstract

To assess the economic burden of amyotrophic lateral sclerosis (ALS) in the United Kingdom, yearly direct medical costs were determined for four defined ALS health states (mild, moderate, severe and terminal disease stages). Resource utilisation patterns for each health state were obtained from United Kingdom neurologists and local costs (1996/97) were attached to the resources. The annual direct cost of the health states increased from £1185.20 in mild disease to £3127.51 in the terminal state. Hospitalisation was a major contributor to total cost in mild (43.3%), severe (31.6%) and terminal (45.1%) states. In contrast, in moderate disease the impact of hospitalisation was minimal (0.8%) compared to physician remuneration costs (59%). The economic burden of ALS is therefore directly related to the severity of the disease. The study identifies the major cost drivers in current ALS care and provides a means for determining how potential therapeutic interventions might affect the overall cost of the disease.     

Economic burden associated with the management of cervical cancer,cervical dysplasia and genital warts in Belgium

Abstract

Objective: Human papillomavirus (HPV) infections can lead to cervical intraepithelial neoplasia (CIN) lesions, cervical cancer (CC) and genital warts (GWs). This study intended to assess the annual cost of CC, CIN and GW management in Belgium.

Method: A retrospective study using a Belgian Hospital Disease Database (for yearly hospital cost of CC and GW patients) and a clinical expert survey were performed to assess the medical management of CC, CIN and GW patients. Belgian official sources were used to estimate the annual costs of management of CC, CIN and GW patients both from a healthcare payer perspectives (HCPP) and a societal perspective.

Results: Based on the 667 patients diagnosed annually in Belgium with CC and an annual cost per patient of €9,716, the total annual cost of CC is €6.5 million (HCPP). The 10,495 estimated CIN 1, 2 and 3 patients led to an annual cost of €1.97 million (HCPP). The 7,989 estimated annual number of diagnosed GW patients led to an estimated annual cost of €2.53 million (HCPP).

Conclusion: HPV-related diseases represent an important burden on Belgian society, especially when considering that the estimates in this study are probably underestimations, as the management costs of other HPV-related diseases (vulvar, vaginal, penile, oropharyngeal (pre-) cancers, recurrent respiratory papillomatosis etc.) are not included in this analysis.     

Estimating the cost of an emergency room visit for migraine headache

SUMMARY

To provide a more comprehensive accounting of direct cost of treating headaches, it is imperative to quantify the cost of emergency room (ER) services specific to treating headaches. Published cost estimates for migraine-specific ER visits are currently not available. This study estimated the cost of treating migraine headaches in the ER from a payer's perspective, using ER discharge data for migraine from the 2000 National Hospital Ambulatory Medical Care Survey (NHAMCS). Costs were estimated using Medicare reimbursement rates. The total cost of an ER visit for migraine headache, defined as the ER visit and all additional services and procedures, was US$238.16. Based on the migraine prevalence of 9% to 27%, the annual estimate for total ER visit costs for migraine headache in the US in 2000 ranged from US$646 million to US$1.94 billion, which is substantial. ER costs for migraine may be much larger then previously estimated.     

Scotland as an optimal currency area

The June 2016 UK referendum on continued EU membership where the people of Scotland voted to remain, while the rest of the United Kingdom voted to leave, once again makes the issue of whether Scotland is an optimal currency area very topical. England voted strongly to leave Europe while Scotland backed remain by 62% to 38%. The Scottish government published its draft bill on a second independence referendum in October 2016. The move does not mean another referendum will definitely be held, but this does raise the possibility that Scotland might choose independence and staying in the EU without the rest of the United Kingdom. If Scotland charts a course of independence from the rest of the United Kingdom, then they would likely either issue their own currency or join or form another currency area. In this paper, we test the microeconomic foundations of a common currency area for Scotland, United Kingdom, and the rest of the United Kingdom without Scotland. We find that the United Kingdom, Scotland, and the United Kingdom without Scotland all meet the microeconomic criteria for a common currency area. In contrast, banking data suggest that lending in Scotland is different from lending in the rest of the United Kingdom, adding some doubt to the issue of whether or not Scotland is a common currency area with the United Kingdom.     

