Cost of gastro-oesophageal reflux disease to the employer: a perspective from the United States.

BACKGROUND: Employers pay more than just salary for their employees. Previous studies have largely focused on direct medical and prescription drug costs of gastro-oesophageal reflux disease (GERD), and few have reported on total absenteeism costs. AIMS: To examine the annual cost of illness of GERD in an employed US population by benefit category and by place of service for direct medical costs. METHODS: Retrospective data analysis from 2001 to 2004. International Classification of Diseases (ICD)-9 codes (530.1, 530.10, 530.11, 530.12, 530.19, 530.81, 787.1x, 787.2x or 251.5x) were used to identify employees with and without GERD (the control group). Measures included medical and prescription drug claims, plus indirect costs for sick leave, short- and long-term disability, and workers' compensation. For a subset of the population, the direct medical claims were analysed by place of service. RESULTS: Data were available for 267,269 eligible employees of which 11,653 had gastro-oesophageal reflux disease. GERD was associated with a mean incremental cost of US $3,355 per employee of which direct medical costs accounted for 65%, prescription drug costs 17%, and indirect costs 19%. The place of service 'out-patient hospital or clinic' accounted for the largest part (47%) of the difference in medical costs. CONCLUSIONS: GERD is associated with substantial direct and indirect costs, which highlight the importance of managing the disease effectively.

The role of sevelamer in achieving the kidney disease outcomes quality initiative (K/DOQI) guidelines for hyperphosphatemia.

BACKGROUND: End-stage renal disease (ESRD) is a chronic health care problem associated with multiple co-morbidities and escalating costs. Disregulation of mineral metabolism (principally hyperphosphatemia and hypercalcemia) contributes to substantial morbidity and mortality. Accordingly, new and more-aggressive Kidney Disease Outcomes Quality Initiative (K/DOQI) Guidelines from the National Kidney Foundation promote lower serum phosphorus (3.5-5.5 mg/dL), lower calcium (8.4-9.5 mg/dL), and lower calcium-phosphorus product (< 55 mg(2)/dL(2)) targets. REVIEW FINDINGS: Traditional calcium-based and metal-based phosphate binders are effective but are associated with side effects and toxicity that limit their use. Achieving rigorous K/DOQI goals demands higher therapeutic doses of phosphate binders and may require more-aggressive use of calcium-free and metal-free phosphate binders. Sevelamer hydrochloride is a calcium- and metal-free polymer that binds phosphate effectively without contributing to calcium load or metal accumulation. In the Treat-to-Goal trial, sevelamer-treated dialysis patients had less progression of coronary and aortic calcification than patients treated with calcium-based binders. This offers the potential promise of reducing cardiovascular morbidity and mortality. The 800-mg tablet (Renagel) increases the daily sevelamer dose while reducing the number of tablets required per meal. Nine of the 800-mg tablets per day (3 x 800-mg tablets tid with meals) of sevelamer monotherapy have been shown to achieve K/DOQI serum phosphorus and calcium-phosphorus product targets. CONCLUSION: In summary, this review of the current evidence-base concludes that the new, more-aggressive, K/DOQI goals limit the use of metal-based and calcium-based phosphate binders. Sevelamer offers the advantages of lowering serum phosphorus without the risks of calcium or metal accumulation - and offers the promise of slowing the progression of vascular calcification and potentially reducing the morbidity and mortality of hemodialysis patients.

Prevalence of treated dry eye disease in a managed care population.

BACKGROUND: Survey studies are of limited utility in estimating the prevalence of treated dry eye. The use of claims data, which include only individuals who have a diagnosis of the disorder, provides a better estimation of the clinical significance of dry eye symptoms and appraisal of community needs. OBJECTIVE: The purpose of this paper is to estimate the prevalence of treated dry eye disease using a nonsurvey methodology. METHODS: Patients with dry eye diagnoses or who underwent punctal occlusion procedures were identified from PharMetrics' Integrated Outcomes database of medical claims for approximately 10 million patients enrolled in managed care plans. Prevalence estimates were calculated for 1997 and 1998. RESULTS: The prevalence of dry eye was 0.48% in 1997 and 0.39% in 1998, representing 25,180 and 27,289 cases, respectively. Patients aged > or = 65 years were approximately 4 times as likely as those aged < 65 years to be diagnosed with keratoconjunctivitis sicca or tear film insufficiency. In 1997, dry eye was diagnosed or treated in 0.65% of women compared with 0.26% of men (P < 0.001). Rates of dry eye disease in 1998 were highest among women aged 75 to 79 years (2.02%) and men aged 80 to 84 years (1.30%). Women tended to receive a diagnosis at a younger age than did men. The most common diagnosis was tear film insufficiency (73.96% and 73.41% of dry eye patients in 1997 and 1998, respectively). The most common procedure was lacrimal punctal occlusion by plug (7.78% and 8.74% of dry eye patients in 1997 and 1998, respectively). CONCLUSION: The prevalence of treated dry eye disease is 0.4% to 0.5% and is highest among women and the elderly.