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Objective: To determine the impact of respiratory syncytial virus (RSV) infection on healthcare resource use and costs in the US from the third-party payer perspective.Design: The study retrospectively analysed cross-sectional medical encounter data from three federally funded databases that comprise nationally representative samples of hospital inpatient stays, physician office visits and visits to hospital outpatient departments and emergency rooms.Methods: Identification of RSV infection-related medical encounters was based on the occurrence of RSV-specific International Classification of Diseases (9th Edition)-Clinical Modification diagnosis codes (079.6, 466.11, 480.1) as principal discharge diagnoses or the assumption that 10-15% of all otitis media visits were due to RSV infection. Outpatient drug costs were estimated based on average wholesale price, and physician fees and test/procedure costs were estimated based on prevailing national fees. Inpatient costs were estimated from total billed charges using a cost-to-charge ratio of 0.53.Results: In 2000, nearly 98% of RSV infection-related hospitalisations occurred in children <5 years old. There were approximately 86,000 hospitalisations, 1.7 million office visits, 402 000 emergency room visits and 236,000 hospital outpatient visits for children <5 years old that were attributable to RSV infection. Total annual direct medical costs for all RSV infection-related hospitalisations ($US394 million) and other medical encounters ($US258 million) for children <5 years old were estimated at $US652 million in 2000. Otitis media was a major cost driver for physician visits. RSV infection-related hospitalisations increased from 1993 to 2000, but average costs per hospitalisation were relatively stable.Conclusion: Treatment of RSV infection-related illness represents a significant healthcare burden in the US. The economic impact of ambulatory care for RSV infection-related illness could be as important as that for RSV infection-related hospitalisation. [ABSTRACT FROM AUTHOR]

Objective: The long-term risk of cardiovascular disease and diabetes have not been modeled for individuals with metabolic syndrome or other related cardiometabolic risk factors, nor have their long-term costs been estimated. Therefore, we used a Markov model to estimate these risks and costs over a decade. Methods: A Markov model was used to predict the development of diabetes and cardiovascular events (myocardial infarction [MI], stroke) in cohorts according to their specific risk factor profiles. Six risk factors profiles were based on adults (18 years and older) in the NHANES 2001–2002 database. These profiles were combined with risk equations to estimate transition probabilities for the Markov model. Costs of both acute (MI, stroke) and chronic (MI, stroke, diabetes) management were estimated based on all-payer discharge data, insurance claims data, government sources, and the published literature. Results: The model estimated that approximately 11% and 23% of individuals within the National Cholesterol Education Program Adult Treatment Panel III metabolic syndrome risk cohort would have new onset of diabetes within 3 years and 7 years, respectively. By year 10, the risk of developing diabetes was 31% for the metabolic syndrome risk cohort, and the risk of an incident acute MI or stroke event was approximately 3% to 4%. Cumulative costs as a result of new onset of diabetes within 10 years were estimated at $6200 per individual in the metabolic syndrome cohort and $20,000 per patient within the cohort who developed diabetes. The corresponding costs for incident acute MI and stroke were estimated at $2200 and $1300, respectively, per individual in the cohort, and $55,000 and $37,000, respectively, per patient in the cohort who had an event. Conclusion: Based on the results of these analyses, individuals with cardiometabolic risk factors such as those comprising the metabolic syndrome are expected to have a substantial risk for cardiovascular events and conditions. In addition, these individuals can be expected to place a considerable economic burden on the health-care system even in the short term. [ABSTRACT FROM AUTHOR]

Objective: To estimate the return on US investment (ROI) in overall health as well as four specific conditions. Methods: The study utilized three distinct approaches to “triangulate” the evidence as related to ROI in health care: 1) an estimation of the average ROI in additional health-care service expenditures in the United States for the year 2000 compared with the year 1980, based on US summaries of health expenditures and health outcomes; 2) an estimate of the ROI in Medicare services for the period from 1985 to 2000 for treatment of heart attack, stroke, type 2 diabetes, and breast cancer, based on National Long-term Care Survey data and Medicare claims; and 3) an estimate of the ROI for selected major treatment innovations for the same four conditions during the period from 1975 to 2000. Results: We calculated that each additional dollar spent on overall health-care services produced health gains valued at $1.55 to $1.94 under our base case assumptions. The return on health gains associated with treatment for heart attack, stroke, type 2 diabetes, and breast cancer were $1.10, $1.49, $1.55, and $4.80, respectively, for every additional dollar spent by Medicare. The ROI for specific treatment innovations ranged from both savings in treatment costs and gains in health to gains in health valued at $1.12 to $38.00 for every additional dollar spent. Conclusion: The value of improved health in the US population in 2000 compared with 1980 significantly outweighs the additional health-care expenditures in 2000 compared with 1980. [ABSTRACT FROM AUTHOR]