Economic evaluation of the use of Innohep® in the treatment of acute pulmonary embolism

Summary

This article reports the cost implications of using Innohep® (tinzaparin), a low-molecular-weight heparin (LMWH), instead of intravenous (iv) unfractionated heparin (UFH) in the treatment of acute pulmonary embolism (PE). The expected cost per patient, including initial treatment costs and the cost of managing adverse outcomes (but excluding costs common to both regimes) was found to be £191.81 for patients treated with UFH and £186.64 for patients treated with Innohep® (costs estimated as of end 1997). Therefore, the use of Innohep® reduces the expected cost per patient by £5.17 or 3%. When the costs of managing adverse outcomes occurring after cessation of UFH/Innohep® therapy are excluded, expected costs per patient for UFH and Innohep® treatment are £136.70 and £120.22, respectively. Therefore, when outcomes not directly attributable to the choice between UFH and Innohep® treatment are reduced, the use of Innohep® reduces the expected cost per patient by £16.48 or 12%.

Innohep® reduces costs through greater ease of administration, by removing the need for extensive laboratory monitoring and by saving staff time. These results are generally robust to variations in key assumptions. Sensitivity analysis demonstrates that if patients treated with Innohep® can be discharged from hospital earlier, with their treatment continuing at home, substantial cost savings may result.     

Modelling the peopling of Australia: 1900-1930

An analysis of migration from the United Kingdom to Australia during the period 1900 to 1930 is presented. The author attempts "first to explicitly develop and estimate a model of the behavioural relations of the two blades of the Marshallian scissors, rather than mixing supply and demand (under the polyglot terms of 'push-pull') in a single equation without regard to the problem of identification. And second, [he attempts] to incorporate in these structural equations key elements of government intervention in the migration process." The relationship between economic factors and Australian government support for immigration is considered. The author also identifies three factors influencing annual variations in the flow of migration from the United Kingdom: expected income gains, transport costs, and the costs of job search.     

Use of a diagnosis-based risk adjustment model to estimate costs of indigent care in a community at Medicaid reimbursement rates

Objectives: This study used a diagnosis-based risk adjustment model to estimate the annual costs of uninsured patients in Austin, Texas, and describe the prevalence and costs of their chronic conditions. The data were supplied by the Indigent Care Collaboration, a partnership of local safety-net hospitals and clinics.

Methods: This study used the Diagnostic Cost Groups prospective Medicaid All-Encounters model, which uses diagnoses, age and gender to assign relative risk scores to patients. The relative risk scores were multiplied by the per capita Texas Medicaid expenditure to obtain estimated annual costs. Chronic diseases were described in terms of prevalence and total estimated annual cost.

Results: A total of 471,194 encounters were recorded for 163,729 patients meeting the study inclusion criteria between the 1st March 2004 and the 28th February 2005. The mean estimated patient yearly cost was US $1,307, and the total estimated yearly population cost was $228,909,529. The most common chronic conditions included hypertension, diabetes, depression, substance abuse, pregnancy, asthma, chronic obstructive pulmonary disease and congestive heart failure.

Conclusions: This study demonstrates how the unknown costs associated with caring for indigent uninsured patients in a community can be estimated at Medicaid reimbursement rates using the Diagnostic Cost Group model on aggregated patient encounter data.     

Resource Utilization and Economies of Size in Secondary Schools

This paper identifies the determinants of costs per pupil in English secondary schools. A distinction is made between the short run and the long run in order to estimate the separate effects on costs per pupil of short‐run variations in school output and school size. A school’s capacity utilization rate is used to indicate short‐run deviations in output from pupil capacity, and pupil capacity is used as an indicator of school size to capture scale effects on costs per pupil. The statistical analysis uses both published and unpublished data for secondary schools in England. Two separate analyses are undertaken, one for grant‐maintained schools alone and the other for all schools. A separate analysis is undertaken for grant‐maintained schools since cost data are available only for schools in this sector. Staff hours per pupil is used as a proxy for costs per pupil for schools as a whole. The main finding is that costs per pupil and staff hours per pupil are both highly significantly negatively related to both school size and the capacity utilization rate of schools. A range of other variables are also estimated to have a significant effect on costs per pupil in secondary schools. The main finding is that there is scope for reducing the costs of schooling in the secondary schools sector in England.     

