Joish, V.N.

Kamalakar, R.

Luong, B.

Operschall, E.

Spilsbury-Cantalupo, M.

Elsevier - Publisher Connector 

PHS19 Direct medical costs associated with exacerbations related to non-cystic fibrosis bronchiectasis 

A188 V A L U E  I N  H E A L T H  1 6  ( 2 0 1 3 )  A 1 - A 2 9 8  
  
 
of Diseases (ICD)-9 diagnosis codes 381 or 382. Incremental total expenditures 
associated with OM were estimated using a regression model adjusting for age, 
gender, race, ethnicity, education, geographic region, insurance status and 
number of medications used (proxy for comorbidity). Given the skewed 
distribution of expenditure variables, multiple model specifications including 
ordinary least squares regression, generalized linear model (GLM) with Poisson, 
gamma and negative binomial variance functions were evaluated. RESULTS: The 
prevalence of OM among children in the US was estimated at 11.32%, i.e., 8.47 
million persons (95% CI: 10.30% to 12.33%). A majority of children with OM were 
male (51.7%), white (84.2%), and insured (97.3%) with mean age of 4.7±0.20 years 
and education of 0.9±0.11 years. In unadjusted analysis among patients with OM, 
physician office visits comprised the largest proportion of total expenditures at 
$769.06 (SE: 54.99), followed by prescription medications at $606.56 (SE: $41.72), 
and inpatient visits at $500.73 (SE: $148.42). After controlling for covariates, 
children with OM had 48% higher total expenditures than those without OM 
(Estimate: 1.48; p=0.001). The annual adjusted mean incremental total 
expenditure associated with OM was $543.10 (SE: $192.0; p=0.005) per person. 
CONCLUSIONS: Given the prevalence of OM in children and its associated 
incremental expenditures, the annual direct medical expenditure for treating OM 
in children is estimated at approximately $4.6 billion in 2012 US dollars.  
 
PHS19  
DIRECT MEDICAL COSTS ASSOCIATED WITH EXACERBATIONS RELATED TO 
NON-CYSTIC FIBROSIS BRONCHIECTASIS  
Joish VN1, Spilsbury-Cantalupo M2, Kamalakar R3, Operschall E4, Luong B5 
1Bayer HealthCare Pharmaceuticals, Inc., Wayne, NJ, USA, 2Bayer HealthCare Pharmaceuticals, 
Inc, Wayne, NJ, USA, 3Bayer Pharmaceuticals, Wayne, NJ, USA, 4Bayer Schering Pharma, AG, 
Berlin, Berlin, Germany, 5Bayer Pharma AG, Berlin, Berlin, Germany  
OBJECTIVES: To estimate direct medical costs in non-cystic fibrosis 
bronchiectasis (NCB) patients with exacerbations. METHODS: An observational, 
retrospective cohort study was conducted using data from MarketScan claims 
database. Bronchiectasis patients were identified as those with a medical claim 
with ICD-9 codes of 494.0 or 494.1 anytime between July 1, 2009 to June 30, 2010. 
The first bronchiectasis-related claim during this period was defined as the 
index event. All patients had to have no other bronchiectasis related medical 
claim 12-months before the index event and no cystic fibrosis related medical 
claim (ICD-9 code:277.0) 12-months before and after index event. NCB patients 
were divided into two cohorts. Each NCB patient with exacerbation (NCB-E) was 
matched to three NCB patients without exacerbations (NCB-W) on geographic 
region, health plan and gender. Medical resource use and expenditures were 
estimated for 12-months before and after index event and compared between 
the two cohorts using non-parametric univariate statistical tests. RESULTS: 897 
NCB-E patients were matched to 2,691 NCB-W patients. NCB-E patients were 
older (67 vs. 64, p<0.01), had greater overall comorbidity as estimated by the 
Charlson’s comorbidity score (1.83 vs. 1.66, p=0.01), and respiratory/chest-related 
symptoms (73% vs. 66%, p<0.001) at baseline compared to NCB-W patients. Total 
average costs per patient post index-event were significantly greater among 
NCB-E versus NCB-W patients ($35,718 vs. $26,868). After adjusting for baseline 
health care expenditures, the overall annual average incremental burden due to 
exacerbations were estimated to be $7,643. Of this, inpatient hospital costs 
accounted for $5,772 or 75% of this burden. Bronchiectasis-related total costs 
were also significantly (p<0.001) higher in the follow-up period among NCB-E 
patients compared to NCB-W patients ($4,609 vs. $1,210), even after adjusting for 
baseline consumption. CONCLUSIONS: NCB patients with exacerbations have 
greater medical expenditures than those without. Effective management of 
exacerbations may be the key in controlling economic burden in this patient 
population.  
 
