Limited data exist on the costs of care of patients with multiple sclerosis (MS) in low- to middle-income nations. The purpose of this study was to describe the economic burden associated with care of Mexican patients with relapsing-remitting MS in a representative sample of the largest institution of the Mexican public healthcare system. We analysed individual data of 492 patients (67% women) with relapsing-remitting MS registered from January 2009 to February 2011 at the Mexican Social Security Institute. Direct costs were measured about the use of diagnostic tests, disease-modifying therapies (DMTs), symptoms control, medical consultations, relapses, intensive care and rehabilitation. Four groups were defined according to DMT alternatives: (1) interferon beta (IFNβ)-1a, 6 million units (MU); (2) IFNβ-1a, 12MU; (3) IFNβ-1b, 8MU; and (4) glatiramer acetate. All patients received DMTs for at least 1 year. The most frequently used DMT was glatiramer acetate (45.5%), followed by IFNβ-1a 12MU (22.6%), IFNβ-1b 8MU (20.7%), and IFNβ-1a 6MU (11.2%). The mean cost of a specialised medical consultation was €74.90 (US $107.00). A single relapse had a mean total cost of €2,505.97 (US $3,579.96). No differences were found in annualised relapse rates and costs of relapses according to DMT. However, a significant difference was observed in total annual costs according to treatment groups (glatiramer acetate being the most expensive), mainly due to differences in unitary costs of alternatives. From the public institutional perspective, when equipotent DMTs are used in patients with comparable characteristics, the costs of DMTs largely determine the total expenses associated with care of patients with relapsing-remitting MS in a middle-income country.

Objectives: Incremental health care resource utilization associated with autosomal dominant polycystic kidney disease (ADPKD) was estimated across two subgroups; individuals with ADPKD and end-stage renal disease (ESRD) and those with ADPKD but without ESRD. MethOds: Study data were from a large administrative claims and enrollment database. Individuals 18 y/o or older, enrolled in tracked health plans for 12 months from April 1, 2011 through March 31, 2012, and with an ICD-9-CM diagnosis code for "polycystic kidney, autosomal dominant" (753.13) or for "polycystic kidney, unspecified type (753.12) were identified as having ADPKD, and linked one-to-one with individuals without ADPKD on age and gender. ESRD was identified by presence of ICD-9-CM code 585.6. Zero-inflated negative binomial models estimated incremental hospitalizations, hospital days, outpatient visits, and emergency room visits for each subgroup , adjusting for age, gender, Charlson co-morbidity index, cardiovascular disease, diabetes and geographical region. Results: A total of 3,844 individuals with ADPKD who satisfied selection criteria were linked one-to-one with 3,844 individuals without ADPKD. Among persons with ADPKD, 644 had a diagnosis of ESRD. The sample was 53% female and 55% were between 45 to 64 years old. Incremental mean (standard error) resource utilization associated with ADPKD with ESRD as compared to persons without ADPKD was 0.35 (0.052) or 35 additional hospitalizations per 100 patients, 2.5 (0.42) or 250 hospital days per 100 patients, and 24.0 (1.2) or 2,400 outpatient visits per 100 patients. Incremental mean (standard error) resource utilization associated with ADPKD but without ESRD as compared to persons without ADPKD was 0.065 (0.028) or 6.5 additional hospitalizations per 100 patients, 0.5 (0.091) or 50 hospital days per 100 patients, and 4.4 (0.41) or 440 outpatient visits per 100 patients. cOnclusiOns: ADPKD was associated with incrementally greater health care resource utilization even before patients reached ESRD.

94.78 USD for pregabalin and gabapentin per patient respectively. Total costs per treatment were 478.15 and 514.73 USD for pregabalin and gabapentin treatments respectively, representing a cost-saving per patient of 36.58 USD for pregabalin. CONCLUSIONS: Pregabalin is a cost-saving option compared to gabapentin, representing a treatment that diminishes the health care system resource utilization while shortening patient's length of treatment and reducing the burden related to other concomitant medications used. OBJECTIVES:To model the value of screening for early Parkinson's Disease (PD). A model to evaluate lifetime economic value from slowing progression over the course of PD was adapted to assess sequential olfactory testing and dopamine transporter (DAT) imaging for screening for pre-motor disease in different patient groups. METHODS: Data from the PD Associated Risk Study (PARS) were used to parameterize the model. We assessed screening in patients aged 55 with varying risk: a general population; persons with a relative with PD; persons with LRRK2ϩ genotype; and persons with REM sleep disorder. PD prevalence per 100,000 at screening was 5, 20, 100 and 200 for these groups. Olfactory test and DAT costs were $15 and $2500. We assumed that disease modifying (DM) therapy was available that slowed disease progression by 20% at a cost of $35,000. Economic value was measured in terms of net monetary benefit (NMB), valuing quality-adjusted life-years at $50,000. RESULTS: Of those who took the olfactory test, 13.4% yielded positive results and also took the DAT. The sensitivity and specificity of screening were 64% and 99%. NMB for the four groups was -$211, $217, $2,495, and $5,344, indicating that screening has positive economic value in persons with a close relative with PD, persons with LRRK2ϩ genotype, and persons with REM sleep disorder. Screening value was positively correlated with rate of progression from preclinical to clinical PD, efficacy of DM therapy, and preclinical health utility. Screening value was negatively correlated with costs of false positives or false negatives, screening cost, age at preclinical onset, age at unscreened diagnosis, Hoehn and Yahr stage at which the unscreened diagnosis is made, and cost of DM therapy. CONCLUSIONS: Under certain scenarios, particularly in high risk groups, screening for early PD may be a cost effective strategy.

