#Substance Use Disorders: Cost to Employer-Sponsored Health Insurance

The AMA Network gave a report on January 27, 2023 on the cost for treatment of Substance Use Disorders (SUD) for employee-sponsored health insurance. The cost of care for employees who were diagnosed with an SUD (previously referred to simply as addictions) was compared to employees without that diagnosis.

The total cost of care to employer-sponsored health insurance for employees with an SUD diagnosis on their chart was $35 billion in 2018. The highest cost was for Alcohol Use Disorder at $10.2 billion; the second most costly was Opioid Use Disorder at $7.3 billion.

The average annual cost per employee with an SUD was $26,000 vs $10,400 for employees without that diagnosis.

The study was done by the CDC who believe that these higher costs are underestimates because only 1% of employees in the study had a diagnosis of an SUD in their medical records, but 11% of employees self-report having an SUD.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

# Weight-loss Surgery

An interesting article on bariatric (weight loss) surgery and the death rate from any cause was published in the journal Obesity on January 25, 2023. It was based on retrospective research on death rates comparing obese patients who had any of the 4 major types of weight loss surgery with obese patients who did not have surgery.

Over a 40 year timespan, patients who had surgery had a16% lower death rate from any cause than patients with the same level of obesity who did not have surgery.

Four specific causes of death were analyzed, which showed a lower percent of deaths from heart disease (29% less), cancer (43% less), diabetes (72% less), and suicide (2.4 times more than non-surgical patients); but this was mainly in younger patients undergoing surgery when they were between ages 18 and 34.

So, bariatric surgery reduces the death rate from any cause except for suicide, but that was mainly a problem in patients who underwent surgery at a younger age.

The higher suicide rate in younger patients led the researchers to conclude that a thorough psychological evaluation needs to be done before surgery, and close follow-up by a mental health provider should take place after surgery.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Alzheimer Medication

A new Alzheimer drug has shown promise in slowing down the progression of Alzheimer’s Disease in patients with mild disease. It is donanemab, which is an antibody that attacks the amyloid (protein) in the brain that accumulates and damages nerve cells.

The developer is Eli Lilly, a pharmaceutical company. They submitted to the FDA early research showing the benefits of their new drug. Lilly requested accelerated approval based on their findings. However, the FDA denied the request because they wanted to see more research subjects treated before granting approval.

Lilly has indicated that they already have a larger study underway, which includes over 100 patients. They are confident the results will enable them to receive full standard approval from the FDA. Their current results showed complete absence of the abnormal protein in 40% of research subjects after 6 months of treatment.

Hopefully, the promise of this new drug will be realized, and patients with mild Alzheimer’s will have the disease slowed down or even stopped. Time will tell.

One challenge with antibody-based treatment is the cost. Alzheimer’s is the most common cause of dementia. According to the CDC, there are about 6.5 million people in the US who have it.

Roughly half of all patients have mild disease. That means that about 3.25 million people in the US might be eligible for this new treatment. Will it be affordable? That remains to be seen.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Cancer in 2023: Predictions

Each year the American Cancer Society publishes predictions about cancer for that year based on recent trends. For 2023, their predictions in Cancer Statistics was provided in CA: A Cancer Journal for Clinicians on January 12, 2023.

The good news is that overall deaths have decreased by 33% since 1991. This represents 3.8 million lives saved. However, cancer remains a major cause of death, and the ACS estimates almost 2 million new cancer diagnoses will be made this year. Of those, 609,820 are expected to die from their cancer.

Lung and colorectal cancers account for most cancer deaths. Lung cancer has decreased by 2.6% in men and 1.1% in women. Prostate cancer is increasing, and, unfortunately is often found in late stages.

There is really good news about cervical cancer in young women (in their 20’s); the rate has decreased by 65%, probably due to the HPV vaccine given in childhood. HPV is a virus that predisposes women to get cervical cancer. Reducing the infection rate, reduces the cancer rate.

Older women have been experiencing higher rates of breast and uterine cancer, liver cancer, and melanomas. Men have not experienced an increase in liver cancer and melanoma.

More good news. As a result of newer treatments, deaths have gone down in leukemia, melanomas, and kidney cancer.

The American Cancer Society summarizes their conclusions, “… although cancer mortality rates continue to decline, future progress may be attenuated by rising incidence for breast, prostate, and uterine corpus cancers …”

Peter M. Hartmann, MD

Family Medicine & Psychiatry

#Procrastination

Procrastination is a common problem among adults of all ages but especially among younger adults. About 1/2 of university students report struggling with procrastination.

A research study on procrastination among 3525 Swedish university students was published in JAMA Network Open in January 2023. They defined procrastination as “voluntarily delaying an intended course of action despite expecting to be worse off because of the delay and is common, especially among younger people.”

Students with procrastination had “worse subsequent mental health (depression, anxiety, and stress symptom levels), having disabling pain in the upper extremities, unhealthy lifestyle behaviors (poor sleep quality and physical inactivity), and worse levels of psychosocial health factors (higher loneliness and more economic difficulties).”

Suggested reasons for these negative outcomes were thought to be the result of greater stress, less healthy behavior, and delayed treatment. Prior studies have shown that psychological treatment of procrastination results in better mental and physical health.

The bottom line is that procrastination is common, especially among younger adults, and results in a variety of physical and mental health problems. Fortunately, psychotherapy has been shown to be effective treatment.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Poor # Hydration, Early #Aging, and # Dying Young

A study about inadequate hydration in middle age adults was reported in the journal, eBioMedicine on January 2, 2023. The study involved 11,000 adults, ages 45-66 who were followed for 25 years.

Researchers wondered if inadequate hydration would cause early aging and an increased number of chronic diseases in middle aged adult humans. This was based on findings from studies on mice who were chronically dehydrated and ended up having a shortened lifespan and more degenerative diseases.

Evidence of dehydration was based on blood levels of sodium, which is elevated when someone is inadequately hydrated. They considered dehydration to be present when the sodium went above 141 mmol/L.

The study showed that adults who had a sodium of 142 or higher (dehydrated) had a 39% increased risk of chronic disease and up to a 50% increase in early aging (physically “older” than their chronological age).

If the sodium was even higher (worse dehydration) with levels at 144 or higher, those people had a 21% increased risk of premature death. Also, people with premature aging associated with dehydration had increased chronic diseases and premature death.

Although more studies need to be done, these results give more reasons to keep well hydrated. Current recommendations from The National Academy of Medicine is for men to take in 13 cups of fluids and women to take in 9 cups per day.

The recommendations above are for the average adult. You likely need more if you exercise regularly, work in a hot environment, or otherwise lose more fluid each day. Bottom line: stay hydrated!

Peter M. Hartmann, MD

Family Medicine & Psychiatry