Annual patient and caregiver burden of oncology clinic visits for granulocyte-colony stimulating factor therapy in the US

Objective:

Prophylactic treatment with granulocyte-colony stimulating factors (G-CSFs) is indicated for chemotherapy patients with a significant risk of febrile neutropenia. This study estimates the annual economic burden on patients and caregivers of clinic visits for prophylactic G-CSF injections in the US.

Methods:

Annual clinic visits for prophylactic G-CSF injections (all cancers) were estimated from national cancer incidence, chemotherapy treatment and G-CSF utilization data, and G-CSF sales and pricing information. Patient travel times, plus time spent in the clinic, were estimated from patient survey responses collected during a large prospective cohort study (the Prospective Study of the Relationship between Chemotherapy Dose Intensity and Mortality in Early-Stage (I–III) Breast Cancer Patients). Economic models were created to estimate travel costs, patient co-pays and the economic value of time spent by patients and caregivers in G-CSF clinic visits.

Results:

Estimated total clinic visits for prophylactic G-CSF injections in the US were 1.713 million for 2015. Mean (SD) travel time per visit was 62 (50) min; mean (SD) time in the clinic was 41 (68) min. Total annual time for travel to and from the clinic, plus time at the clinic, is estimated at 4.9 million hours, with patient and caregiver time valued at $91.8 million ($228 per patient). The estimated cumulative annual travel distance for G-CSF visits is 60.2 million miles, with a total transportation cost of $28.9 million ($72 per patient). Estimated patient co-pays were $61.1 million, ～$36 per visit, $152 per patient. The total yearly economic impact on patients and caregivers is $182 million, ～$450 per patient.

Limitations:

Data to support model parameters were limited. Study estimates are sensitive to the assumptions used.

Conclusions:

The burden of clinic visits for G-CSF therapy is a significant addition to the total economic burden borne by cancer patients and their families.     

Societal costs of multiple sclerosis in Ireland

Aims: This paper evaluates the impact of multiple sclerosis (MS) in Ireland, and estimates the associated direct, indirect, and intangible costs to society based on a large nationally representative sample.

Materials and methods: A questionnaire was developed to capture the demographics, disease characteristics, healthcare use, informal care, employment, and wellbeing. Referencing international studies, standardized survey instruments were included (e.g. CSRI, MFIS-5, EQ-5D) or adapted (EDSS) for inclusion in an online survey platform. Recruitment was directed at people with MS via the MS Society mailing list and social media platforms, as well as in traditional media. The economic costing was primarily conducted using a ‘bottom-up’ methodology, and national estimates were achieved using ‘prevalence-based’ extrapolation.

Results: A total of 594 people completed the survey in full. The sample had geographic, disease, and demographic characteristics indicating good representativeness. At an individual level, average societal cost was estimated at €47,683; the average annual costs for those with mild, moderate, and severe MS were calculated as €34,942, €57,857, and €100,554, respectively. For a total Irish MS population of 9,000, the total societal costs of MS amounted to €429m. Direct costs accounted for just 30% of the total societal costs, indirect costs amounted to 50% of the total, and intangible or QoL costs represented 20%. The societal cost associated with a relapse in the sample is estimated as €2,438.

Limitations and conclusions: The findings highlight that up to 70% of the total costs associated with MS are not routinely counted. These “hidden” costs are higher in Ireland than the rest of Europe, due in part to significantly lower levels of workforce participation, a higher likelihood of permanent workforce withdrawal, and higher levels of informal care needs. The relationship between disease progression and costs emphasize the societal importance of managing and slowing the progression of the illness.     

Are labour-intensive efforts to prevent pressure ulcers cost-effective?

Abstract

Background:

Pressure ulcers are a major problem in Danish healthcare with a prevalence of 13–43% among hospitalized patients. The associated costs to the Danish Health Care Sector are estimated to be €174.5 million annually. In 2010, The Danish Society for Patient Safety introduced the Pressure Ulcer Bundle (PUB) in order to reduce hospital-acquired pressure ulcers by a minimum of 50% in five hospitals. The PUB consists of evidence-based preventive initiatives implemented by ward staff using the Model for Improvement.

Objective:

To investigate the cost-effectiveness of labour-intensive efforts to reduce pressure ulcers in the Danish Health Care Sector, comparing the PUB with standard care.

