Background: Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. Methods: The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Gr...

/pdf/2015-american-thyroid-association-management-guidelines-for-32kri8vrhd.pdf

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

计量经济分析 = Econometric analysis

Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010 (vol 380, pg 2197, 2012)

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61689-4.pdf

Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Musculoskeletal conditions are a major burden on individuals, health systems, and social care systems, with indirect costs being predominant. This burden has been recognized by the United Nations and WHO, by endorsing the Bone and Joint Decade 2000-2010. This paper describes the burden of four major musculoskeletal conditions: osteoarthritis, rheumatoid arthritis, osteoporosis, and low back pain. Osteoarthritis, which is characterized by loss of joint cartilage that leads to pain and loss of function primarily in the knees and hips, affects 9.6% of men and 18% of women aged > 60 years. Increases in life expectancy and ageing populations are expected to make osteoarthritis the fourth leading cause of disability by the year 2020. Joint replacement surgery, where available, provides effective relief. Rheumatoid arthritis is an inflammatory condition that usually affects multiple joints. It affects 0.3-1.0% of the general population and is more prevalent among women and in developed countries. Persistent inflammation leads to joint destruction, but the disease can be controlled with drugs. The incidence may be on the decline, but the increase in the number of older people in some regions makes it difficult to estimate future prevalence. Osteoporosis, which is characterized by low bone mass and microarchitectural deterioration, is a major risk factor for fractures of the hip, vertebrae, and distal forearm. Hip fracture is the most detrimental fracture, being associated with 20% mortality and 50% permanent loss in function. Low back pain is the most prevalent of musculoskeletal conditions; it affects nearly everyone at some point in time and about 4-33% of the population at any given point. Cultural factors greatly influence the prevalence and prognosis of low back pain.

/pdf/burden-of-major-musculoskeletal-conditions-1xayk0ikb2.pdf

Burden of major musculoskeletal conditions

A Review of Diabetes Treatment Adherence and the Association with Clinical and Economic Outcomes

Purpose:The aim of this study was to estimate both the direct and indirect annual cost of managing dry eye disease (DED) in the United States from a societal and a payer's perspective.Methods:A decision analytic model was developed to estimate the annual cost for managing a cohort of patients with d

The economic burden of dry eye disease in the United States: a decision tree analysis.

Objectives/Hypothesis:

To determine the prevalence and common causes of dysphonia as diagnosed by primary care physicians (PCPs) and otolaryngologists and to evaluate differences in etiologies offered by these providers.



Study Design:

Retrospective analysis of data from a large, nationally representative administrative U.S. claims database.



Methods:

Patients were identified as dysphonic based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004, to December 31, 2008. Data regarding age, sex, geographic location, and type of physician providing the dysphonia diagnosis were collected. Overall and age-related prevalence rates, as well as frequency of specific etiologies by provider type, were calculated.



Results:

Of the almost 55 million individuals in the database, 536,943 patients (ages 0 to >65 years) were given a dysphonia diagnosis (point prevalence rate of 0.98%). The prevalence rate was higher among females as compared to males (1.2% vs. 0.7%) and among those >70 years of age (2.5%). The most frequent diagnoses overall were acute laryngitis, nonspecific dysphonia, benign vocal fold lesions, and chronic laryngitis. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific dysphonia and laryngeal pathology. Gastroesophageal reflux was more commonly diagnosed as a comorbid condition by otolaryngologists than by PCPs. Overall laryngeal cancer prevalence in this treatment-seeking population was 2.2% and was greatest among males >70 years of age.



Conclusions:

This analysis of insurance claims data from a nationally representative database represents the largest study of its kind. Important differences in dysphonia prevalence related to age, sex, diagnosis, and physician type were identified. Laryngoscope, 122:343–348, 2012

Prevalence and causes of dysphonia in a large treatment-seeking population.

Objective This study estimated the total cost of musculoskeletal disorders for Canadians in 1994 and assessed the sensitivity of these cost estimates to variations in the definition of musculoskeletal disorders

Methods Disease-related costs, from a societal perspective, were measured using a prevalencebased analysis First, direct treatment costs, including expenditures on hospitals and other institutions, physicians and other health professionals, drugs, research, and other items were assessed Second, indirect costs associated with lost (or foregone) productivity due to disability and premature mortality were evaluated using the human capital approach

Results The total cost of musculoskeletal disorders in Canada was $256 billion (in 1994 Canadian dollars, $100 CDN ≈ $075 US) or 34% of the gross domestic product Direct and indirect costs were estimated at $75 billion and $181 billion, respectively Lower and upper bound estimates of the total cost of musculoskeletal disorders, derived from the sensitivity analysis, were $199 billion and $308 billion, respectively Wide variations were reported in the total cost of various musculoskeletal disorder subcategories, with the highest costs reported for injuries ($107 billion), back and spine disorders ($81 billion), and arthritis and rheumatism ($59 billion)

Conclusions The economic cost of musculoskeletal disorders was substantial and was sensitive to the definition of musculoskeletal disorders and other underlying assumptions The hallmark of this study was the variation between subcategories in their cost, pattern of health resource use, and sequelae The cost estimates may provide guidance in setting priorities for research and prevention activities

https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1790110503

The economic cost of musculoskeletal disorders in Canada

Objectives/Hypothesis:

To estimate the annual direct costs associated with the diagnosis and management of laryngeal disorders.



Study Design:

Retrospective analysis of data from a large, nationally representative, administrative US claims database.



Methods:

Patients with a laryngeal disorder based on International Classification of Diseases,Ninth Revision-Clinical Modification codes from January 1, 2004 to December 31, 2008 and who were continuously enrolled for 12 months were included. Data regarding age, gender, geographic location, and type of physician providing the diagnosis were collected. Medical encounter, medication, and procedure costs were determined. Total and mean costs per person for 12 months were determined.



Results:

Of almost 55 million individuals in the database, 309,300 patients with 12 months follow-up, mean age of 47.3 years (standard deviation: 21.3), and 63.5% female were identified. Acute and chronic laryngitis, nonspecific causes of dysphonia, and benign vocal fold lesions were the most common etiologies. The total annual direct costs ranged between $178,524,552 to $294,827,671, with mean costs per person between $577.18 and $953.21. Pharmacy claims accounted for 20.1% to 33.3%, procedure claims 50.4% to 69.9%, and medical encounter claims 16.3% to 8.6% of overall direct costs. Antireflux medication accounted for roughly 10% and antibiotics 6% of annual direct costs.



Conclusions:

This study establishes the economic impact of the assessment and management of patients with laryngeal disorders and permits cost comparisons with other diseases. Laryngoscope, 2012

Carl V. Asche

Papers

A Review of Diabetes Treatment Adherence and the Association with Clinical and Economic Outcomes

The economic burden of dry eye disease in the United States: a decision tree analysis.

Prevalence and causes of dysphonia in a large treatment-seeking population.

The economic cost of musculoskeletal disorders in Canada

Direct health care costs of laryngeal diseases and disorders.