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Background Head and neck cancers are of particular interest to health care providers, their patients, and those paying for health care services, because they have a high morbidity, they are extremely expensive to treat, and of the survivors only 48% return to work. Consequently the economic burden of oral cavity, oral pharyngeal, and salivary gland cancer (OC/OP/SG) must be understood. The cost of these cancers in the U.S. has not been investigated. Methods A retrospective analysis of administrative claims data for 6,812 OC/OP/SG cancer patients was undertaken. Total annual health care spending for OC/OP/SG cancer patients was compared to similar patients without OC/OP/SG cancer using propensity score matching for enrollees in commercial insurance, Medicare, and Medicaid. Indirect costs, as measured by short term disability days were compared for employed patients. Results Total annual health care spending for OC/OP/SG patients during the year after the index diagnosis was $79,151 for the Commercial population. Health care costs were higher for OC/OP/SG cancer patients with Commercial Insurance ($71,732, n = 3,918), Medicare ($35,890, n = 2,303) and Medicaid ($44,541, n = 585) than the comparison group (all p  < 0.01). Commercially-insured employees with cancer (n = 281) had 44.9 more short-term disability days than comparison employees ( p  < 0.01). Multimodality treatment was twice the cost of single modality therapy. Those patients receiving all three treatments (surgery, radiation, and chemotherapy) had the highest costs of cost of care, from $96,520 in the Medicare population to $153,892 in the Commercial population. Conclusions In the U.S., the cost of OC/OP/SG cancer is significant and may be the most costly cancer to treat in the U.S. The results of this analysis provide useful information to health care providers and decision makers in understanding the economic burden of head and neck cancer. Additionally, this cost information will greatly assist in determining the cost-effectiveness of new technologies and early detection systems. Earlier identification of cancers by patients and providers may potentially decrease health care costs, morbidity and mortality.

Objective: To quantify the impact of health risks on medical care and productivity costs in an employed population. Methods: Health risk, medical care, and productivity data were obtained for 5875 Novartis employees in 2005-2006. Factor analysis was performed to identify relationships among health risks. Multiple regression analyses were applied to estimate relationships between combined risk factors and costs. Results: We found a significant and consistent association amon three factors (high biometric laboratory values, cigarette and alcohol use, and poor emotional health) and increased presenteeism for both men and women and increased absenteeism for women. Medical care expenditures were 13-22% higher for men and women at risk for the high biometric laboratory values and the emotional health factor. Conclusions: There is a potential for medical and productivity savings for employers able to reduce health risks among their workers.

Objective: To estimate the impact of medication adherence on absenteeism and short-term disability among employees with chronic disease. Methods: Cross-sectional analysis of administrative health care claims, absenteeism, and short-term disability data using multivariate regression and instrumental variable models for five cohorts of employees: diabetes, hypertension, congestive heart failure, dyslipidemia, and asthma/chronic obstructive pulmonary disease. Adherence was defined as possessing medication on at least 80% of days during follow-up. Results: Adherent employees with diabetes, hypertension, dyslipidemia, and asthma/chronic obstructive pulmonary disease realized between 1.7 and 7.1 fewer days absent from work and between 1.1 and 5.0 fewer days on short-term disability. Absenteeism and short-term disability days by adherent employees with congestive heart failure were not significantly different from nonadherent employees with the condition in most specifications. Conclusions: Appropriate management of chronic conditions can help employers minimize losses due to missed work.

Objective: To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Methods: Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. Results: High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Conclusions: Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

To compare health care utilization and expenditures in patients with depression whose initial antidepressant (AD) treatment was augmented with a second-generation antipsychotic. Claims data from January 1, 2001, through June 30, 2009, were used to select patients aged 18 to 64 years with depression treated with ADs augmented with aripiprazole, olanzapine, or quetiapine. Patients were required to have 6 months of continuous eligibility before the first AD prescription and 6 months after the second-generation antipsychotic augmentation (index) date. Utilization and expenditures were assessed for 6 months after the index date. Multivariate regression was used to estimate adjusted expenditures and risks for hospitalizations and emergency department visits. A total of 483 patients treated with aripiprazole, 978 with olanzapine, and 2471 with quetiapine were selected. Mean adjusted expenditures for aripiprazole were significantly lower than those for olanzapine for each service category (all-cause, all-cause medical care, mental health-related, and mental health-related medical care) and were significantly lower than those for quetiapine for each category with the exception of mental health-related. The adjusted risks for hospitalization and emergency department visits were significantly higher for quetiapine than for aripiprazole. Compared with patients treated with ADs and aripiprazole, those treated with ADs and olanzapine or quetiapine had greater utilization and higher expenditures.

