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The Hidden Cost of Insomnia: Clinical Comorbidities and Treatment Strategies
Insomnia is a significant burden to the healthcare system, and many healthcare providers may not realize the extent to which insomnia affects patients. Insomnia is linked with decreased daytime alertness and performance, and there is an association with psychiatric conditions such as depression and anxiety. Compared with those who sleep well, patients with insomnia report more medical problems and physician office visits, are hospitalized twice as often, and use more medications. Depression, heart disease, body pain, and memory problems are associated with more prevalent symptoms of insomnia. Chronic insomnia may be associated with medical, neurologic, or psychiatric disorders. Other studies show an increase in absenteeism and higher accident rates. The socioeconomic impact of insomnia is also important; an economic analysis in 1994 estimated the total annual cost of insomnia at $92.5 to $107.5 billion. In 1999, investigators found that total cost for substances used to treat insomnia was $1.97 billion, and healthcare services for insomnia totaled $11.96 billion. A multi-site survey of various clinics revealed that insomnia is associated with increased healthcare resource use in enrollees of managed-care organizations. Healthcare providers and managed care decision makers need to understand the health and quality of life effects of insomnia and how to optimally utilize sleep medications in the managed care setting to minimize healthcare costs and maximize clinical outcomes.


Schizophrenia: Improving Outcomes While Managing Care Schizophrenia affects about 1% of Americans, which is well over two million adults. There is no cure. It is a chronic, severe brain disorder. Symptoms usually start in late teens to early 20s for men and mid 20s to early 30s for women CME valid to June 30, 2010
The Physical and Fiscal Impact of Sleep Disorders Sleep disorders are common, result in significant health care costs, and have an important impact on patient functioning. The major sleep disorders are chronic insufficient sleep syndrome, obstructive sleep apnea, and insomnia. There are effective treatments for each. Managed care can easily implement interventions in several areas for both clinical and fiscal improvement in the treatment of sleep disorders. CME valid to June 30, 2010	The Management and Treatment of Parkinson's Disease Research suggests that Parkinson's Disease (PD) affects at least 500,000 people in the United States, and some estimates are much higher. The total cost to the nation is estimated to exceed $6 billion annually. The financial and public health impact of this disease is expected to increase as the population ages. CME valid to February 15, 2010
Improving Patient Outcomes: VTE Prophylaxis and Treatment Pulmonary embolism and deep vein thrombosis are collectively referred to as ve¬nous thromboembolism (VTE). Pulmonary embolism is the most common prevent¬able cause of hospital death. Pharmacologic methods to prevent VTE are safe, ef¬fective, cost-effective, and advocated by evidence-based guidelines. Hospitalized medical and surgical patients routinely have multiple risk factors for VTE, but pro¬phylaxis is significantly underused. Multiple national quality initiatives are underway to decrease the rate of VTE during hospitalization and after discharge. CME valid to February 1, 2010	How to Improve Outcomes in a Patient Population of Asthmatics Management of an asthmatic population to achieve the best outcomes is difficult and complex. Current strategies are likely to be ineffective. Plans need to re-evaluate their current asthma management programs to identify areas for improvement. A successful asthma management program requires consideration of all stakeholders and a multifaceted and, in some cases, individualized approach. CME valid to February 1, 2010
Stroke: Primary and Secondary Prevention Strokes are a leading cause of death and disability in the US. Stroke prevention must target both patients with risk factors who have not yet had a stroke (primary prevention) and patients who have already had an event (secondary prevention). Some risk factors for stroke are not modifiable but many others can be reduced. CME valid to February 1, 2010	Economic Value of the Prevention and Treatment of Diabetic Foot Ulcers Foot ulcers are a significant problem in patients with diabetes. Prevention programs should be targeted to those patients identified in a managed care population with major risk factors for ulceration. To minimize overall costs, treatment of ulcers that develop should include advanced therapies in those patients likely to have a difficult healing process. CME valid to February 1, 2010
Management of the Liver Transplant Patient The outcomes of liver transplantation have improved significantly over the years. The process for placing patients on the transplant waiting list has also improved. Since there are approximately 16,000 people on the liver transplant waiting list and only 5,000 transplants per year, clinicians are searching for effective ways to expand the donor pool. Because of the regenerative potential of the liver, one way to expand the donor pool is through the use of living donors. CME valid to February 1, 2010	Managing Alzheimer’s Disease in Managed Care The impact of AD on health care costs, including direct and indirect medical and social services, is currently estimated to be greater than $100 billion per year. Because there is currently no cure for AD, the challenge for the near future will be the development of new therapies and therapeutic targets for disease modification and prevention. The presenter will provide information on diagnosis and treatment methods to improve the patients quality of life. CME valid to February 1, 2009
