title: Medical care costs of Paget's disease of bone in a privately insured population.
abstract: BACKGROUND
  Medical care costs are difficult to calculate in diseases such as Paget's disease because they have low detection rates and a wide range of clinical manifestations that commonly occur in aging patient populations.
  
  
  METHODS
  Using 2001-2002 MarketScan Research databases, this study linked medical claims, prescription records, and encounter data on 2.8 million active and retired employees to create a longitudinal panel with 24 months of observation. Patients with Paget's disease were identified by ICD-9 code 731.0. Matched controls (MC) were identified through an exact match procedure using gender, age, and predicted Medicare costs estimated with a risk adjuster. Diagnostic and expenditure records were extracted for the sample and prevalence rates calculated for 20 conditions with well-documented associations to Paget's disease. Comorbidities and health care costs of Paget's disease patients were compared to those of the MCs, and the differences tested using Chi-square and t tests.
  
  
  RESULTS
  Our study identified 244 matched pairs. The average age was 72.7 years; 50.8% were female. Significantly higher comorbidities (P < 0.05) were detected in Paget's disease patients relative to MCs for: pathological fractures (4.9% vs. 0.4%), heart murmurs (3.3% vs. 0.4%), low back pain (19.7% vs. 8.6%), spinal stenosis (16.4% vs. 9.8%), and hearing loss (13.5% vs. 5.7%), respectively. Biannual per patient outpatient costs were significantly higher in Paget's disease patients (Paget's disease $9301 vs. MC $6339, P < 0.05), especially for services associated with physician visits and diagnostic tests. Prescription costs for antiresportive agents and analgesics were also higher (Paget's disease $1115 vs. MC $507, P < 0.05). Inpatient costs (Paget's disease $16,144 vs. MC $21,480) were comparable.
  
  
  CONCLUSIONS
  This study is the first to describe the excessive costs of Paget's disease, based on known patterns of disease expression, evaluation, and treatment.
authors.affiliation: University of Massachusetts Medical School, Division of Geriatric Medicine, Biotech Four, Suite 315, 377 Plantation Street, Worcester, MA 01605, USA. Becky.Briesacher@umassmed.edu
authors.forename: Becky A
authors.initials: BA
authors.lastname: Briesacher
authors.forename: Denise
authors.initials: D
authors.lastname: Orwig
authors.forename: Margaret
authors.initials: M
authors.lastname: Seton
authors.forename: Mohamed
authors.initials: M
authors.lastname: Omar
authors.forename: Kristijan H
authors.initials: KH
authors.lastname: Kahler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010001:Osteitis Deformans / Q000175:diagnosis / Q000191:economics* / Q000628:therapy