Direct and indirect costs associated with Dupuytren’s contracture

Figures & data

Table 1.   Sample selection process.

Step	Description	n
0	All employees in companies providing disability data, 1/1/2000–3/31/2009	2,894,706
1	Employees with at least 1 DC diagnosis (ICD-9-CM: 728.6 or 718.44), 1/1/2000–3/31/2009	8776
2	Continuous eligibility at least 6 months before (‘baseline period’) and 1 year after the index date (‘study period’)	5409
3	Aged 18–64 during the baseline and study periods	2590
4	Actively employed during the baseline and study periods	1406
5	Matched on age, region, gender, and index date to controls	1406

Table 2.  Baseline characteristics and comorbidities.

Characteristics and comorbidities	Employees with DC (n = 1406)	Employee controls (n = 1406)	p-value^a
Demographic characteristics
Age, years, Mean (SD)	49 (8.6)	49 (8.6)	–
Age distribution, N (%)
18–30 years	47 (3.3%)	47 (3.3%)
31–44 years	341 (24.3%)	341 (24.3%)
45–54 years	584 (41.5%)	584 (41.5%)
55–64 years	434 (30.9%)	434 (30.9%)
Male, N (%)	1025 (72.9%)	1025 (72.9%)	–
Employee status, N (%)
Salaried	506 (36.0%)	506 (36.0%)
Non-salaried	403 (28.7%)	403 (28.7%)
Unknown	497 (35.3%)	497 (35.3%)
Select comorbidities, N (%)^b
Hyperlipidemia	297 (21.1%)	220 (15.6%)	0.0002
Chronic obstructive pulmonary disease	10 (0.7%)	12 (0.9%)	0.6698
Peyronie’s disease	2 (0.1%)	0 (0.0%)	0.5000
Ledderhose disease	29 (2.1%)	0 (0.0%)	<0.0001
Garrod’s nodules	3 (0.2%)	0 (0.0%)	0.2500
Hypothyroidism	49 (3.5%)	28 (2.0%)	0.0167
Charlson Comorbidity Index (CCI), Mean (SD)^c	0.319 (0.904)	0.165 (0.686)	<0.0001
Select comorbidities included in the CCI, N (%)^c
Chronic pulmonary disease	43 (3.1%)	27 (1.9%)	0.0523
Diabetes mellitus	114 (8.1%)	51 (3.6%)	<0.0001
Any malignancy including leukemia and lymphoma	43 (3.1%)	21 (1.5%)	0.0045

^aMcNemar tests were used for comparisons of categorical variables. Wilcoxon signed-rank tests were used for comparisons of continuous variables.

^bSelect comorbidities were defined using ICD-9-CM codes during the baseline period.

^cThe 17 conditions included in the CCI were identified using ICD-9 diagnosis codes reported by Romano et al.21.

Table 3.  Direct resource use during the study period.

12-month resource utilization^a	Employees with DC	Employee controls	p-value^b
	(n = 1406)	(n = 1406)
Direct resource utilization
Number (%) of patients with at least one:
All-cause resource use
Inpatient stay	108 (7.7%)	74 (5.3%)	0.0076
Emergency Department (ED) visit	279 (19.8%)	196 (13.9%)	<0.0001
Outpatient/other visit	1406 (100.0%)	1102 (78.4%)	<0.0001
PT/OT visits	424 (30.2%)	101 (7.2%)	<0.0001
Hand splinting	117 (8.3%)	14 (1.0%)	<0.0001
Any prescription drug use	1195 (85.0%)	973 (69.2%)	<0.0001
Select prescription drug classes use
Anti-hyperlipidemics	332 (23.6%)	256 (18.2%)	0.0004
Medication related to diabetes (e.g., insulin,      anti-hyperglycemics, etc.)	116 (8.3%)	65 (4.6%)	<0.0001
Anti-convulsants	79 (5.6%)	33 (2.3%)	<0.0001
Thyroid medications	81 (5.8%)	58 (4.1%)	0.0511
Analgesics	641 (45.6%)	329 (23.4%)	<0.0001
Narcotic opioids	501 (35.6%)	206 (14.7%)	<0.0001
Other analgesics	319 (22.7%)	215 (15.3%)	<0.0001
Anti-depressants	231 (16.4%)	145 (10.3%)	<0.0001
Corticosteroid injections (i.e., triamcinolone)	68 (4.8%)	27 (1.9%)	<0.0001
Mean [Median] (SD) number of:
All-cause resource use
Inpatient stays	0.11 [0.00] (0.52)	0.06 [0.00] (0.30)	0.0094
Inpatient days	0.47 [0.00] (3.26)	0.21 [0.00] (1.25)	0.0102
ED visits	0.32 [0.00] (1.11)	0.21 [0.00] (0.84)	0.0006
Outpatient/other visits	13.71 [9.00] (14.34)	7.25 [4.00] (10.02)	<0.0001
PT/OT visits	2.48 [0.00] (7.41)	0.73 [0.00] (3.65)	<0.0001
Prescription drugs used (9-digit NDC)	6.49 [5.00] (6.73)	4.13 [3.00] (4.83)	<0.0001
DC surgery resource use
Number (%) with one fasciectomy	85 (6.0%)
Number (%) with two or more fasciectomies	1 (0.1%)
Number (%) with at least one fasciotomy	25 (1.8%)

^aResource utilization was measured during the 12-month post-index study period.