Methods:

A decision analytic model was constructed to assess the costs and consequences of hospital-acquired pressure ulcers during an average hospital admission in Denmark. The model inputs were based on a systematic review of clinical efficacy data combined with local cost and effectiveness data from the Thy-Mors Hospital, Denmark. A probabilistic sensitivity analysis (PSA) was conducted to assess the uncertainty.

Results:

Prevention of hospital-acquired pressure ulcers by implementing labour-intensive effects according to the PUB was cost-saving and resulted in an improved effect compared to standard care. The incremental cost of the PUB was ?€38.62. The incremental effects were a reduction of 9.3% prevented pressure ulcers and 0.47% prevented deaths. The PSAs confirmed the incremental cost-effectiveness ratio (ICER)’s dominance for both prevented pressure ulcers and saved lives with the PUB.

Conclusion:

This study shows that labour-intensive efforts to reduce pressure ulcers on hospital wards can be cost-effective and lead to savings in total costs of hospital and social care.

Key limitations:

The data included in the study regarding costs and effects of the PUB in Denmark were based on preliminary findings from a pilot study at Thy-Mors Hospital and literature.     

How Much Will It Cost to Join the Club? The Extra Costs of Approximating Lithuanian Environmental Laws with Those of the European Union

This paper presents estimates of costsassociated with approximating Lithuanianenvironmental protection legislation with thatof the European Union (EU). Lithuania is oneof twelve EU associate members in Central andEastern Europe that is currently preparing foraccession by approximating their legislationwith that of the EU. The costs of fifteen EUdirectives are considered and details are givenon four directives. Necessary investments maytotal Euro 1500 million by 2015 and the presentvalue of all annualized costs is expected to beabout Euro 2200 million. In 2015, annualized costsare estimated to be approximately Euro 500 million,but these costs are only part of the totalcosts of approximation. Non-environmentalcosts are not considered. Assuming a modestlyambitious average annual growth of GDP of 2.0%per year implies that approximation with thefifteen directives analyzed will cost roughly3.5% of GDP in 2015. This level of additional commitment to environmentalprotection is itself much higher than the 2.0%of GDP being spent on average by OECD countriesand suggests the possibility of a substantialeconomic burden on the Lithuanian economy. Public budgets and households are expected tocarry a substantial portion of this cost,because many directives are the responsibilityof national and local governments. Making theright choices that are expected to be part ofapproximation with the environmental acquis is likely to benefit from carefulcomparisons of costs and willingness to pay forthe environmental benefits of approximation.     

Wind Power in Europe: A Simultaneous Innovation–Diffusion Model

The purpose of this paper is to provide a quantitative analysis of innovation and diffusion in the European wind power sector. We derive a simultaneous model of wind power innovation and diffusion, which combines a rational choice model of technological diffusion and a learning curve model of dynamic cost reductions. These models are estimated using pooled annual time series data for four European countries (Denmark, Germany, Spain and the United Kingdom) over the time period 1986–2000. The empirical results indicate that reductions in investment costs have been important determinants of increased diffusion of wind power, and these cost reductions can in turn be explained by learning activities and public R&D support. Feed-in tariffs also play an important role in the innovation and diffusion processes. The higher is the feed-in price the higher is, ceteris paribus, the rate of diffusion, and we present some preliminary empirical support for the notion that the impact on diffusion of a marginal increase in the feed-in tariff will differ depending on the support system used. High feed-in tariffs, though, also have a negative effect on cost reductions as they induce wind generators to choose high-cost sites and provide fewer incentives for cost cuts. This illustrates the importance of designing an efficient wind energy support system, which not only promotes diffusion but also provides continuous incentives for cost-reducing innovations.      

SNAKE RIVER SALMON RECOVERY: QUANTIFYING THE COSTS

Economic costs are relevant to endangered species protection in both theory and practice. Recovering endangered Snake River salmon will require modifying public land use, restricting fishing and hatchery production, reducing water for agriculture, and altering the operation of hydroelectric dams. The economic costs are estimated to range from $246 million to $359 million per year. While the estimated cost is not matched by the estimated increased value of fishing, the nonuse value of salmon recovery may be very large. Better economic and biological information is needed to assure that decisions for salmon species protection are reasonably cost effective. ( JEL Q28, H43)     

Economic burden of hospital malnutrition and the cost–benefit of supplemental parenteral nutrition in critically ill patients in Latin America

Abstract

Aim: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost–benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost–benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America.

