Objective. Osteoarthritis (OA) is a major debilitating disease affecting ϳ27 million persons in the US. Yet, the financial costs to patients and insurers remain poorly understood. The purpose of this study was to quantify by multivariate analyses the relationships between OA and annual health care expenditures borne by patients and insurers. Conclusion. The health care cost burden associated with OA is quite large for all groups examined and is disproportionately higher for women. Although insurers bear the brunt of treatment costs for OA, the OOP costs are also substantial. Osteoarthritis (OA) is a common and debilitating disease that affects ϳ27 million people in the US (1).Given an aging population, the prevalence and costs associated with OA are projected to increase. Forecasts indicate that by the year 2030, 25% of the adult US population, or nearly 67 million people, will have physician-diagnosed arthritis (2). It is thus important from a policy perspective to quantify the direct health care costs associated with this disease.While a number of studies have estimated the direct costs of OA (3-12), existing studies using US data are regionally based, and the results may not be generalizable. These studies typically use data obtained during the early 1990s. In reviewing the literature on the costs of OA, Xie et al (13) noted that ". . . cost of OA studies were insufficiently performed in the past decade . . ." Existing studies typically did not perform multivariate analyses to better isolate the effects of OA on health expenditures. While studies have adjusted for age and sex in comparing cohorts of OA and non-OA patients, Maetzel (14) noted that such matching ". . . is unlikely to weed out the costs that are attributable to other comorbidities, unless they have been adjusted for."Evidence on the direct costs of OA varies greatly. In their literature review, Xie et al (13) noted that direct costs from OA varied 10-fold among studies in the US. Wide variations across other countries were observed as well. These striking variations reflect a host of factors, including different geographic regions assessed, differ-

RATS lobectomy and wedge resection seem to have higher hospital costs and longer operating times, without any differences in adverse events.

No abstract

No abstract

BackgroundOral anticoagulants substantially reduce the risk of stroke in atrial fibrillation but are underutilised in current practice. AimTo measure the distribution of stroke risk in patients with atrial fibrillation (using the CHADS 2 and CHA 2 DS 2 -VASc scores) and changes in oral anticoagulant use during 2007-2010. Design and settingLongitudinal series of cross-sectional survey in 583 UK practices linked to the QResearch ® database providing 99 351 anonymised electronic records from people with atrial fibrillation. MethodThe proportion of patients in each CHADS 2 and CHA 2 DS 2 -VASc risk band in 2010 was calculated; for each of the years 2007-2010, the proportions with risk scores ≥2 that were using anticoagulants or antiplatelet agents were estimated. The proportions identified at high risk were re-estimated using alternative definitions of hypertension based on coded data. Finally, the prevalence of comorbid conditions in treated and untreated high-risk (CHADS 2 ≥2) groups was derived. ResultsThe proportion at high risk of stroke in 2010 was 56.9% according to the CHADS 2 ≥2 threshold, and 84.5% according to CHA 2 DS 2 -VASc ≥2 threshold. The proportions of these groups receiving anticoagulants were 53.0% and 50.7% respectively and increased during 2007-2010. The means of identifying the population of individuals with hypertension significantly influenced the estimated proportion at high risk. Comorbid conditions associated with avoidance of anticoagulants included history of falls, use of nonsteroidal anti-inflammatory drugs, and dementia. ConclusionOral anticoagulant use in atrial fibrillation has increased in UK practice since 2007, but remains suboptimal. Improved coding of hypertension is required to support systematic identification of individuals at high risk of stroke and could be assisted by practice-based software.