^bMcNemar tests were used for comparisons of categorical variables. Wilcoxon signed-rank tests were used for comparisons of continuous variables.

Table 4.  Indirect resource use during the study period.

12-month resource utilization^a	Employees with DC	Employee controls	p-value^b
	(n = 1406)	(n = 1406)
Indirect resource utilization
Number (%) of patients with at least one:
Disability day	115 (8.2%)	48 (3.4%)	<0.0001
Medically related absenteeism day	1377 (97.9%)	1090 (77.5%)	<0.0001
Work loss day	1405 (99.9%)	1103 (78.4%)	<0.0001
Mean [Median] (SD) number of:
Disability days	6.68 [0.00] (35.89)	3.55 [0.00] (26.35)	0.0002
Medically related absenteeism days	7.55 [4.50] (9.51)	3.75 [2.00] (6.04)	<0.0001
Work loss days	14.24 [5.00] (36.20)	7.31 [2.00] (26.82)	<0.0001

^aResource utilization was measured during the 12-month post-index study period.

^bMcNemar tests were used for comparisons of categorical variables. Wilcoxon signed-rank tests were used for comparisons of continuous variables.

Table 5.  Direct and indirect costs during the study period ($2009).

12-month costs^a	Employees with DC (n = 1406)	Employee controls (n = 1406)	p-value^b
Total direct costs, Mean [Median] (SD)	$5974 [$3118] ($10,571)	$3175 [$1006] ($7688)	< 0.0001
Medical costs	$4733 [$1928] ($9691)	$2321 [$424] ($7041)	<0.0001
Hospital inpatient costs	$969 [$0] ($6509)	$543 [$0] ($4431)	0.0186
ED costs	$118 [$0] ($507)	$81 [$0] ($404)	0.0003
Outpatient/other costs	$3646 [$1,799] ($5418)	$1697 [$398] ($4615)	<0.0001
PT/OT costs	$154 [$0] ($545)	$48 [$0] ($484)	<0.0001
Hand splinting costs	$9 [$0] ($51)	$1 [$0] ($7)	<0.0001
Prescription drug costs	$1241 [$450] ($2332)	$855 [$127] ($2350)	<0.0001
Total DC-related direct costs	$501 [$92] ($1337)
Total indirect costs, Mean [Median] (SD)	$2737 [$1241] ($5900)	$1309 [$482] ($3576)	<0.0001
Disability costs	$732 [$0] ($5323)	$308 [$0] ($3078)	<0.0001
Medically related absenteeism costs	$2006 [$1088] ($2913)	$1001 [$455] ($1873)	<0.0001
Total costs, Mean [Median] (SD)	$8712 [$4754] ($13,490)	$4485 [$1660] ($9529)	<0.0001

^aCosts were measured during the 12-month post-index study period. All costs were inflated to 2009 US$. Direct costs were inflated using the CPI for Medical Care. Indirect costs were inflated using average hourly compensation data from the Bureau of Labor Statistics.

^bWilcoxon signed-rank tests were used for comparisons of continuous variables.

Table 6.  Risk-adjusted direct and indirect costs during the study period ($2009)*.

Risk-adjusted 12-month costs*	Employees with DC (n = 1406)	Employee controls (n = 1406)	p-value^a
Total direct costs, Mean [Median] (SD)	$6174 [$5223] ($5687)	$3231 [$2733] ($2976)	<0.0001
Total indirect costs, Mean [Median] (SD)	$2811 [$2320] ($3213)	$1370 [$1131] ($1566)	<0.0001
Total costs, Mean [Median] (SD)	$9005 [$7622] ($8641)	$4590 [$3885] ($4404)	<0.0001

*Generalized linear models with gamma distribution and log link were used to calculate and compare risk-adjusted key cost outcomes between DC employees and controls, adjusting for baseline characteristics such as age and comorbidities. Only comorbidities with at least 5% and less than 95% prevalence in the DC or control group were included in the model. Potential confounders included age, gender, index year, region, employee status (i.e., salaried, non-salaried, unknown), the Charlson Comorbidity Index (CCI), and hyperlipidemia.

^ap-values were calculated for the variable in the models that controlled for whether an employee had DC.

Romano PS, Roos LL, Jollis J. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol 1993;46:1075-9

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