PurposeMultiple sclerosis (MS) imposes a huge burden on patients. This study examined the relationship between MS and health-related and economic burden in Japan; secondarily, health status was compared across patients with MS in Japan, US, and five European Union (5EU) countries (France, Germany, Italy, Spain, and UK).MethodsA retrospective cross-sectional study was conducted using self-reported data from 2009 to 2014 Japan National Health and Wellness Survey (n=145,759). Health status, work productivity loss, activity impairment, health care resource utilization, and annual costs associated with MS (n=85) were compared with controls without MS (n=145,674). Propensity score matching and multivariable linear regressions determined the effect of MS after controlling for confounders. Health status in Japan was also compared with that of 5EU (n=62) and US (n=67) patients with MS.ResultsPatients with MS in Japan reported significantly worse health status via mental component summary score (MCS; 40.1 vs 45.8) and physical component summary score (PCS; 41.4 vs 51.2) and health state utility scores (0.63 vs 0.74; all P<0.001). They also reported more absenteeism (12.0% vs 3.7%), presenteeism (33.8% vs 19.8%), overall work impairment (40.9% vs 21.6%), and activity impairment (43.6% vs 24.0%), with higher indirect costs (¥2,040,672/US $20,102 vs ¥1,076,306/US$10,603) than controls (all P<0.001). Patients with MS reported higher resource use, including provider visits (8.0 vs 4.7), emergency room visits (0.03 vs 0.1), and hospitalizations (2.7 vs 0.69) in the past 6 months, with higher direct costs (¥3,670,906/US$36,162 vs ¥986,099/US$9,714) than controls (all P<0.001). Finally, Japanese patients with MS reported lower MCSs and higher PCSs than their US and 5EU counterparts.ConclusionMS in Japan is associated with poor health status and high work productivity loss, resource use, and costs, underscoring the need for improved treatment, especially vis-à-vis mental health, when comparing Japanese patients with their 5EU and US counterparts.

OBJECTIVES: Irritable bowel syndrome (IBS) is a relapsing, chronic functional gastrointestinal disorder leading to long-term disturbances on health-related quality of life (HRQoL). Various functional and QoL measures have been developed to evaluate IBS outcomes, but none of the preference-based QoL measure has been applied and validated on Taiwanese people. This study aimed to explore the feasibility of applying preference-based HRQoL measures to IBS patients in Taiwan. METHODS: This prospective study was conducted from July to December 2010 at gastroenterology clinics in a regional hospital in southern Taiwan. IBS outpatients diagnosed by Rome III criteria were invited into participate semi-structure interview survey by using EuroQol (EQ-5D) questionnaire, 100-mm visual analogue scale (EQ-5D VAS) and standard gamble (SG) method. The EQ-5D assessment was transformed into EQ-5D index using Japanese preference weight. Multiple regression was used to assess factors associated with utilities, e.g. demographic, socioeconomic status and disease severity. RESULTS: Of all, 29 participants (mean age 45.8Ϯ16.5 years; 62.1% female) completed QoL survey, except for one rejected SG survey for disagreeing with SG hypothesis. Participants' IBS subtypes include constipation (nϭ11; 37.9%), diarrhea (nϭ16; 55.2%) and unsubtyped IBS (nϭ2; 6.9%); and 12 (41.4%) participants were newly diagnosed IBS and 12 had over two-year disease history. Participants had no problem in EQ-5D survey, some expressed difficulties in dimensions of pain/discomfort and anxiety/depression. Mean utility derived from SG (0.85Ϯ0.16), EQ-5D index (0.79Ϯ0.15) and EQ-5D VAS (0.59Ϯ0.17) were significantly different (pϽ0.05). SG utility was significantly associated with unsubtyped IBS and whether the IBS was newly diagnosed (pϽ0.05). CONCLUSIONS: IBS is well-tolerated but causing problem in anxiety/depression and pain/discomfort in QoL survey. Mean utility of SG is higher than results derived from EQ-5D and EQ VAS, and this finding matches previous literature. Further validate the utility measures in more IBS patients with various subtypes and severity is needed.