IntroductionMany patients with obstructive sleep apnoea (OSA) experience excessive daytime sleepiness (EDS) despite primary airway therapy. This study aimed to understand the burden of EDS in European adults with OSA who received primary airway therapy.MethodsNon-interventional, qualitative study in patients with EDS in OSA, from the UK, Germany, and Spain. Post-IRB approval, patients with self-reported OSA were recruited via patient panels. Eligible patients had Epworth Sleepiness Scale (ESS) score ≥10, self-reported adequate nightly sleep, current/past primary airway therapy, and no other self-reported EDS-associated conditions. Patients completed a quantitative pre-interview questionnaire and a qualitative, semi-structured telephone interview.ResultsFifteen patients (n=5/country; 60% female; mean age, 48.7 years; mean years since OSA diagnosis, 7.7) were included. Six of 8 current positive airway pressure (PAP) users were compliant (≥4 h, 7 nights/wk); 6 of 7 non-PAP users had prior airway surgery. Mean ESS score was 14.5; 60% of those without an EDS diagnosis reported discussing EDS with their doctor. Patients experienced broadly consistent negative impacts from EDS, including physical functioning (n=15), daily life activities (n=15), work/study habits (n=14), emotional (n=15), social life (n=14), and cognition (n=13). No between-country differences were observed.DiscussionFindings demonstrate the patient-perceived burden of residual EDS in OSA. Forty percent of patients without an EDS diagnosis did not discuss EDS with their doctor despite daily impacts.

Introduction Previous research has found that the percentage of US adults with diabetes achieving a glycated hemoglobin (HbA1c) target of <7.0% with currently available treatments has been fairly constant from 2003 to 2010, remaining at just over 50% [ 1 ]. The objective of this study was to compare the most recent data (2011–2014) with earlier data to track progress on HbA1c target achievement, for both the general target of <7.0% and inferred individualized targets based on age and the presence of complications. Methods Data from 2677 adults with self-reported diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2014 were examined to determine the percentage of adults who achieved HbA1c targets of <7% and an individualized target based on age and comorbidities. National estimates are reported by using weights that account for the complex sampling design of the NHANES. Results The percentage of people with diabetes and HbA1c <7.0% slightly declined from 52.2% (95% CI 48.7–55.7%) to 50.9% (95% CI 47.2–54.7%) between the two most recent waves of data. Achievement of individualized targets declined from 69.8% (95% CI 66.5–73.0%) to 63.8% (95% CI 60.1–67.5%). The percentage with HbA1c >9.0% increased from 12.6% (95% CI 10.5–14.8%) to 15.5% (95% CI 12.9–18.2%). Achievement of individualized targets varied by age group and presence of comorbidities, but exhibited similar trends as general target achievement. Conclusions Despite the development of many new medications to treat diabetes during the past decade, the proportion of patients achieving glycemic control targets has not improved. Funding Intarcia Therapeutics.

Objectives: To develop a calculator that measures the potential cost impact of changes in health risks and presents results graphically. Methods: Demographic and health risk data for Novartis employees were input into a calculator that estimated employer medical care, short-term disability, absenteeism, and presenteeism costs associated with risk prevalence, based on a previous cross-sectional analysis of the association between risks and costs. Estimated costs were presented as a relative score, the Novartis Health Index, which is a measure of the overall costs associated with the risk profile of a population of interest. Results: The population of Novartis employees had an index score of 81.5 (out of 100), indicating a relatively healthy risk profile, and baseline annual costs of $9619 per employee. Risk reduction of 1% and 10% for tobacco, alcohol use, and emotional health risks had the potential to generate annual savings of $91,500 and $915,000, respectively. Conclusions: The Novartis Health Index framework allows employers to track performance relative to health risk management using a single, accessible, user-friendly measure.

Objective: To estimate direct medical costs and indirect (productivity related) for women age 25 to 54 who had clinically significant and symptomatic uterine fibroids (UF). Methods: We compared direct medical expenditures among 30,659 women who had clinically significant and symptomatic UF to expenditures among an equal number of matched controh who did not. We also compared indirect costs for a sub-sample of 910 employed women in each group. Regression analyses controlled for demographic and casemix factors. Results: Mean 12month direct medical costs for women with UF were $11,720 versus $3257 for controls, and mean 12-month indirect costs for women with UF were $11,752 versus $8083 for controls. Differences were statistically significant (P < 0.0001). Conclusions: UF is a costly disorder and merits thought as interventions are considered to improve women's health and productivity.

Background Following withdrawals, failures, and significant litigation settlements, drug product launches in the anti-obesity category slowed despite a large and growing unmet need. Litigation concerns, a more risk-averse regulatory policy, and the difficulty of developing a product with a compelling risk-benefit profile in this category may have limited innovators’ expected return on investment and restricted investment in this therapeutic area. Objective The objective of the study was to estimate perceived manufacturer risk associated with product safety litigation and increased development costs vs. revenue expectations on anticipated return on investment and to determine which scenarios might change a manufacturer’s investment decision. Methods Expected net present value of a weight-management drug entering pre-clinical trials was calculated for a range of scenarios representing evolving expectations of development costs, revenue, and litigation risk over the past 25 years. These three factors were based on published estimates, historical data, and analogs from other therapeutic areas. Results The main driver in expected net present value calculations is expected revenue, particularly if one assumes that litigation risk and demand are positively correlated. Changes in development costs associated with increased regulatory concern with potential safety issues for the past 25 years likely did not impact investment decisions. Conclusions Regulatory policy and litigation risk both played a role in anti-obesity drug development; however, product revenue—reflecting efficacy at acceptable levels of safety—was by far the most important factor. To date, relatively modest sales associated with recent product introductions suggest that developing a product that is sufficiently efficacious with an acceptable level of safety continues to be the primary challenge in this market.