PHS20  
DIRECT MEDICAL COSTS OF DIABETIC COMPLICATIONS IN THE UNITED 
STATES  
Alvarez P1, Ward A1, Chow W2, Vo L2, Martin S2 
1United BioSource Corporation, Lexington, MA, USA, 2Janssen Scientific Affairs, LLC, Raritan, NJ, 
USA  
OBJECTIVES: To estimate the direct medical costs associated with managing 
complications of type 2 diabetes in the United States. METHODS: A combination 
of direct data analysis and microcosting was used to estimate costs for an event 
leading to either a hospital admission or outpatient care, and the post-acute care 
associated with managing macrovascular, microvascular, and other 
complications. Data were obtained from many sources, including inpatient and 
emergency department care databases, national physician and laboratory fee 
schedules, government reports, and published literature. For each complication, 
the event year costs derived refer to those associated with the acute episode and, 
when appropriate, include subsequent ongoing care provided within the first 
year following the acute episode. Annual costs after the first year for the 
continued management of complications were also estimated. All costs are 
reported in 2012 USD. RESULTS: Annual costs accrued per patient in the year of 
the event were estimated for the following macrovascular complications: 
myocardial infarction $56,445, ischemic stroke $42,119, congestive heart failure 
$23,758, ischemic heart disease $21,406, and transient ischemic attack $7,388. 
Event year costs per patient for microvascular complications were: chronic 
kidney disease $71,714, lower extremity amputations $9,041, blindness  
$2,862, and diabetic foot ulcers $2,147. Cost estimates of a medically managed 
hypoglycemic episode were: $176, $1,311, and $16,478 for a mild, moderate, or 
severe (i.e., requiring hospitalization) episode. CONCLUSIONS: This study 
provides updated and additional estimates of the cost of diabetic complications 
in 2012 USD, following the methodology used to generate prior cost estimates in 
2000 USD referenced in many diabetes economic models (O’Brien et al.  
Clin Ther 2003;25(3):1017-1038). Managing complications results in substantial 
costs to the health care system, as macrovascular complications yield high 
inpatient care costs in the event year, and long-term management of 
complications such as chronic kidney disease lead to substantial ongoing annual 
costs.  
 
PHS21  
RENAL CELL CARCINOMA TREATMENT IN SÃO PAULO, BRAZIL: PATTERNS  
AND COSTS OF HOSPITALIZATION  
Fernandes RA1, Takemoto MMS1, Takemoto MLS1, Amaral LM1, Vasconcellos JF1, Haas 
LC1, Silva MA1, Fujii RK2, Cortes M2, Mould J3 
1ANOVA - Knowledge Translation, Rio de Janeiro, RJ, Brazil, 2Pfizer, Inc., São Paulo, Brazil, 
3Pfizer, New York, NY, USA  
OBJECTIVES: São Paulo is a Brazilian state with the largest number of cancer 
reference hospitals and hosts 21% of country population. This study aims to 
describe hospitalization patterns and costs for renal cell carcinoma (RCC) in 
public hospitals in São Paulo state, Brazil. METHODS: A retrospective analysis of 
São Paulo public hospital admissions for RCC was developed according to ICD-10 
classification (C64) as reported in Brazilian Hospital Information System 
(SIH/DATASUS) database from January 2007 to December 2011. Admissions were 
categorized into surgical (containing any surgical procedures codes at 
hospitalization data eg.: tumor excision, biopsy, etc.) or clinical (all non-surgical 
eg.: chemotherapy, infection treatment, anemia, etc.). Costs represent federal 
reimbursement values for hospitalizations (includes medical procedures, exams, 
medications and taxes), presented in 2012 Brazilian Real (BRL). Average 2012 
exchange rate was 1,9544BRL/USD. RESULTS: In the period, 4,138 hospital 
admissions were identified (951, 1,126, 1,207, and 854 for 2007, 2008, 2009, and 
2011, respectively), and total cost was 5,472,534BRL, which represents 0.78% of all 
cancer in-hospital treatment in the state. Mean cost per patient was 1,326BRL, 
675BRL, and 1,854BRL for all hospitalizations, clinical and surgical procedures, 
respectively. Surgical procedures were responsible for 55.07% of cases, and 
77.29% of total costs, with partial or total nephrectomy representing the main 
cause (48.9%). Mean length of stay was 6.99 days. In-hospital mortality rate was 
9.98% for all cause (17.7% and 3.69% for clinical and surgical procedures, 
respectively). When compared to the national cases, São Paulo represents 29.74% 
of them, while representing 33.18% of total national hospitalization costs related 
to RCC. CONCLUSIONS: RCC hospitalizations costs in São Paulo are responsible 
for less than 1% of all cancer in-hospital treatments in the state, which may 
suggest under-diagnosing when compared to international incidence rates. São 
Paulo is an important RCC treatment center in Brazil, capturing about one third 
of country resources.  
 
