title: Direct and indirect costs associated with Dupuytren's contracture.
abstract: OBJECTIVE
  To compare direct (medical and drug) and indirect (work loss) costs between privately insured US employees with Dupuytren's contracture (DC) and demographically matched controls without DC.
  
  
  METHODS
  Employees aged 18-64 with ≥ 1 DC diagnosis (ICD-9-CM: 728.6, 718.44) with service dates 1/1/2000-3/31/2009 were selected from a de-identified, privately insured claims database (n∼3,000,000). The index date was defined as the most recent DC diagnosis with continuous eligibility for 6 months prior (baseline period) and 1 year after (study period) diagnosis. Employees with DC were matched 1:1 on age, region, gender, and index date to controls without DC, Peyronie's, or Ledderhose disease diagnoses in their claims histories. Descriptive analyses compared demographic characteristics, comorbidities, resource utilization, direct costs, and indirect costs inflated to 2009 dollars.
  
  
  RESULTS
  DC employees (n=1406, mean age 49 years) with matched controls met the inclusion criteria. DC employees compared with controls had significantly (all p<0.05) higher baseline comorbidities, including hyperlipidemia (21.1% vs 15.6%), hypothyroidism (3.5% vs 2.0%), cancer (3.1% vs 1.5%), and diabetes (8.1% vs 3.6%). During the study period, DC employees had significantly (all p<0.01) higher rates of inpatient stays (7.7% vs 5.3%), emergency department visits (19.8% vs 13.9%), outpatient visits (100.0% vs 78.4%), physical therapy visits (30.2% vs 7.2%), and any prescription use (85.0% vs 69.2%), as well as higher mean work loss days (14.2 vs 7.3). DC employees had on average significantly (all p<0.01) higher annual direct costs ($5974 vs $3175), indirect costs ($2737 vs $1309), and total costs ($8712 vs $4485) compared with controls during the study period.
  
  
  CONCLUSIONS
  Findings did not account for lost productivity at work and were based on a privately insured, employed population, which may not be generalizable to all DC patients.
  
  
  CONCLUSIONS
  Employees with DC had substantially higher comorbidity rates, utilization, and direct and indirect costs compared with demographically matched controls.
authors.affiliation: Analysis Group, Inc., New York, NY 10020, USA. dmacaulay@analysisgroup.com
authors.forename: Dendy
authors.initials: D
authors.lastname: Macaulay
authors.forename: Jasmina
authors.initials: J
authors.lastname: Ivanova
authors.forename: Howard
authors.initials: H
authors.lastname: Birnbaum
authors.forename: Rachael
authors.initials: R
authors.lastname: Sorg
authors.forename: Paul
authors.initials: P
authors.lastname: Skodny
mesh_terms: D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis / Q000379:methods; D016208:Databases, Factual; D004387:Dupuytren Contracture / Q000191:economics* / Q000628:therapy; D005260:Female; D006264:Health Benefit Plans, Employee / Q000191:economics; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018582:Sick Leave / Q000191:economics*; D014481:United States; D055815:Young Adult