OBJECTIVES: Describe costs and utilization patterns of corticosteroid (CTS), immunosuppressive (IMS), and biologic (BIO) treatment use in patients with chronic non-infectious uveitis. Costs and utilization of CTS, IMS and BIO indicate economic burden but have not been studied in a large sample. METHODS: Patients with 31 NPSU diagnosis (ICD-9-CM 360.x-364.x, excluding infectious uveitis) by an ophthalmologist or 32 by a primary care physician, under age 65, with continuous insurance coverage during a six-month baseline were selected from a privately insured claims database (Nϭ80.7 million). Sample index dates were defined as the first prescription/administration of CTS, IMS, or BIO between 2003-2009. CTS patients had 32 10-day or 31 30-day scripts. Analysis was in a per-member-per-month (PMPM) framework based on treatment episodes, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes. RESULTS: CTS (Nϭ19,426), IMS (Nϭ5,466) and BIO (Nϭ1,694) samples were selected; average time on continuous therapy (i.e., treatment episode duration) was 1.79, 3.66, and 8.18 months (pϽ0.05 across groups). Baseline Charlson Comorbidity Index was highest for BIO (0.83), then IMS (0.78), then CTS (0.039) (pϽ0.05 across groups). Baseline PMPM inpatient admission rates were 0.021 for CTS, 0.044 for IMS, and 0.045 for BIO (pϽ0.05 across groups); study period values were 0.032, 0.048, and 0.024, respectively (pϽ0.05 CTS different vs. both). Emergency room visits had a similar ordering.

METHODS:A retrospective analysis of the HealthCore Integrated Research Database (HIRD) was conducted to estimate the incidence, costs, and predictors of COPD exacerbations. The study population included CB patients aged Ն40 years with Ն2 years of continuous enrollment in the HIRD, Ն1 hospitalization/emergency department (ED) visit or Ն2 outpatient visits with CB diagnosis (ICD-9-CM 491.xx) from January 1, 2004 to May 31, 2011, and Ն2 pharmacy fills for COPD medications during the follow-up year (the first fill served as the index date). Patients with asthma, cystic fibrosis, respiratory tract cancer, and long-term oral corticosteroid use were excluded. COPD exacerbations were categorized as severe (hospitalization with COPD as primary diagnosis) or moderate (ED visit with a primary COPD diagnosis or an oral corticosteroid filled within 7 days of a COPD-related office visit). When multiple exacerbations occurred within a 14-day window, only one (the most severe, if applicable) was counted. Prevalence, costs, and predictors of exacerbations were measured. RESULTS: A total of 17,382 treated CB patients met inclusion/ exclusion criteria (50.6% female, mean age 66.7Ϯ11.4 years). During pre-index year, 25% had moderate or severe and 14.3% had severe exacerbations. During the postindex year, the mean COPD maintenance medication fills number was 7.6Ϯ6.3; 42.6% experienced moderate or severe and 24.7% experienced severe exacerbations. Mean exacerbation-related healthcare costs were $8,219Ϯ$22,644 per moderate or severe and $18,120Ϯ$31,592 per severe exacerbation. Incidence of baseline exacerbation was the best predictor of post-index incidence of exacerbation (␤ϭ0.2595, pϽ0.0001) and also predicted post-index exacerbation-related costs (␤ϭ0.0870, pϽ0.0002). CONCLUSIONS: CB individuals' exacerbation rates remain high despite treatment with COPD maintenance medications. New treatment strategies designed to reduce CB exacerbations and associated costs should focus on patients with high prior-year exacerbation rates.OBJECTIVES: Invasive aspergillosis (IA) is a major infectious complication in inmonusupressed patients. Its incidence ranges from 5 percent to more than 20 percent A55