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To compare the indications for hospital admission between current, former, and never smokers and to compare their costs per hospital admission, testing the hypothesis that the cost per hospital admission would be higher for smokers than for former and never smokers.

AbstractObjective:Patients with constipation account for 3.1 million US physician visits a year, but care costs for patients with irritable bowel syndrome with constipation (IBS-C) or chronic idiopathic constipation (CIC) compared to the general public have received little study. The study aim was to describe healthcare utilization and compare medical costs for patients with IBS-C or CIC vs matched controls from a community-based sample.Methods:A nested case-control sample (IBS-C and CIC cases) and matched controls (1:2) for each case group were selected from Olmsted County, MN, individuals responding to a community-based survey of gastrointestinal symptoms (2008) who received healthcare from a participating Rochester Epidemiology Project (REP) provider. Using REP healthcare utilization data, unadjusted and adjusted standardized costs were compared for the 2- and 10-year periods prior to the survey for 115 IBS-C patients and 230 controls and 365 CIC patients and 730 controls. Two time periods were chosen as these conditions are episodic, but long-term.Results:Outpatient costs for IBS-C ($6,800) and CIC ($6,284) patients over a 2-year period prior to the survey were significantly higher than controls ($4,242 and $5,254, respectively) after adjusting for co-morbidities, age, and sex. IBS-C outpatient costs ($25,448) and emergency room costs ($6,892) were significantly higher than controls ($21,024 and $3,962, respectively) for the 10-year period prior. Unadjusted data analyses of cases compared to controls demonstrated significantly higher imaging costs for IBS-C cases and procedure costs for CIC cases over the 10-year period.Limitations:Data were collected from a random community sample primarily receiving care from a limited number of providers in that area.Conclusions:Patients with IBS-C and CIC had significantly higher outpatient costs for the 2-year period compared with controls. IBS-C patients also had higher ER costs than the general population.

The aim of this study was to determine the utility of intraoperative cystoscopy in detecting and managing ureteral injury among women undergoing vaginal hysterectomy.

Objective:To evaluate the cost–effectiveness of the following three treatments of uterine fibroids in a population of premenopausal women who wish to preserve their uteri: myomectomy, magnetic resonance-guided focused ultrasound (MRgFUS) and uterine artery embolization (UAE). Materials & methods:A decision analytic Markov model was constructed. Cost–effectiveness was calculated in terms of US$ per quality-adjusted life year (QALY) over 5 years. Two types of costs were calculated: direct costs only, and the sum of direct and indirect (productivity) costs. Women in the hypothetical cohort were assessed for treatment type eligibility, were treated based on eligibility, and experienced adequate or inadequate symptom relief. Additional treatment (myomectomy) occurred for inadequate symptom relief or recurrence. Sensitivity analysis was conducted to evaluate uncertainty in the model parameters. Results: In the base case, myomectomy, MRgFUS and UAE had the following combinations of mean cost and mean QALYs, respectively: US$15,459, 3.957; US$15,274, 3.953; and US$18,653, 3.943. When incorporating productivity costs, MRgFUS incurred a mean cost of US$21,232; myomectomy US$22,599; and UAE US$22,819. Using probabilistic sensitivity analysis (PSA) and excluding productivity costs, myomectomy was cost effective at almost every decision threshold. Using PSA and incorporating productivity costs, myomectomy was cost effective at decision thresholds above US$105,000/QALY; MRgFUS was cost effective between US$30,000 and US$105,000/QALY; and UAE was cost effective below US$30,000/QALY. Conclusion:Myomectomy, MRgFUS, and UAE were similarly effective in terms of QALYs gained. Depending on assumptions about costs and willingness to pay for additional QALYs, all three treatments can be deemed cost effective in a 5-year time frame.