Methods: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost–benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN.

Results: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion–$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone.

Limitations: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown.

Conclusions: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost–benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.     

Reduction in costs of inpatient stay associated with clozapine treatment: A retrospective study

Summary

Clozapine is an atypical antipsychotic drug used to treat the 10-25% of patients who suffer from schizophrenia who are treatment resistant or intolerant to standard antipsychotic drug treatment. A major issue associated with treatment is the high cost of the drug compared to standard antipsychotic drug treatment. Research carried out to date has suggested that despite the high cost of clozapine, it is overall a cost-effective treatment. This contention is based on the findings described elsewhere that clozapine treatment is associated with a dramatic decrease in psychiatric inpatient stay.

There are many ethical difficulties associated with a prospective double-blind controlled trial of clozapine treatment. We have therefore reported on a retrospective audit. A retrospective analysis was carried out by the examination of computerised patient records to determine if clozapine treatment had been associated with a reduction in psychiatric inpatient stay. Also examined was whether clozapine treatment had been associated with an overall shift from intensive therapeutic ward usage.

For example, patients are moved from intensive care and acute wards to wards with less intensive therapeutic input such as continuing care and rehabilitation wards. The inpatient stay details for 76 patients prescribed clozapine since early 1991 were examined before and after clozapine treatment commenced. The main problem with this retrospective analysis is that without any control group observed over the same time period, it is very difficult to assess how much of the decrease in bed usage is related to either the natural history of the disease and/or to changes in bed use over time associated with changes in mental health service provision and the development of community facilities.

Psychiatric inpatient stay decreased by a statistically non-significant average of 13.2 days (6%) in the first year of treatment (p=0.7692), a non-significant average of 34 days (15%) in the second year of treatment (p=0.0669), a significant average of 38.4 days (17%) in the third year of treatment (p=0.0007) and again by a significant average of 51.2 days (22%) in the fourth year of treatment (p=0.0011).

The average cost per inpatient bed-day for the main psychiatric hospital in the Health Board's area is £90.86 (based on 100% occupancy rate, 1994/95 prices). The reduction in bed days identified was equivalent to a saving of £1,200 per patient in the first year of treatment, £3,090 per patient in the second year, £3,490 per patient in the third year and £4,652 per patient in the fourth year. The average annual cost of clozapine per patient is approximately £2,500.

Clozapine treatment was also associated with a shift from intensive care and acute ward inpatient usage to continuing care and rehabilitative ward usage. In the year prior to clozapine treatment intensive care and acute ward stay accounted for 72.7% of total inpatient stay. In the first year of treatment this proportion decreased to 63.7%, in the second year to 39.5%, in the third year to 31.8% and in the fourth year to 24.6%. This represented potential savings of £500,000 per annum.

Overall, the data generated from this study indicated that clozapine treatment is associated with both a reduction in psychiatric bed usage and a shift to less therapeutically intensive care wards. However, the decrease identified is not as dramatic as the reduction quoted elsewhere in the literature. These findings provide useful costing information to support the view that clozapine is a cost-saving or cost-neutral treatment in terms of the provision of psychiatric services in the UK. However, the costs associated with the increased use of community services by the study group were not identified in this review. In order to establish whether or not clozapine is cost saving overall compared to standard antipsychotic treatment it would have been necessary to identify all costs, including the whole range of community costs, before and after treatment commenced.     

Evaluation of cost savings with ferric carboxymaltose in anemia treatment through its impact on erythropoiesis-stimulating agents and blood transfusion: French healthcare payer perspective

Abstract

Objective:

To evaluate the economic impact of intravenous iron (in the form of intravenous iron preparation of ferric carboxymaltose) in three different clinical settings of iron deficiency anemia: chemotherapy-induced anemia in breast cancer, chemotherapy-induced anemia in digestive cancer, and perioperative anemia in knee and hip surgery.