The Hidden Cost of Insomnia: Clinical Comorbidities and Treatment Strategies Insomnia is a significant burden to the healthcare system, and many healthcare providers may not realize the extent to which insomnia affects patients. Insomnia is linked with decreased daytime alertness and performance, and there is an association with psychiatric conditions such as depression and anxiety. Compared with those who sleep well, patients with insomnia report more medical problems and physician office visits, are hospitalized twice as often, and use more medications. Depression, heart disease, body pain, and memory problems are associated with more prevalent symptoms of insomnia. Chronic insomnia may be associated with medical, neurologic, or psychiatric disorders. Other studies show an increase in absenteeism and higher accident rates. The socioeconomic impact of insomnia is also important; an economic analysis in 1994 estimated the total annual cost of insomnia at $92.5 to $107.5 billion. In 1999, investigators found that total cost for substances used to treat insomnia was $1.97 billion, and healthcare services for insomnia totaled $11.96 billion. A multi-site survey of various clinics revealed that insomnia is associated with increased healthcare resource use in enrollees of managed-care organizations. Healthcare providers and managed care decision makers need to understand the health and quality of life effects of insomnia and how to optimally utilize sleep medications in the managed care setting to minimize healthcare costs and maximize clinical outcomes. CME valid through February 28, 2010	How to Manage and Treat a Psoriatic Arthritis (PsA) Patient Population to Improve Outcomes Psoriatic arthritis (PsA) is a disabling condition and patients with PsA may have significant morbidity, disability, and early mortality. Newer agents which target tumor necrosis factor (TNF) alpha have been shown to improve all domains of the psoriatic arthritis and are the treatment of choice. There are more agents targeting different aspects of the pathophysiology of this disease on the horizon. CME valid to December 31, 2009
MS: The New Treatment Paradigm: A Pathway to Success for Improved Patient Outcomes With advances in the understanding of the dual nature of multiple sclerosis (MS) – inflammation and nerve fiber destruction, treatment is now recommended in earlier phases of the disease. Early treatment after the first attack of symptoms highly suggestive of MS with disease modifying medications can delay progression to clinically definite MS. Early treatment can also significantly delay the development of disability. Because of the effects on progression and disability, overall cost savings should occur with early treatment. CME valid to December 31, 2009	The Relationship & Impact of Osteoporosis & Breast Cancer in Post Menopausal Women Osteoporosis and breast cancer are two diseases that affect a large number of women. Because of the effects of estrogen on each, there are medications which can be used to treat osteoporosis and prevent breast cancer. Selecting which women would benefit the most from an agent for both diseases is not yet well defined. CME valid to December 31, 2009
Preventing Respiratory Syncytial Virus in High Risk Populations Respiratory syncytial virus (RSV) continues to be a major cause of infant morbidity, resulting in rising hospital admission rates and costs. Infection with this virus early in life can have long-term consequences such as asthma. Children with certain risk factors are particularly vulnerable to infection with RSV and should receive prophylaxis during the RSV season. Emerging data indicates that appropriate prophylaxis in high risk children reduces long-term respiratory morbidity. CME valid to December 31, 2009	Health Economic Implications of Wound Care and Limb Preservation Ulcers and the subsequent consequences are costly to the health care system. Prevention of ulcers is important in all diabetic patients. Once an ulcer occurs, it must be treated quickly and aggressively to prevent amputation. One option for limb preservation is the use of negative pressure wound therapy to promote faster healing, get patients out of the hospital faster, and reduce overall costs. CME Valid to December 31, 2009
Striking at the Heart of Atherosclerosis: Current Problems and Future Solutions for Managed Care (Program 1 of 2) The science of atherosclerosis and the understanding of who is at risk for this disease has evolved, forcing clinicians to look beyond traditional risk factors. While cholesterol, specifically low-density lipoprotein has been proven to be causative of atherosclerosis, the role of inflammation is revealing itself to be just as important to the pathophysiology of this disease. This online program examines the evolving science of atherosclerotic disease development and the cost effective benefits of pursuing primary as well as secondary prevention in a managed care setting. CME Valid to September 30, 2009	Striking at the Heart of Atherosclerosis: Current Problems and Future Solutions for Managed Care (Program 2 of 2) Treatment for atherosclerosis quickly escalates from the basic to the invasive, the economical to the cost prohibitive. Traditionally, it starts with lifestyle changes – diet, exercise, smoking cessation – usually includes the addition of pharmacologic therapy, and may lead to interventional surgery. Sometimes all three approaches are necessary, but this costly continuum of care can be managed while disease progression is delayed or halted. This online program explores strategies for treating and managing atherosclerosis and controlling its costs in a managed care setting. CME Valid to December 31, 2009
Obesity Management Currently, obesity is the number one health problem in the U.S. Although lifestyle changes and anti-obesity medications can result in modest weight loss, this loss is generally not sufficient for the severely obese patient. Weight loss surgeries such as laproscopic adjustable gastric banding are proving to be efficacious for the morbidly obese patient. CME Valid to December 31, 2009