IMPORTANCE Cigarette smoking adds an estimated $100 billion in annual incremental direct health care costs nationwide. Cigarette smoking increases complication risk in surgical patients, but the potential effects of smoking status on perioperative health care costs are unclear. OBJECTIVE To test the hypothesis that current and former smoking at the time of admission for inpatient surgery, compared with never smoking, are independently associated with higher incremental health care costs for the surgical episode and the first year after hospital discharge. DESIGN, SETTING, AND PARTICIPANTS This population-based, propensity-matched cohort study, with cohort membership based on smoking status (current smokers, former smokers, and never smokers) was performed at Mayo Clinic in Rochester (a tertiary care center) and included patients at least 18 years old who lived in Olmsted County, Minnesota, for at least 1 year before and after the index surgery. EXPOSURE Undergoing an inpatient surgical procedure at Mayo Clinic hospitals between April 1, 2008, and December 31, 2009. MAIN OUTCOMES AND MEASURES Total costs during the index surgical episode and 1 year after hospital discharge, with the latter standardized as costs per month. Costs were measured using the Olmsted County Healthcare Expenditure and Utilization Database, a claims-based database including information on medical resource use, associated charges, and estimated economic costs for patients receiving care at the 2 medical groups (Mayo Clinic and Olmsted Medical Center) that provide most medical services within Olmsted County, Minnesota. RESULTS Propensity matching resulted in 678 matched pairs in the current vs never smoker grouping and 945 pairs in the former vs never smoker grouping. Compared with never smokers, adjusted costs for the index hospitalization did not differ significantly for current or former smokers. However, the adjusted costs in the year after hospitalization were significantly higher for current and former smokers based on regression analysis (predicted monthly difference of $400 [95% CI, $131-$669] and $273 [95% CI, $56-$490] for current and former smokers, respectively). CONCLUSIONS AND RELEVANCE Compared with never smokers, health care costs during the first year after hospital discharge for an inpatient surgical procedure are higher in both former and current smokers, although the cost of the index hospitalization is not affected by smoking status.

Propensity score (PS) methods have proliferated in recent years in observational studies in general and in observational comparative effectiveness research (CER) in particular. PS methods are an important set of tools for estimating treatment effects in observational studies, enabling adjustment for measured confounders in an easy-to-understand and transparent way. This article demonstrates how PS methods have been used to address specific CER questions from 2001 through to 2012 by identifying six impactful studies from this period. This article also discusses areas for improvement, including data infrastructure, and a unified set of guidelines in terms of PS implementation and reporting, which will boost confidence in evidence generated through observational CER using PS methods.

The article focuses on the corrupt practices committed within the corporate dental industry. Topics include the performance of unnecessary dental procedures, the daily production quotas in place at corporate dental chains, and the use of restraints on dental patients. Information is provided on fraudulent Medicaid claims made by corporate dental practices.

We previously reported the costs associated with surgery for chronic ulcerative colitis in the Olmsted County population and found that direct medical costs after surgery were significantly reduced compared with before surgery. However, in that study, costs associated with chronic medical therapy for ulcerative colitis were not assessed in nonsurgical patients.

The purpose of this study was to report the use of plasmapheresis in the management of choroidal vasculitis associated with Wegener granulomatosis.

The volume and duration of stay of the critically ill in the emergency department (ED) is increasing and is affected by factors including case-mix, overcrowding, lack of available and staffed intensive care beds and an ageing population. The purpose of this study was to describe the clinical activity associated with these high-acuity patients and to quantify resource utilization by this patient group.

ObjectiveThere is no coordinated cascade testing program for familial hypercholesterolemia (FH) in the U.S. We evaluated the contemporary cost-effectiveness of cascade genetic testing relatives of FH probands with a pathogenic variant.

Background

Cerhan: Regeneron Genetics Center: Other: Research Collaboration; Genentech: Research Funding; Celgene/BMS: Other: Connect Lymphoma Scientific Steering Committee, Research Funding; NanoString: Research Funding. Tun: Mundipharma, Celgene, BMS, Acrotech, TG therapeutics, Curis, DTRM: Research Funding; Gossamer Bio, Acrotech: Consultancy.We are describing the use of Yttrium-90 ibritumomab tiuxetan in the first line setting in comparison to the bendamustine plus rituximab which is the standard of care

Excavations at site U.C.L.J.-M-15 at Agua Hedionda Lagoon in southern California have provided a radiocarbon date of 7070 B.C. for a transitional phase between the San Dieguito and the La Jolla complex. The many radiocarbon dates taken from sites in San Diego County demonstrate a somewhat greater age than was hitherto generally expected for the three cultures in the area. The age of the most recent culture, the Yuman-Diegueno, has been extended to about 1000 B.C. The La Jolla shows an extremely long period of occupation spanning roughly 1000 B.C. to 7070 B.C. The third group, the San Dieguito, a pre-Desert culture, is still undated. Samples are now in process and should, judged from the new La Jolla dates, give a date earlier than 7000 B.C. for the earliest phases of the San Dieguito.