Urinary tract infection RR= 1.2, p< .0001) and comorbidities (anemia RR= 1.2, p< .0001; cardiac dysrhythmia RR= 1.1, p< .0001) were associated with longer LOS. Readmissions occurred within 30 days for 9.3% of inpatient admissions with infection (12.4%), CHF (7.5%), and rehabilitation services (6.9%) as the most common primary diagnoses for readmission. 3.2% were readmitted for hyperkalemia. The most common predictors of readmission included severe liver disease (OR= 1.4, p< .0001), kidney transplant (OR= 1.3, p= .0005), paraplegia/hemiplegia (OR= 1.3, p< .0001), anemia (OR= 1.2, p< .0001), renal failure (OR= 1.2, p< .0001), and CHF (OR= 1.2, p< .0001). ConClusions: Hyperkalemia patients are treated primarily in the inpatient setting and are resource intensive with long lengths of stay, high cost and a high rate of readmission within 30 days.

essential for providers to identify patients at risk for prolonged opioid use. As a first step, our research identifies significant patient characteristics that may predict prolonged opioid use and associated complications.

A 1 -A 2 9 8 those included in the 1-year and change analyses completed the SF-36 within 30days of their 1-year follow-up date. RESULTS: All patients contributed to the baseline analysis, and approximately 47% contributed to the 1-year and change analyses. At baseline, mean SF-6D values for all patients 50-59, 60-69, and 70-79 were 0.744 (SD=0.113), 0.743 (SD=0.105), and 0.722 (SD=0.101), respectively. At 1year, E+P arm mean values were 0.754 (SD=0.117), 0.751 (SD=0.117), and 0.725 (SD=0.109), and placebo arm mean values were 0.751 (SD=0.122), 0.748 (SD=0.109), and 0.716 (SD=0.106), respectively. The E+P arm mean changes were -0.008 (SD=0.106), -0.004 (SD=0.096), and 0.000 (SD=0.093), and the placebo arm mean changes were 0.000 (SD=0.105), -0.003 (SD=0.095), and 0.011 (SD=0.093), respectively. CONCLUSIONS: We found minimally decreasing utilities among older age groups, and little variability between utilities by hormone replacement therapy use. These results may be particularly useful in future health economic evaluations of aging women given that they are derived from a large randomized sample, and age group specific. However, our findings may be limited by the homogeneity and representativeness of the E+P trial participants.OBJECTIVES: National health care policy in Brazil is delivered via a two-tiered (public/private) system. Controversy exists since access to private insurance is skewed towards those with higher socioeconomic status, with 75% having incomes >5x the minimum wage, and 95% living in urban areas, mainly in the South and Southeast regions. Our objective was to assess the impact on health status, productivity and health care utilization due to insurance type among patients residing in different regions of Brazil. METHODS: Data were analyzed from the 2011 National Health and Wellness Survey, a nation-wide survey of adults in Brazil (N=12,000). Health status (SF-12v2), work productivity loss (WPAI), and health care resource use within a six-month time frame were compared across individuals in different insurance type strata (i.e., public/private). Data were also stratified according to Brazilian regions comprising the Mid-West, North, Northeast, South and Southeast, and the Federal District. Statistics included unpaired Student-t and Chi-square tests. ANOVA was used to test differences among regions of Brazil. RESULTS: A total 11,985 individuals comprised the public (N=6,074) and private (N=5,911) insurance assessment. Health care utilization was significantly lower among individuals with private insurance (physician consultations: 70.9% versus 86.0%; emergency room visits: 19.6% versus 25.7%; and hospitalizations: 8.9% versus 11.0%; all p<0.05). Overall work impairment (i.e., absenteeism and presenteeism combined) was also significantly lower in the private insurance group (difference=2.8%, 95%CI=1.3%-4.3%). Mental SF-12 score favored those with private insurance (difference=0.058, 95%CI=0.022-0.095), whereas physical SF-12 score favored those with the public insurance (difference=0.062, 95%CI=0.035...