Methods:

The economic model compared the usual therapeutic strategies of anemia without intravenous iron and strategies including intravenous iron, in each of the three clinical settings selected. Costs related to anemia treatment by erythropoiesis-stimulating agents (ESA), blood transfusion, and intravenous iron were estimated and compared inside each setting. Cost savings were calculated from the French healthcare payer perspective. Data included in the economic model were obtained from scientific literature, public health agencies, and medical experts.

Results:

The most prominent annual cost savings were observed in chemotherapy-induced anemia in breast cancer (€997 and €360 per patient for metastatic and non-metastatic breast cancers, respectively; global cost saving, €33.6 million). This large impact of intravenous iron on costs was mainly explained by both a lower number of women treated and lower ESA dosing. Mean annual cost saving in digestive cancers and knee and hip surgery were estimated to €168 and €216 per patient and global cost savings of €7.5 and €12.1 million, respectively. Overall, annual cost savings in these three settings were estimated to €53 million including €39 million for ESA cost savings. Sensitivity analysis showed that strategies including intravenous iron remained cost-effective even with wide variations in the assumptions, particularly for cost savings on ESA.

Limitations:

Economic model based on literature data and expert opinions.

Conclusions:

The present economic model suggests that use of intravenous iron, according to recommendations of international guidelines, is cost saving, particularly in chemotherapy-induced anemia in breast cancers.     

Cost of illness associated with Niemann-Pick disease type C in the UK

Abstract

Objective: Niemann-Pick disease type C (NP-C) is a rare and devastating genetic disorder characterised by a range of progressive neurological symptoms, which imposes a burden on patients, family members, the healthcare system and society overall. The objective of this study was to assess direct and indirect costs associated with NP-C in the UK.

Methods: This was a non-interventional, retrospective, cross-sectional cohort study based on responses from patients and/or their carers/guardians recruited from a UK NP-C database. Resource use and direct medical, direct non-medical and indirect costs were evaluated using data collected via postal survey in October 2007, which included a Medical Resource Use questionnaire. Total annual costs per patient were estimated.

Results: In total, 18 Medical Resource Use questionnaires (29% response rate) were received and analysed. The mean total annual cost (SD) of NP-C per patient was £39,168 (£50,315); 46% were direct medical costs, to which home visits and residential care contributed 68% and 15%, respectively. Direct non-medical costs accounted for 24% of the average annual cost per patient, mainly due to specialist education, and indirect costs 30%. If only direct medical costs were considered, the mean annual cost (SD) per patient was reduced to £18,012 (£46,536).

Conclusions: The direct annual per-patient cost of NP-C illness in 2007 appears moderate when compared with other rare and severely disabling diseases. However, cost estimates may be conservative, since findings are limited by a small sample size, low survey response rate and potential recall bias. As demonstrated by this study, a substantial proportion of the cost is shifted from the healthcare system to the patient, family and non-medical providers. These findings highlight the need for treatments that can slow or stop disease progression in NP-C.     

Annual cost of hospitalization,inpatient rehabilitation and sick leave of anal cancer in Germany

Abstract

Objective:

Literature on the economic burden of anal cancer in Germany is scarce. About 84% of these cancers are associated with human papillomavirus infection. This study, therefore, aimed to assess the annual costs of human papillomavirus-related anal cancer incurred by hospitalization, inpatient rehabilitation, and sick leave in 2008 in Germany.

Methods:

A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to anal cancer in 2008 were analyzed. Associated numbers of anal cancer hospitalizations, healthcare resource use, and costs were identified and extracted using the ICD-10 code C21 as the main diagnosis. The annual cost of human papillomavirus-related anal cancer was estimated based on the percentage of anal cancer likely to be attributable to human papillomavirus.

Results:

In 2008, there were 5774 hospitalizations (39% males, 61% females), 517 inpatient rehabilitations, and 897 sick leaves due to anal cancer representing costs of €34.11 million. The estimated annual costs associated with human papillomavirus-related anal cancer were €28.72 million, mainly attributed to females (62%). Direct costs accounted for 90% (86% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 10% of human papillomavirus-related costs.

Conclusions:

The economic burden of human papillomavirus-related anal cancer in 2008 in Germany is under-estimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, this study is the first analysis to investigate the economic burden of anal cancer in Germany. The estimated annual costs of human papillomavirus-related anal cancer contribute to a significant economic burden in Germany and should be considered when assessing health and economic benefits of human papillomavirus vaccination in both genders.