To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults.

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The author reviews literature relating to the use of activities in the treatment of chronic schizophrenia, citing several programs that combined activities and psychotherapy to produce effective modes of treatment. He also describes a program in which he used collagemaking to help a group of schizophrenic women improve interpersonal relationships, reality-testing, and self-image as well as to help them express problems and develop feelings of autonomy. The author believes that such combined programs help meet the basic needs of schizophrenic patients and alleviate their tendencies to withdraw from their surroundings.

Background:Familial hypercholesterolemia (FH) is an autosomal dominant disorder that significantly increases the risk of premature coronary heart disease (CHD). Unfortunately, no coordinated screening programs currently exist in the U.S.Objective:The goal of this study was to evaluate the contemporary cost-effectiveness of cascade testing of relatives of FH probands with an identifiable pathogenic variant and to assess whether cost-effectiveness is affected by the age at which testing is initiated in family members and the degree of relatedness to the proband.Methods:A Markov Decision Tree model was created in Arena?simulation software (Rockwell Automation, Coraopolis, PA) to simulate multiple family trees starting with progenitor individuals carrying a pathogenic variant for FH who were followed through multiple generations. This approach allowed us to examine a family tree that had grown sufficiently enough to have large numbers of relatives across multiple degrees of relatedness. The model identified FH probands and estimated costs and life years gained when cascade genetic testing was done in their family members. Costs were valued in 2017 U.S. dollars. Future costs and life years projected by the model were discounted at an annual rate of 3%.Results:For first-degree relatives of an FH proband, the average number of life years gained per person was 4.4 when genetic testing was done in relatives who were 10 years of age or older. At this age threshold, the average discounted cost per life year gained per person was approximately $1047. Results were similar for second-degree relatives. However, beginning with third-degree relatives, the average number of life years gained per person dropped to less than 1 and the average discounted cost per life year gained implied no benefit for treatment for many age thresholds.Conclusion:Cascade genetic testing of first-degree and second-degree relatives of FH probands with a known pathogenic variant is more cost-effective than testing relatives with more distant degrees of relatedness. The age threshold at which testing relatives appears to be most cost-effective is 10 years of age. These findings support establishing an FH cascade testing program in the US.

Introduction:Differences in cost of care for acute and subsequent 3 year follow up after first acute ischemic stroke (AIS) according to patient level factors are not fully understood.Hypothesis:Patient-level factors would be key drivers of cost associated with acute hospitalization and subsequent 3 year follow up.Methods:A retrospective study of adults ?18 years of age hospitalized for first AIS (n = 811) at Mayo Clinic between 2003 and 2014Results:Unadjusted differences in costs by patient-level characteristics are presented in the figure. Predictors of the cost were identified by multivariable general linear regression model with log transformation. Index hospitalization cost:higher costs were independently associated with the lowest age group (< 55 years vs 10-year age groups; 65 - 74, 75 - 84, ? 85 year), non-white ethnicity, higher NIHSS score quintiles (16 - 20, 11 - 15, and 6 - 10 vs 0-5) and concomitant chronic kidney disease (CKD). 3 year aggregate cost:Adults aged < 55 years had a significantly higher cost of care than those aged ?85 year. Similar to their predictive potential for index hospitalization cost, non-White ethnicity remained significant predictors of increased cost. On the other hand among the 5-subgroups of AIS patients by NIHSS scores, the lowest quintile (NIHSS score 0-5) had lower cost compared to 2nd(NIHSS score 6-10) and 3rdquintiles (NIHSS score 11 -15) but higher cost compared to highest quintile (NIHSS score ? 21). In addition to CKD, arthritis, cancer, and anemia were positively associated with increased cost whereas dementia compared to no dementia was associated with lower cost.Conclusions:Among patients with 1st AIS, direct inpatient cost for index hospitalization and the 3 year aggregate cost for subsequent 3 year follow up were significantly influenced by patient?s socio-demographics, severity of stroke, and select pre-existing comorbid conditions.

Discusses the plastic plumbing system known as polybutylene (PB) and the problems associated with it. How it was introduced to the construction industry; Description of PB; Where PB plumbing is common; Agreement by Shell Oil Company and Hoescht Celanese; Description of settlement in Cox versus Shell Oil Company; Contact number for people with PB plumbing.