Class of 2010 Abstract / OBJECTIVES: The purpose of this study was to determine the number of inpatient discharges and burden of illness due to testicular cancer with data from the national database Healthcare Cost and Utilization Project (HCUP). METHODS: This retrospective study looked at hospital discharge records to obtain information regarding the inpatient burden of illness of testicular cancer patients. The study looked at procedures, co-­‐morbidities, hospital characteristics, case-­‐mix control, and the Deyo-­‐Charlson to see how they were associated with the charges, length of stay, and inpatient mortality. Also included in the study was information regarding patient age, method of payment, and hospital type and size. A linear multivariate regression was performed to estimate determinates of hospital costs. RESULTS: During the 5-­‐year time frame of the study, 28,985 inpatient admissions with testicular cancer were identified. For the overall sample, the average total charges per hospitalization were $29,857. For the 717 patients that died while receiving inpatient treatment, the associated charges averaged $73,800, more than double that associated with the overall sample. The gamma regression of charges for the overall sample showed an association between increased charges and age, length of stay, number of procedures, all admission years in reference to 2002, admission to a large-­‐sized hospital in reference to a small hospital, admission to an urban hospital in reference to a rural hospital, admission to a teaching in reference to a nonteaching hospital and the Deyo-­‐Charlson score. CONCLUSIONS: Testicular cancer is on the rise worldwide and is associated with a high inpatient burden of illness.

Class of 2007 Abstract / Objectives: To explore the economic burden of illness and outcomes associated with in-patient related cases of asthma. Methods: This retrospective database study used Healthcare Cost and Utilization Project’s National Inpatient Survey to investigate the total number of discharges, length of stay and health care costs of patients with a primary diagnosis of asthma based on gender, payer and level of income. Data was analyzed using a non-parametric z-test to determine if results were significant. Results: A total of 418,789 patients (164,045 male, 251,264 female, 3,479 missing) were admitted with the category diagnosis of asthma in 2004. Females had a longer mean length of stay, higher mean charges and higher aggregate charges than males. These apparent differences were found to be significant. Medicaid had a larger number of total discharged and higher aggregate charges. Both these outcomes were found to be significant when compared to all other payers, expect there was no significance between Medicaid and Medicare in regards to aggregate charges. Medicare had a longer mean length of stay and higher mean charges which were found to be significant when compared to all other payers. Not low median income had more discharges, longer mean length of stay and higher mean and aggregate charges compared to low median income. These apparent differences were found to be significant. Conclusions: Being of female gender, or part of a government funded program (Medicaid or Medicare) or having an income of $36,000+ would result in higher discharge rates, longer mean length of stay and higher mean and aggregate charges in respect to asthma hospitalizations.

BACKGROUND:Neurogenic detrusor overactivity (NDO) leads to impaired health-related quality of life (HRQoL), productivity, and greater healthcare resource burden. The humanistic and economic burden may be more apparent in NDO patients with urinary incontinence (UI). The objective of this study was to compare the HRQoL, productivity, and health resource use (HRU) between continent and incontinent NDO patients.METHODS:A retrospective database analysis was conducted using the Adelphi Overactive Bladder (OAB)/UI Disease Specific Programme, a multi-national, cross-sectional survey reported from both patients' and physicians' perspectives. The population for this analysis included NDO patients with or without UI. General and disease-specific HRQoL were assessed using the EuroQoL-5D (EQ-5D), Incontinence Quality of Life questionnaire (I-QOL), and the Overactive Bladder Questionnaire (OAB-q). Productivity and daily activity impairment were measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. HRU indicators included OAB-related surgery, OAB-related hospitalizations, incontinence pad usage, switching anticholinergics used for OAB due to inadequate response or adverse effects, and OAB-related physician visits. Bivariate analyses, multivariate ordinary least squares (OLS) regression analyses and published minimal clinically important differences (MCID) were used to assess relationships between incontinent status and the aforementioned outcome measures.RESULTS:A total of 324 NDO patients with or without urinary incontinence were included, averaging 54years of age (SD 16), of whom 43.8 percent were male. Bivariate analyses detected no significant relationship between incontinent status and HRU variables. Regression analyses revealed that incontinent patients had clinically and statistically lower disease-specific HRQoL and greater impairment in daily activities as compared to continent patients. On average, incontinent patients scored 10 points lower on the I-QOL total score, 9 points lower on the OAB-q HRQoL score, 15 points higher on OAB-q symptom severity, and experienced 8.2 percent higher activity impairment due to their bladder condition (all p <0.001).CONCLUSIONS:Incontinent NDO patients experience significantly lower HRQoL and activity impairment as compared to continent NDO patients.

Introduction: The purpose of this research was to assess the relationship between the degree of incontinence severity and treatment seeking behavior, healthcare utilization, and work productivity; and to compare overactive bladder (OAB) related disease burden from a global perspective. Methods: A cross-sectional online survey was administered to eligible participants with idiopathic OAB residing in Australia, Canada, France, Germany, Italy, Spain, United Kingdom, and the United States. Participants were categorized into subgroups with dry, mild (1 leak/per day), moderate (2 leaks/day), and severe (3 leaks/day) urinary incontinence (UI) severity groups. Results: A total of 1,334 participants completed the survey. Persons with more severe urinary incontinence symptoms related to OAB consumed more healthcare resources, had a higher occurrence of OAB related clinical consequences, and higher work productivity loss compared to individuals with less severe symptoms. Even though OAB is associated with significant disease burden, many patients do not seek treatment.

Current and potential future trends in the burden of acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut and Iqaluit, Nunavut, Canada were investigated in the context of climate change. A concurrent mixed methods design was used in which quantitative and qualitative data were concurrently collected and analyzed and then combined to better understand the burden of AGI. In-depth interviews with government stakeholders (n=11), PhotoVoice workshops (n=11), and two community surveys (n=185) were conducted to identify and characterize climate-sensitive health priorities in the Nunatsiavut region. Then, four cross-sectional retrospective surveys in Rigolet (two community censuses, n=462) and Iqaluit (two surveys with randomly selected households, n=1,055), as well as in-depth interviews with cases (n=9) were conducted to examine the incidence, risk factors, and healthcare seeking behavior of AGI. Finally, a scenario planning approach was used to identify and rank trends and conditions driving changes in future waterborne disease in Nunatsiavut. This involved in-depth interviews with national and international experts (n=20) and community focus group discussions (n=29). Climate-sensitive health priorities identified in Nunatsiavut included food security, water security, mental health, new hazards and safety concerns, and health services and delivery. The annual estimated incidence of self-reported AGI ranged from 2.9-3.9 cases/person/year in Rigolet and Iqaluit, which are the highest published estimates globally. Significant risk factors for AGI included food, water, animal exposure, and socio-economic conditions; while community interviewees perceived hygiene, retail food, tap water, boil water advisories, and personal stress to be important risk factors. The proportion of AGI cases seeking medical services ranged from 3-19%, which are among the lowest published rates globally. In the scenario planning process, critical drivers of AGI included ‘extreme weather events’; ‘technology development’; and ‘global interest in Northern resources’. These results provided information about AGI-related exposures and sensitivities to climate change, which can be used to provide information for public health planning, prioritization, and programming in Inuit regions. The improved understanding of AGI in two Canadian Aboriginal communities sheds light on the need to better understand the burden in sub-sets of the population that might be at higher risk, including Aboriginal populations in the context of climate change. / Vanier Canada Graduate Scholarship (CIHR); Public Health Agency of Canada; IRIACC initiative (CIHR, NSERC, SSHRC, IDRC); Nasivvik Centre for Inuit Health and Changing Environments