The use and cost of resources of the hypothalamic obesity is not understood because the incidence and prevalence are related to some rare basic diseases. According to our analysis, TTR-AHO indicates that it is associated with HCRUs significantly higher than Nono. TTR-AHO is associated with increasing hospitalization, visiting outpatients and increasing cost-intensive drugs. In terms of excess cost, the cost of inpatient patients has accounted for the largest portion of the overall excess cost for two years, mainly led by subsequent hospitalization, which can include expensive neurosurgical intervention. However, prescription costs appear to have a serious economic burden over time. The average prescription cost has actually increased during the subsequent period, doubling the contribution to prescription for the overall excess cost of the second year. This increase is due to cost -intensive hormone replacement therapy. Since hormone replacement therapy is continuous, prescription costs are likely to be an important driver of long-term overtime costs of TTR-AHO. Compared to non-loyalty obesity, TTR-AHO represents high resources and cost-intensive diseases in the early and long term.
It should be noted that the analysis is that hormone replacement therapy does not try to distinguish the degree of tumor itself or the degree of development of obesity. In the clinical environment, patients with selar/parasellar tumor are receiving close medical services, and symptoms and complications are completely treated. In fact, hormone replacement treatment is based on individual profiles of each patient, and doctors do not distinguish tumor and obesity demands for hormone replacement therapy.
In addition, for the analysis of overtime costs, we also noted that the treatment of relatively expensive GLP1R agents was not used in Cohort. This is because the treatment has not yet been repaid by the legal health system. But theoretically, the patient can have a self -burden on GLP1R prescription, but cannot be observed in the data.
The identification approach of this study depends on three stages. After diagnosis of an accident in the case of a tumor that led to a potentially leading to TTR-AHO; 12 months after the index event diagnosis; Less than 12 months after the index event, AVP-D and Death Morph Rein prescription. This approach can exclude non-type TTR-AHO trajectory patients, such as those who have not developed AVP-D or have not been diagnosed with obesity within 12 months after the index event. However, this non-shape trajectory is possible, but I think it is unlikely that the hypothalamic obesity can be confirmed through AVP-D due to rapid weight gain and endocrine damage. Moreover, according to other studies, even patients with low base weight can cause pathological obesity in the short term (22). Therefore, we think that the identification approach is conservative but reasonable. In addition, the approach does not require obesity diagnosis to persist in the long run, but according to further analysis, the diagnosis of the identified patient remains. But considering the claim data settings, obesity diagnosis can be delivered simply rather than carefully coding every time you visit.
In general, the goal of this identification approach was to provide a conservative estimate with a low risk of Oh detection (14). Therefore, 37 patients are relatively small, but we think that it represents the important lower limit of the TTR-AHO group. But we notice that estimates on economic burden should be interpreted as careful corresponding to small samples. In the future, this study must be critical of this identification method in other databases and settings. This is important for creating an agreement on the standard definition of TTR-AHO. Standard definition will alleviate uncertainty in future epidemiological estimates and other analysis.
This study analyzes the cohort of patients who have developed accidents for cohorts in general obesity patients after diagnosis of inpatient inpatients and inpatient brain surgery/radiation treatment. Another possible comparison group No ~ Develop accidents. This comparison theoretically will provide insights to the excess costs of obesity itself, but this approach is related to great uncertainty in the climbing data settings because it is difficult to build a powerful comparison cohort based on the lack of diagnostic code. Depending only on claim data, obesity cannot be described as a diagnosis or the possibility of documentation due to significant delays. Therefore, future studies on other data settings must be compared with the excess costs between tumor patients who do not develop TTR-AHO.
