Several cost-of-illness (COI) studies related to diabetes mellitus have been performed over the last three decades. This review examines the results of these COI studies, identifies the strengths and limitations of the various methods utilised, and suggests future research that will help determine the economic burden of diabetes more accurately. Diabetes imposes a large economic burden on society. The economic cost of diabetes is estimated to be as much as dollars US 100 billion per year in the US alone (1997 values). This estimated cost has increased notably over time, primarily due to price inflation and the increasing prevalence of diabetes. Differing methodologies have significantly influenced the cost estimates and made comparisons between COI studies problematic. For example, early reports tended to rely exclusively on data where diabetes was listed as the primary diagnosis or reason for healthcare use. To better capture the costs associated with diabetes-related complications, later studies have included costs related to diabetes as a secondary or tertiary diagnosis using the attributable risk methodology. Given the types of long-term complications that are associated with diabetes, attempts at capturing these secondary costs are appropriate. However, estimates of attributable risk can be limited by the epidemiological data currently available. The tremendous economic burden of diabetes makes the disease an important clinical and public health problem. In order to formulate an effective response to this problem, it is important to track future economic trends as healthcare delivery, morbidity and mortality patterns evolve. Future research efforts should focus on refining methods to estimate costs, improving the interpretation of study findings, and facilitating comparisons between studies.

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In a 2007 report, the US Surgeon General called for health care professionals to renew efforts to reduce underage drinking. Focusing on the adolescent patient, this review provides health care professionals with recommendations for alcohol-related screening, brief intervention, and referral to treatment. MEDLINE and published reviews were used to identify relevant literature. Several brief screening methods have been shown to effectively identify underage drinkers likely to have alcohol use disorders. After diagnostic assessment when germane, the initial intervention typically focuses on education, motivation for change, and consideration of treatment options. Internet-accessible resources providing effective brief interventions are available, along with supplemental suggestions for parents. Recent changes in federal and commercial insurance reimbursement policies provide some fiscal support for these services, although rate increases and expanded applicability may be required to prompt the participation of many practitioners. Nevertheless, advances in clinical methods and progress on reimbursement policies have made screening and brief intervention for underage drinking more feasible in general health care practice. Proc. 2010;85(4):380-391 Mayo Clin

Purpose We examined rural primary care providers’ (PCPs) self-reported practices of screening, brief interventions, and referral to treatment (SBIRT) on adolescent alcohol use and examined PCPs’, adolescents’, and parents’ attitudes regarding SBIRT on adolescent alcohol use in rural clinic settings. Methods In 2007, we mailed surveys that inquired about alcohol-related knowledge, attitudes, and treatment practices of adolescent alcohol use to all PCPs in 8 counties in rural Pennsylvania who may have treated adolescents. We then conducted 7 focus groups of PCPs and their staffs (n = 3), adolescents (n = 2), and parents (n = 2) and analyzed the narratives using structured grounded theory, evaluating for consistent or discordant themes. Results Twenty-seven PCPs from 7 counties returned the survey. While 92% of PCPs felt that routine screening for alcohol use should begin by age 14, 84% reportedly screened for alcohol use occasionally, and reportedly 32% screened all adolescent patients. The provider focus groups (n = 20 PCPs/staff) related that SBIRT for alcohol use for adolescents was not currently effective. Poor provider training, lack of alcohol screening tools, and lack of referral treatment options were identified barriers. Adolescents (n = 12) worried that physicians would not maintain confidentiality. Parents (n = 12) acknowledged a parental contribution to adolescent alcohol use. All groups indicated computer-based methods to screen for alcohol use among adolescents may facilitate PCP engagement. Conclusions Despite awareness that rural adolescent alcohol use is a significant problem, PCPs, adolescents, and parents recognize that SBIRT for adolescent alcohol use in rural PCP settings is ineffective, but it may improve with computer-based screening and intervention techniques.

From a medical payer perspective, our models demonstrate that CT for inflicted traumatic brain injury can be cost-effective and improve outcomes. The finding of higher societal cost reflects the substantial short-term costs of child protection. Our study supports a low medical threshold for CT screening and highlights the need for improved understanding of long-term costs and outcomes of child abuse.