Prevalence and Socioeconomic Status of Patients with Genetic Myopathy in Korea: A Nationwide, Population-Based Study.

BACKGROUND: Genetic myopathy is a clinically and genetically heterogeneous group of genetic disorders characterized by progressive degeneration of skeletal muscles. Epidemiological studies of genetic myopathy have not yet been performed in Korea. OBJECTIVES: This study used data from the national health insurance claims database to determine the prevalence and socioeconomic status of patients with genetic myopathy in Korea. METHODS: We analyzed the Health Insurance Review and Assessment database from 2007 to 2011. Patients with genetic myopathy were defined based on diagnostic and procedure codes. We then evaluated the prevalence, types of health insurances, and medical expenses of these patients. RESULTS: During the 11-year study period, 2,988 patients with genetic myopathy were enrolled. Among them, 1,762 were men and 1,226 were women. The prevalence per 100,000 population in 2017 was 3.09 (3.94 for men and 2.24 for women). The prevalence of genetic myopathy among men <35 years old (8.33 per 100,000 population) was approximately twice that among women <35 years old (4.06 per 100,000 population). However, there was no significant difference in the prevalence of genetic myopathy among those ≥35 years old according to sex. The ratio of patients using medical aid among all genetic myopathy patients was approximately 4 times than that among the general population in Korea. The medical expenses per person for genetic myopathy increased from USD 2,027 in 2007 to USD 4,810 in 2017. CONCLUSIONS: Our study was the first nationwide epidemiologic study of the prevalence and socioeconomic status of patients with genetic myopathy in Korea. Our results confirmed a sex divergence in a younger population and those with low socioeconomic status among patients with genetic myopathy.

Value of a Hypothetical Pharmacogenomic Test for the Diagnosis of Statin-Induced Myopathy in Patients at High Cardiovascular Risk.

We recently conducted two economic evaluations of a hypothetical pharmacogenomic test for statin-induced myopathy (SIM) in patients at high cardiovascular risk. Although the models differed in modeling technique and data inputs, both yielded similar results. We believe our approach to assessing the economic value of a diagnostic test was highly advantageous as it characterized the complete range of false-negative and false-positive test outcomes. We used a broad interpretation of test parameters that reflected physician and patient behavioral responses to the test results and accounted for patient adherence to treatment. Both economic evaluations indicated that a highly accurate pharmacogenomic test for SIM would provide a positive incremental net monetary benefit (INMB) for a provincial payer in Canada. However, the value of the test would depend on its ability to accurately diagnose patients when they experience musculoskeletal pain symptoms and guide patients with a test result indicating no SIM to adhere to treatment. Interestingly, our results indicated that a highly inaccurate test would still yield a positive INMB. We found this surprising result was driven by the imbalance of the risk of cardiovascular events outweighing the risk of rhabdomyolysis in patients at high cardiovascular risk. A highly accurate pharmacogenomic test for SIM in patients at high cardiovascular risk would provide economic value for payers. However, the economic and clinical value of the test would depend on the credibility of the test results and their success in influencing patients without SIM to adhere to therapy.

A Discrete Event Simulation Model to Assess the Economic Value of a Hypothetical Pharmacogenomics Test for Statin-Induced Myopathy in Patients Initiating a Statin in Secondary Cardiovascular Prevention.

BACKGROUND: Statin (HMG-CoA reductase inhibitor) therapy is the mainstay dyslipidemia treatment and reduces the risk of a cardiovascular (CV) event (CVE) by up to 35%. However, adherence to statin therapy is poor. One reason patients discontinue statin therapy is musculoskeletal pain and the associated risk of rhabdomyolysis. Research is ongoing to develop a pharmacogenomics (PGx) test for statin-induced myopathy as an alternative to the current diagnosis method, which relies on creatine kinase levels. The potential economic value of a PGx test for statin-induced myopathy is unknown. METHODS: We developed a lifetime discrete event simulation (DES) model for patients 65 years of age initiating a statin after a first CVE consisting of either an acute myocardial infarction (AMI) or a stroke. The model evaluates the potential economic value of a hypothetical PGx test for diagnosing statin-induced myopathy. We have assessed the model over the spectrum of test sensitivity and specificity parameters. RESULTS: Our model showed that a strategy with a perfect PGx test had an incremental cost-utility ratio of 4273 Canadian dollars ($Can) per quality-adjusted life year (QALY). The probabilistic sensitivity analysis shows that when the payer willingness-to-pay per QALY reaches $Can12,000, the PGx strategy is favored in 90% of the model simulations. CONCLUSION: We found that a strategy favoring patients staying on statin therapy is cost effective even if patients maintained on statin are at risk of rhabdomyolysis. Our results are explained by the fact that statins are highly effective in reducing the CV risk in patients at high CV risk, and this benefit largely outweighs the risk of rhabdomyolysis.

Outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery.