There is still a lack of comparison data for other analysis for the treatment and cost of TTR-AHO patients. Thus, the economic analysis of patients with Craniopharyngioma, one of the most common causes of TTR-AHO, can provide a comparative direction. But even these studies are rare. Current data in the United States deals with initial treatment and surgery for two races, but lacks information on subsequent subsequent costs. Long -term follow -up measures for adults or pediatric groups have not been widely reported in relation to HCRU payment and re -hospitalization. Considering the frequent endocrine dermatology and complications according to this procedure that can affect the quality of life, reports on health care indicators are important to inform the procedure cost analysis, bundle payment considerations and the burden of patient health care. Dietz et al. Depending on the degree of endocrine and non -endocrine complications, they reported to be hospitalized after 30 days of discharge between 8% and 58% (23). We observed a total of 18%of TTR-AHO patients who were hospitalized for TTR-AHO-AHO-AHO-AHO-AHO-AHO-AHO-AHO-AHO-AHO-AHO. In addition, dietz et al. Compared to patients without complications, higher hospital hospitalization and more drug refills were observed for patients with endocrine and non -separated complications (23). These results are consistent with our discovery, which means that neuro endocrine complications, such as the development of hypothalamic obesity, are related to higher resources and higher costs. Dietz and colleagues use adult cohorts exclusively and identify patients based on diagnosis of skull race and skull basic surgery procedure code. This contrasts with our identification approach to attempting to identify the hypothalamic obesity in cohorts of all ages. Dietz and colleagues provide US cost data. But comparing these results is limited by changes in the cost structure of the United States and Germany.
The recent analysis of Germany’s non -obesity costs estimates a significant amount of pain and pain on individuals who are affected by a significant excessive burden and influence on social welfare systems (24). As TTR-AHO uses a significant increase in excess resources and costs than non-HO-related obesity, TTR-AHO is likely to be burdened with large costs for medical and social welfare systems. Due to the rapid process of increasing weight by TTR-AHO, patients can experience many mental and physical pain. Increasingly increasing the increase in hormonal therapy and hormonal replacement therapy consistently indicates a cumbersome and expensive treatment trip that has been ongoing for a long time after initial tumor hospitalization.
One of the main advantages of this study is a large data set, including TTR-AHO patients, and provides a comprehensive database for verification of TTR-AHO through accident obesity, central AVP-D diagnosis and design prescriptions. Data sets are generally representative of age and gender. However, the insured of the data set is slightly younger than the entire German population, and men are slightly overlooked in the data. In terms of locality, Germany, west and southwest are slightly overdose than East Germany. Representative evaluation of AHO or basic tumor groups is impossible due to lack of comparison data. In addition, the research design and methods face the limit. First of all, we are limited to lack of information on the history of TTR-AHO application and verification criteria to define the group of thinking research before the observation period. If the treatment interval between the inpatients with TTR-AHO is longer, the one-year washing period is too short, which can lead to a classified TTR-AHO accident. However, if there is no standardized definition of TTR-AHO, the selected approach indicates the best approximation of the TTR-AHO cohort for treatment and cohort characteristics. In the future research, it is necessary to critically test the definition of this TTR-AHO in other databases and settings. Second, since clinical parameters such as BMI, laboratory test results and information on health behavior are not available in claim data, weight gain analysis is limited by the diagnostic code available. The poor sensitivity of ICD-10 diagnostic data on the management diagnosis of overweight/obesity has been reported in the literature (25). However, it can be assumed that documents can be more accurate because of the high patient relationship with TTR-AHO’s rapid weight gain. Third, some verification criteria should consider the possibility of upward -up (26). However, this effect must be small due to strict case definition (ie, in the first analysis, all verification criteria must be documented in the fourth quarter after index hospitalization). Fourth, the patient’s self -choice is possible. For example, severe weight gain patients may be more likely to be treated or documented by patients with less health after TTR-AHO. However, this effect can be written about the verification criteria applied in this study because the symptoms are generally serious and diagnosed by a doctor. This is because classification is less likely to be affected by self -choice. Lastly, we apply the perspective of payment for the use and cost of TTR-AHO resources and estimate the economic burden of patients and caregivers. Except for some cost components, one more thing appears. Our evaluation includes only TTR-AHO or related excess costs and direct diseases. We do not consider indirect costs such as import losses or unofficial caregivers. The survey of 82 caregivers of a two -type pharyngoma shows the unproven demands of the skull racial survivors and caregivers associated with the symptoms of the survivors affecting HRQOL (27).
New treatment for acquired HOs, such as setmelanotide, is likely to increase pharmacological costs and overall costs. This should be justified by reducing the burden of disease for patients and caregivers, improving long -term results and improving patient QOL.