PHS22  
COSTS AND HEALTH CARE RESOURCE UTILIZATION ASSOCIATED WITH 
ASTHMA IN CANADA: A SYSTEMATIC REVIEW  
Ismaila A1, Sayani A1, Marin M2, Tacon C1, Crater G1, Su Z1 
1GlaxoSmithKline, Mississauga, ON, Canada, 2OptumInsight, Life Sciences, Burlington, ON, 
Canada  
OBJECTIVES: To determine the cost and health care resource utilization 
associated with asthma management in Canada. METHODS: A systematic 
literature search of PUBMED, EMBASE and EMCare electronic databases using 
relevant search strategy was conducted from 2000 until 2011 to identify articles, 
published in English, that reported the data on the clinical and economic burden 
of asthma in Canada. Two investigators independently screened citations, 
reviewed studies, assessed study quality and abstracted data. Heterogeneity in 
study design, data sources and asthma definition precluded meta-analysis of 
study outcomes. All costs were reported in Canadian dollars and inflated to 2011. 
RESULTS: Of the 570 citations identified, 67 full-text articles were reviewed, of 
which 33 studies met inclusion criteria. Both children and adults with asthma 
averaged less than one emergency department (ED) visit per patient per year. In 
children, frequency of visits was largely influenced by the presence of prior 
asthma exacerbations. In adults, increased ED visits were associated with 
inappropriate use of asthma medication. ED visit rates were significantly higher 
in women than in men and, increased with age. Hospitalization rates in children 
decreased with age and patients with persistent asthma were more than one and 
a half times admitted more often than those with non-symptomatic asthma. 
Average hospitalization costs per acute asthma episode ranged from $458 to $923 
and the average costs for ED visit per acute asthma episode ranged from $219.08 
to $276.76, excluding medication cost. The average annual cost of asthma 
medication was $230.58 per patient. Annual productivity loss days in adult 
asthma patients varied from 12 in employed persons to 20 in students and 49 in 
disability pensioners. CONCLUSIONS: The available evidence shows that the 
asthma-related costs, both direct and indirect remain substantial. The overall 
burden varies based on whether studies reported costs from the perspective of 
an individual asthmatic or from the population level.  
 
PHS23  
MELANOMA HEALTH CARE PATHWAYS IN AN ITALIAN POPULATION  
Ascierto P1, Bernardi D2, De Rosa M3, Martini N4, Rielli R5, Rossi E3 
1Istituto Nazionale Tumori Fondazione “G. Pascale”, Napoli, Italy, 2CINECA, Casalecchio di Reno - 
Bologna, Italy, 3CINECA Interuniversity Consortium, Casalecchio di Reno , BO, Italy, 4National 
Academy of Medicine, Roma, Italy, 5CINECA, Casalecchio di Reno (BO), Italy  
OBJECTIVES: To describe treatment patterns, direct costs and comorbidities in a 
population of patients with melanoma. METHODS: Starting from ARNO 
Observatory, an Italian population-based patient-centric system through record 
linkage of 11 million inhabitants, we identified a cohort of patients with 
melanoma (ICD-9 code: 172 and/or V10.82) during 2009. Discharge records, 
reimbursed prescription patterns, lab tests and diagnostic examinations were 


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PHS19 Direct medical costs associated with exacerbations related to non-cystic fibrosis bronchiectasis

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