OBJECTIVE: The goal of this study was to assess outcomes and costs associated with hospitalist comanagement of medically complex children undergoing spinal fusion surgery for neuromuscular scoliosis. METHODS: A hospitalist comanagement program was implemented at a children's hospital. We conducted a retrospective case series study of patients during 2003-2008 to compare clinical and cost outcomes for 87 preimplementation patients, 40 patients during a partially implemented program, and 80 patients during a fully implemented program. RESULTS: When compared with preimplementation patients, full implementation program patients did not demonstrate a statistically significant difference in median length of stay on the medical/surgical unit after transfer from the PICU (median: 6 vs 8 days; P = .07). Patients in the full implementation group received fewer days of parenteral nutrition (median: 0 vs 6 days; P = .0006) and had fewer planned and unplanned laboratory studies on the inpatient unit. There was no statistically significant change in returns to the operating room (P = .08 between preimplementation and full implementation), other complications, or 30-day readmissions. Median hospital costs increased from preimplementation ($59372) to partial implementation ($89302) and remained elevated during full implementation ($81 651) compared with preimplementation (P = .004). Mean physician costs followed a similar trajectory from preimplementation ($18425) to partial implementation ($24101) to full implementation ($22578; P = .0006 [versus preimplementation]). CONCLUSIONS: A hospitalist comanagement program can significantly affect the care of medically complex children undergoing spinal fusion surgery. Initial program costs may increase.

Health care utilization for musculoskeletal back disorders, Washington State union carpenters, 1989-2003.

OBJECTIVE: Private health care utilization rates for musculoskeletal back disorders were contrasted to rates of work-related injuries or disorders for a large cohort of union carpenters over a 15-year period. METHODS: Yearly utilization rates were compared with rates of work-related back injuries or disorders. Negative binomial regression with generalized estimating equations was used to assess utilization rates based on age, gender, union tenure, type of work, and previous work-related back injuries. RESULTS: Private utilization rates were over twice as high in 2003 as in 1989 whereas compensation rates declined substantially. Utilization was higher among carpenters with less union tenure and increased with the number of work-related injuries. CONCLUSIONS: Patterns of utilization across private and workers' compensation delivery systems are not independent; we need to look broadly at sources of health care coverage to better understand the health of working populations.

[Dentist and disability: a matter of occupational disease?]. / Tandarts en arbeidsongeschiktheid: ziek van het werk?

The incidence of and background to disability claims by dentists relating to 1999 are presented on the basis of data from Movir insurance company. Possible cases of occupational related disease are indicated. Claims resulting in more than 2 weeks sick leave have been received from almost 7% of the insured dentists (excluding pregnancy related sick leave). In nearly 30% of the cases, sick leave lasted for more than 1 year (particularly due to mental and musculoskeletal disorders). Compared to the figures for 1992 long-term health related absenteeism (longer than 365 days) has increased by as much as 155%. It is estimated that at least 15% of the claims are occupationally related. Based on the 1999 data a dentist would have approximately a chance of 50% for partial or complete premature retirement due to ill health.

Disability pensions due to musculo-skeletal disorders among men in heavy occupations. A case-control study.

The relative risk of disability pension due to musculo-skeletal disorders has been studied with regard to occupation and work load. The study population comprised men born 1915 to 1934, living in Stockholm county. 1307 men who received a disability pension during 1979, 1980, 1981 and 1984 due to disorders from the low back, neck/shoulder, hip, and knee were compared with 298 randomly selected men concerning occupation and occupational work load. Disability pensions were more common both in men with medium and high physical work load compared to men with low physical work load. Construction workers and metal workers had a high relative risks of receiving disability pensions because of disorders in all four body regions, and men in many other occupations had disorders in two or three regions. In office workers the risk of disability pension because of musculo-skeletal disorders was low.

Costs of veterinary services and vaccines/drugs used for prevention and treatment of diseases in 60 Tennessee cow-calf operations (1987-1988).

Four percent of the total cost of disease in 60 Tennessee cow-calf herds in 1987 to 1988 was attributable to veterinary services, and 2.3% was attributable to the purchase of drugs to treat sick animals. When producers spent money on therapeutic veterinary services, it was most often attributable to diseases of the reproductive system ($0.69/cow annually), especially dystocia ($0.51/cow annually). When drugs were used therapeutically, the most was spent on products to treat respiratory tract disease ($0.37/cow annually). The cost of preventive veterinary services accounted for 8.8% of the total cost of preventive actions. Pregnancy examinations (considered here as a preventive action) was the most costly preventive service ($0.62/cow annually). The cost of drugs and biologicals used to prevent disease accounted for 69.4% of the total cost of preventive actions, with drugs to prevent intestinal and external parasites being the most costly ($7.79/cow annually). These figures are based on cow-calf herds randomly selected by use of a 2-stage, stratified plan. Herds were visited once a month for 1 year. Results of this study support other work that showed that beef producers perceive veterinarians as primary sources of information on diagnosis and treatment of sick animals and on reproduction/breeding, but less knowledgeable or cost effective in the areas of animal/herd management, feed nutrition, and agribusiness/economics.

