Economic Implications of Sleep Disorders

Sleep disorders such as insomnia, obstructive sleep apnoea (OSA), excessive daytime sleepiness (EDS) and fatigue, sleep deprivation and restless legs syndrome (RLS) are increasingly seen in clinical practice. Sleep is considered vital for preserving daytime cognitive function and physiological well-being. Sleep insufficiency may have deleterious effects on work-life balance, overall health and safety. The consequential economic burden at both the individual and societal levels is significant. Moreover, sleep disorders are commonly associated with other major medical problems such as chronic pain, cardiovascular disease, mental illness, dementias, gastrointestinal disorders and diabetes mellitus. Thus, in order to properly care for patients presenting with sleep-related morbidity, and to reduce the consequential economic burden, accurate screening efforts and efficacious/cost-effective treatments need to be developed and employed.Cost-of-illness, Dyssomnias, assessment, Fatigue, assessment, Intrinsic-sleep-disorders, assessment, Parasomnias, assessment, Restless-legs-syndrome, assessment, Sleep-apnoea-syndrome, assessment, Sleep-disorders, assessment.

Use of power-law analysis to predict abuse or diversion of prescribed medications: proof-of-concept mathematical exploration

Abstract Objective To conduct a proof-of-concept study comparing Lorenz-curve analysis (LCA) with power-law (exponential function) analysis (PLA), by applying segmented regression modeling to 1-year prescription claims data for three medications—alprazolam, opioids, and gabapentin—to predict abuse and/or diversion using power-law zone (PLZ) classification. Results In 1-year baseline observation, patients classified into the top PLZ groups (PLGs) were demographically and diagnostically similar to those in Lorenz-1 (top 1% of utilizers) and Lorenz-25 (top 25%). For prediction of follow-up (6-month post-baseline) Lorenz-1 use of alprazolam and opioids (i.e., potential abuse/diversion), PLA had somewhat lower sensitivity compared with LCA (83.5–95.4% vs. 99.5–99.9%, respectively) but better specificity (98.2–98.8% vs. 75.5%) and much better positive predictive value (PPV; 34.5–45.3% vs. 4.0–4.6%). Of top-PLG alprazolam- and opioid-treated patients, respectively, 20.7 and 9.9% developed incident (new) Lorenz-1 in followup, compared with < 3% of Lorenz-25 patients. For gabapentin, neither PLA nor LCA predicted incident Lorenz-1 (PPV = 0.0–1.4%). For all three medications, PLA sensitivity for follow-up hospitalization was < 5%, but specificity was better for PLA (97.3–99.2%) than for LCA (74.3–75.4%). PLA better identified patients at risk of future controlled substance abuse/diversion than did LCA, but the technique needs refinement before widespread use

Hospital Length of Stay for Schizophrenia: Is Primary Payer an Influencing Factor?

Objective: The purpose of this study was 3-fold: (i) to determine the distribution of US patients diagnosed with schizophrenia and requiring a hospitalisation in the calendar year 1988 or 1992, by primary payer type (Medicare; Medicaid; or private insurance); (ii) to discern the mean inpatient length of stay and charge per day in 1988 or 1992, by payer type; and (iii) to test for time trends between 1988 and 1992, for inpatient hospital length of stay and charge per day. Design and setting: A retrospective study using the Healthcare Cost and Utilisation Project (HCUP-3) Nationwide Inpatient Sample (NIS), Release 1, as the database. Patients and participants: The study population was selected from all 1988 and 1992 discharges of patients that were >=10 years of age; had an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic code of 295.00 to 295.95, indicating schizophrenia as the primary diagnosis; were hospitalised between 1 and 40 days; and had Medicare, Medicaid, or private insurance, inclusive of fee-for-service or managed care, identified as the primary source of insurance coverage. The final sample used for this analysis consisted of 22 479 discharges from 1988, and 33 969 discharges from 1992. Main outcome measures and results: After adjusting for potentially confounding factors, the mean hospital length of stay for schizophrenia decreased by over 1 day (from 10.1 to 9.0; pPharmacoeconomics, Schizophrenia, Cost-analysis, Hospitalisation, Reimbursement

Trends in the Rate of Self-Report and Diagnosis of Erectile Dysfunction in the United States 1990-1998: Was the Introduction of Sildenafil an Influencing Factor?

Objective: To present the pattern of self-report and diagnosis of erectile dysfunction in the US over the time period 1990 through 1998 and examine whether the introduction of sildenafil in March 1998 influenced these findings. Study design and methods: Retrospective database analysis. Data from the National Ambulatory Medical Care Survey (NAMCS) for the years 1990 through 1998 were used. Data from office-based physician-patient encounters for which either a complaint of erectile dysfunction as one of the reasons for requesting an encounter [National Center for Health Statistics (NCHS) code 1160.3] or a diagnosis of erectile dysfunction [International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 302.72 or 607.84] was documented were extracted for men aged >=40 years. National estimates per year were derived for: 1. the number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an encounter and the number of office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; 2. the rate per 1000 office-based physician-patient encounters for which a complaint of erectile dysfunction as a reason for requesting the encounter was documented and the rate per 1000 office-based physician-patient encounters for which a diagnosis of erectile dysfunction was documented; and 3. the rate per 1000 US male population aged >=40 years with a complaint of erectile dysfunction as a reason for requesting an encounter and the rate per 1000 US male population aged >=40 years with a diagnosis of erectile dysfunction. Results: The number of office-based physician-patient encounters for which a complaint of erectile dysfunction was documented increased from 764 682 in 1990 to 1 273 730 in 1998. The number of office-based physician-patient encounters with a recorded diagnosis of erectile dysfunction more than doubled over the time period examined, from 647 418 in 1990 to 1 495 793 in 1998. Office-based encounters for which a complaint of erectile dysfunction was documented as a reason for requesting an appointment increased from 5.7 per 1000 in 1990 to 7.0 per 1000 in 1998; the rate of diagnosis of erectile dysfunction increased from 4.8 per 1000 in 1990 to 8.2 per 1000 in 1998. The population-adjusted rate of complaint of erectile dysfunction increased from 17.5 per 1000 in 1990 to 24.2 per 1000 in 1998; the rate of diagnosis increased from 14.9 per 1000 in 1990 to 28.4 per 1000 in 1998. In 1998, 2 142 776 office-based physician-patient encounters documented the prescribing of sildenafil; of these, 41% were for patients with a recorded diagnosis of erectile dysfunction. Conclusions: The introduction of sildenafil was found not to have influenced the established upward trend in the documented rate of self-report of erectile dysfunction or the diagnosis of erectile dysfunction. However, the prescribing of sildenafil appears to offer greater insight into the actual magnitude of the problem erectile dysfunction represents in the US. Findings suggest there is a reluctance on the part of patients to discuss concerns about erectile dysfunction with their physician and a reluctance on the part of physicians to document patients' expressed concerns regarding erectile dysfunction and/or to record a diagnosis of erectile dysfunction.Erectile dysfunction, Erectile dysfunction, Pharmacoeconomics, Sildenafil