Health states related to CHB infection have substantial reductions in HRQOL and the utilities reported in this study provide valuable information for comparing new treatment options. The observed intercountry differences suggest that economic evaluations may benefit from country-specific utility estimates. The extent that systematic intercountry differences in utilities hold true for other infectious and chronic diseases remains an open question and has considerable implications for the proper conduct and interpretation of economic evaluations.

OBJECTIVE -The objective of this study was to characterize health care costs associated with diabetic lower-extremity ulcers.RESEARCH DESIGN AND METHODS -Adult patients with diabetes who had a lower-extremity ulcer episode during 2000 and 2001 were identified using claims data. Ulcerrelated direct health care costs were computed for each episode. Episodes were stratified according to severity level based on the Wagner classification.RESULTS -A total of 2,253 patients were identified. The mean age was 68.9 years, and 59% of the patients were male. The average episode duration was 87.3 Ϯ 82.8 days. Total ulcerrelated costs averaged $13,179 per episode and increased with severity level, ranging from $1,892 (level 1) to $27,721 (level 4/5). Inpatient hospital charges accounted for 77% ($10,188) of the overall cost, indicating that hospitalization was a major cost driver. Total ulcer-related costs were significantly higher for patients Ͻ65 years of age compared with those of older patients ($16,390 vs. $11,925, P ϭ 0.02) and for patients with inadequate vascular status compared with patients with adequate vascular status ($23,372 vs. $5,218, P Ͻ 0.0001). Patients who progressed to a higher severity level also had significantly higher ulcer-related costs compared with patients who did not progress ($20,136 vs. $3,063, P Ͻ 0.0001).CONCLUSIONS -The high costs of treating diabetic lower-extremity ulcers emphasize the value of intensive outpatient interventions designed to prevent ulcer progression. Diabetes Care 27:2129 -2134, 2004L ower-extremity ulcers present a significant burden to patients with diabetes and to the health care system. Of persons with diabetes, 2-3% develop a foot ulcer annually, while the lifetime incidence rate is 15% (1,2). Approximately 3% of hospitalizations among patients with diabetes are attributed to lowerextremity ulcers (2). In patients with diabetes, the length of hospitalization among patients with a lower-extremity ulcer can be Ͼ50% longer than that of patients who do not have an ulcer (1).Diabetic lower-extremity ulcers are responsible for 92,000 amputations annually (3). The 10-year cumulative incidence of lower-extremity amputation is ϳ5% in younger-onset diabetes (diagnosis before 30 years of age) and 7% in older-onset diabetes (diagnosis at age 30 or older) (4). Within 5 years after their first amputation, 28 -51% of patients with diabetes require a second leg amputation (1). Survival after amputation is bleak. The 5-year survival rate after amputation is only 27%, translating to a fourfold increase compared with an age-and sexmatched population (5).In addition, lower-extremity ulcers are costly to manage. In 1991 and 1992, costs of diabetic lower-extremity ulcers averaged $2,687 per patient per year among a population of patients Ͻ65 years of age with private employer-sponsored insurance (6). In an analysis of the 1995 Medicare population, the average cost of treatment for a Medicare patient with a diabetic lower-extremity ulcer was approximately $3,600 per year (7). A cost analy...

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Exposure to olanzapine or clozapine is associated with a 34-41% increase in the developing of type 2 diabetes among California Medicaid recipients with schizophrenia. Prospective, randomized trials are needed to confirm these retrospective, observational findings.

Our analysis suggests entecavir improves health outcomes in a cost-effective manner compared with lamivudine with adefovir salvage or combination therapy, and highlights the importance of using evidence-based effectiveness estimates in economic studies of CHB therapies.