Marco DiBonaventura

The costs of obesity in the workplace.

Objective: To quantify per capita and aggregate medical expenditures and the value of lost productivity, including absenteeism and presenteeism, because of overweight, and grade I, II, and III obesity among U.S. employees. Methods: Cross-sectional analysis of the 2006 Medical Expenditure Panel Survey and the 2008 National Health and Wellness Survey. Results: Among men, estimates range from −

Humanistic and economic impacts of hepatitis C infection in the United States

322 for overweight to

The impact of hepatitis C on labor force participation, absenteeism, presenteeism and non-work activities

6087 for grade III obese men. For women, estimates range from

The Burden of Illness for Patients with Viral Hepatitis C: Evidence from a National Survey in Japan

797 for overweight to

Direct and Indirect Costs and Potential Cost Savings of Laparoscopic Adjustable Gastric Banding Among Obese Patients With Diabetes

6694 for grade III. In aggregate, the annual cost attributable to obesity among full-time employees is

Vaccination Rates among the General Adult Population and High-Risk Groups in the United States

73.1 billion. Individuals with a body mass index >35 represent 37% of the obese population but are responsible for 61% of excess costs. Conclusions: Successful efforts to reduce the prevalence of obesity, especially among those with a body mass index >35, could result in significant savings to employers.

Multicountry burden of chronic hepatitis C viral infection among those aware of their diagnosis: a patient survey.

Abstract Objective: Prior research examining the effect of hepatitis C virus (HCV) on health-related quality of life (HRQoL) and healthcare costs is flawed because non-patient controls were not adequately comparable to HCV patients. The current study uses a propensity score matching methodology to address the following research question: is the presence of diagnosed hepatitis C (HCV) associated with poorer health-related quality of life (HRQoL) and greater healthcare resource use? Methods: Using data from the 2009 US National Health and Wellness Survey, patients who reported a HCV diagnosis (nu2009=u2009695) were compared to propensity-matched controls (nu2009=u2009695) on measures of HRQoL and healthcare resource use. All analyses applied sampling weights to project to the US population. Results: HCV patients reported significantly lower levels of HRQoL relative to the matched-control group, including the physical component score (39.6 vs. 42.7, pu2009<u20090.0001) and health utilities (0.63 vs. 0.66, pu2009<u20090.0001). The number of emergency room visits (0.59 vs. 0.44, pu2009<u20090.05) and physician visits (7.7 vs. 5.9, pu2009<u20090.05) in the past 6 months were significantly higher for the HCV group relative to matched controls. Conclusion: The results of this study suggest that HCV represents a substantial burden on patients by having a significant and clinically-relevant impact on key dimensions of HRQoL as well as on utilization of healthcare resources, the latter of which would result in increased direct medical costs. Limitations: Due to limitations of the internet survey approach (e.g., inability to confirm HCV diagnosis), future research is needed to confirm these findings.

Incorporating Indirect Costs into a Cost-Benefit Analysis of Laparoscopic Adjustable Gastric Banding

Abstract Objective: Between 2.7 and 3.9 million people are currently infected with the hepatitis C virus (HCV) in the United States. Although many studies have investigated the impact of HCV on direct healthcare costs, few studies have estimated the indirect costs associated with the virus using a nationally-representative dataset. Methods: Using data from the 2009 United States (US) National Health and Wellness Survey, patients who reported a hepatitis C diagnosis (nu2009=u2009695) were compared to controls on labor force participation, productivity loss, and activity impairment after adjusting for demographics, health risk behaviors, and comorbidities. All analyses applied sampling weights to project to the population. Results: Patients with HCV were significantly less likely to be in the labor force than controls and reported significantly higher levels of absenteeism (4.88 vs. 3.03%), presenteeism (16.69 vs. 13.50%), overall work impairment (19.40 vs.15.35%), and activity impairment (25.01 vs. 21.78%). A propensity score matching methodology replicated many of these findings. Conclusions: While much of the work on HCV has focused on direct costs, our results suggest indirect costs should not be ignored when quantifying the societal burden of HCV. To our knowledge, this is the first study which has utilized a large, nationally-representative data source for identifying the impact of HCV on labor force participation and work and activity impairment using both a propensity-score matching and a regression modeling framework. Limitations: All data were patient-reported (including HCV diagnosis and work productivity), which could have introduced some subjective biases.

The association between osteoporosis and patient outcomes in Japan

OBJECTIVEnViral hepatitis C (HCV) affects 170 million patients worldwide and 2 million patients in Japan. The objective of the current study was to examine the burden of HCV in Japan from a patients perspective.nnnMETHODSnUsing data from the 2008 and 2009 Japan National Health and Wellness Surveys, patients who reported an HCV diagnosis (n = 306) were compared with a propensity-score-matched control group (n = 306) on measures of quality of life (using the Medical Outcomes Study 12-Item Short Form Survey Instrument version 2), work productivity (using the Work Productivity and Activity Impairment questionnaire), and health-care resource use. All analyses applied sampling weights to project to the population.nnnRESULTSnPrior to matching, patients with HCV had higher rates of hepatocellular carcinoma (4.88% vs. 0.02%) and cirrhosis (12.20% vs. 0.11%) than did subjects without HCV. The propensity-matching process eliminated differences between the two groups on demographics and patient characteristics. The postmatching analysis found significantly lower levels of quality of life for patients with HCV as measured by bodily pain (72.07 vs. 76.28), general health (44.64 vs. 48.61), and mental health (66.50 vs. 70.32) (all Ps < 0.05). Furthermore, compared with the matched group, the HCV group had significantly higher workplace absenteeism (8.59% vs. 4.12%), overall work impairment (26.08% vs. 17.32%), and health-care provider visits in the past 6 months (14.80 vs. 9.74).nnnCONCLUSIONSnThe results of this study suggest that HCV can be a substantial burden on patients in terms of quality of life in both physical and mental health measures. In addition, HCV can be a significant cost driver in terms of health-care use and lost productivity.

PCV13 BURDEN OF COMORBIDITIES AMONG PATIENTS WITH ATRIAL FIBRILLATION

Objective: To estimate the time to breakeven and 5-year net costs for laparoscopic adjustable gastric banding among obese patients with diabetes taking direct and indirect costs into account. Methods: Indirect cost savings were generated by quantifying the cross-sectional relationship between medical expenditures and absenteeism and between medical expenditures and presenteeism (reduced on-the-job productivity) and simulating indirect cost savings based on these multipliers and reductions in direct medical costs available in the literature. Results: Time to breakeven was estimated to be nine quarters with and without the inclusion of indirect costs. After 5 years, net savings increase from