An investigation of medical discharges from the British Army 1979-1986.

Male medical discharges from the British Army were analyzed for the years 1979-1986. There was a sudden increase in 1983 which reached a peak in 1985 caused by a significant rise in rates of discharge as a consequence of lower limbs and muscular overuse conditions, injuries from road traffic accidents, sports and falls. Training injuries showed an increase which, although substantial, failed to reach statistical significance. The highest increase took place in lower limb and muscular overuse conditions in the youngest and most junior members of the infantry, especially when undergoing basic training. This category appears to be at the highest risk of medical discharge. Other teeth arms had the highest incidence of medical discharges from road traffic accidents. The importance of medical discharges may be misunderstood through the underestimation of their incidence and the absence of a capital valuation of the skills and experience of personnel discharged. The discharge of an infantry corporal with 8 years service may mean the loss of a capital of at least 149,599 pounds. Any interventions aimed at reducing the number discharges should be evaluated using the cost-benefit approach. Ways of reducing wastage are discussed.

The economic impact of the rheumatic diseases in the United States.

We review the literature and analyze data from the National Health Interview Survey to provide estimates of the economic cost and social impacts of the rheumatic diseases in the United States. Rheumatic diseases had an economic impact in 1980 of 21 billion dollars due to expenditures for health care and lost wages, an amount equal to 1% of gross national product. These conditions are responsible for 5% of all hospital discharges, 10% of all hospital procedures, and 9% of all physician visits. They are also responsible for over 2 million persons being unable to do major activities, for 5 million being limited in other ways, and for at least 1 million being severely limited in the ability to perform activities of daily living. As great these impacts would appear to be, they are likely to grow since the aging of the population increases both the prevalence and severity of impact of the rheumatic diseases.

Disability, utilization, and costs associated with musculoskeletal conditions.

In this report, data from the 1980 National Medical Care Utilization and Expenditure Survey are used to present health characteristics, types and quantities of services used, and the charges for these services for persons with musculoskeletal diseases. Slightly more than 44 million people, or 19.8 percent of the U.S. civilian noninstitutionalized population, were reported in the survey to have at least one musculoskeletal disorder. These data are generally consistent with those from other health surveys, which show that the prevalence of musculoskeletal disorders increases for successive age categories, that such disorders are more common among women than among men, and that they are less prevalent among black persons than among persons of other races. In terms of both functional limitation and perceived health status, persons with musculoskeletal conditions are, with some notable exceptions, in relatively poor health. Persons having back problems in addition to problems with peripheral joints (such as the knee, hip, or shoulder) were more likely to rate their health as "fair" or "poor" compared with persons having only back problems or compared with persons in the civilian noninstitutionalized population as a whole. Musculoskeletal disorders accounted for a considerable proportion of all disability days reported by the total civilian noninstitutionalized population: 13 percent of restricted-activity days, 8.8 percent of bed-disability days, and 11.2 percent of all work-loss days were directly attributable to musculoskeletal conditions. The disabling effects of musculoskeletal problems pose a significant economic burden; they accounted for a total of $3.9 billion in lost productivity costs during 1980 for employed persons in the work force and for homemakers. For persons with musculoskeletal problems, the mean number of ambulatory visits per year was nearly twice the rate of 5.2 for the general civilian noninstitutionalized population. Of ambulatory visits made to all health care providers by persons with these conditions, 35.6 percent were related in some way to the treatment of their musculoskeletal problems. Musculoskeletal conditions are somewhat different from many other illnesses because their treatment is within the professional domain of several types of health care providers. Approximately 13 percent of persons with any type of musculoskeletal disorder received care from chiropractors during the year and this figure rose to nearly 30 percent for back problems only. However, nearly 33 percent of persons with musculoskeletal problems made no visits for treatment of their condition.(ABSTRACT TRUNCATED AT 400 WORDS)

Social and economic impacts of four musculoskeletal conditions. A study using national community-based data.

The present study uses data from a national, community-based survey to compare the social impact of and medical care use due to 4 musculoskeletal conditions: rheumatoid arthritis, osteoarthritis, lower back pain, and tendinitis. The study also compares the impacts experienced by persons with these conditions with those experienced by a sample of persons having a broader range of musculoskeletal conditions, and by an age-adjusted sample representing the entire U.S. population. Rheumatoid arthritis leads to the most frequent use of physician services; lower back pain results in the most hospitalizations and surgery. Rheumatoid arthritis also causes the most restriction in activity. We found that as a broad group, persons with musculoskeletal disease experience about the same amount of restriction in activity and use about the same amount of medical care as U.S. citizens as a whole. This study demonstrates that health planning on the basis of specific musculoskeletal conditions is necessary to serve the disparate needs of persons with particular, discrete conditions.