Actual Health Care Costs Research Articles

Valuation and perception of the costs of climate change on health.

Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context. The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach. Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams. Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

Pharmacoeconomic analysis of biologics and methotrexate for rheumatoid arthritis from the standpoint of the number needed to treat concept under the Japanese health insurance system

ObjectivesTo evaluate the cost-effectiveness of biologics and methotrexate (MTX) for rheumatoid arthritis (RA) using the number needed to treat (NNT) concept and total actual health care cost.MethodsThis study included 121 RA patients with newly prescribed biologics and/or MTX between 2012 and 2017. The NNT was calculated based on the 24 week remission rate of Disease Activity Score in 28 joints using erythrocyte sedimentation rate (DAS28-ESR) and Clinical Disease Activity Index (CDAI).ResultsRemission rates were 76.4% for DAS28-ESR and 45.4% for CDAI in the biologics group and 63.6% and 24.2%, respectively, in the MTX group. The NNT was calculated as 6.4 and 4.2 in the biologics group and 34.2 and 35.2 in the MTX group, respectively. Mean total actual health care costs were 1,044,066 JPY (9835 US$)/24 weeks per treated patient in the biologics group and 75,860 JPY (715 US$)/24 weeks in the MTX group. Although the effectiveness of biologics was superior to MTX from the standpoint of NNT, the mean total health care cost and mean cost per NNT were much higher in the biologics group.ConclusionsCost-effectiveness is clearly higher for MTX than biologics from the standpoint of mean total health care cost per adjusted NNT under the Japanese health insurance system.

Increases in Actual Health Care Costs and Claims After Firearm Injury.

The incidence of firearm injury and death in the United States is increasing. Although the health care-related effect of firearm injury is estimated to be high, existing data are largely cross-sectional, do not include data on preinjury and postinjury health care visits and related costs, and use hospital charges rather than actual monetary payments. To compare actual health care costs (that is, actual monetary payments) and utilizations within the 6 months before and after an incident (index) firearm injury. Before-after study. Blue Cross Blue Shield plans of Illinois, Texas, Oklahoma, New Mexico, and Montana. Plan members continuously enrolled for at least 12 months before and after an index firearm injury sustained between 1 January 2015 and 31 December 2017. Eligible costs, out-of-pocket costs, and firearm injury-related International Classification of Diseases, Ninth or 10th Revision, codes. Total initial (emergency department [ED]) health care costs for persons with index firearm injuries who were discharged from the ED were $8158786 ($5686 per member). Total initial (hospital admission) costs for persons with index firearm injuries who required hospitalization were $41255916 ($70644 per member). Compared with the 6 months before the index firearm injury, in the 6 months after, per-member costs increased by 347% (from $3984 to $17806 per member) for those discharged from the ED and 2138% (from $4118 to $92151 per member) for those who were hospitalized. The number of claims increased by 187% for patients discharged from the ED and 608% for those who were hospitalized. Firearm injury intent was not specified because of misclassification concerns. In the 6 months after a firearm injury, patient-level health care visits and costs increased by 3 to 20 times compared with the 6 months prior. The burden of firearm injury on the health care system is large and quantifiable. None.

A New Healthcare Alliance: Consumer Engagement in the New Healthcare Economy

A New Healthcare Alliance: Consumer Engagement in the New Healthcare Economy

Bundled Payment Models for Actinic Keratosis Management.

Recent legislation encourages alternative payment models, such as bundled payments. There are no clear recommendations on bundled payment design, and research on bundled payments for dermatologic care is limited. To investigate several methods to develop bundled payment models for actinic keratosis (AK) management and the likely effect on the cost of AK management. Cohort cost identification study using claims from Highmark Insurance and the MarketScan Commercial Claims and Encounters databases. Patients with claims for AK during the study period, January 2010 to December 2012, were included (N = 118 129). Utilization measures, such as visits and procedures, and direct costs were calculated and 8 bundled payment models were developed. Indirect costs were not included. The actual health care costs and theoretical cost differences for the bundled payments. Costs are reported in 2012 US dollars and were adjusted for inflation. The proportion of patients and clinicians with annual AK claim costs less than or equal to the bundled payments were calculated. Eight bundled payment models were developed and 2, based on the 75th percentile payment, did not result in theoretical savings for any of the patient samples (increased annual spending of $1.04 million to $6.88 million). The median-based payment without adjustments resulted in the largest theoretical savings (decreased spending of $2.22 million to $6.43 million). In contrast, the mean-based payment with adjustments resulted in the smallest theoretical savings. The median-based with indirect payment (65.2% for patients and 62.0% for clinicians) and mean-based adjusted payments, with (68.9% and 66.2%) and without (68.1% and 65.6%) discount, were equal to or greater than the actual health care costs for similar proportions of patients and clinicians, respectively. In addition, both resulted in a decrease in overall health care costs for the patient cohort. It is important to consider alternative payment models, such as bundled payments, in preparation for payment reform. The dermatology profession needs to understand disease management in dollar terms to advocate on behalf of clinicians and patients for fair and reasonable reimbursement, regardless of payment type.

Counterpoint: Someone Has to Pay

Drs Farrell and Curran raise some provocative issues in their commentary on Dr Hillman’s [1] January 012 JACR editorial “Somebody Has to Pay.” Many of their suggestions are reasoned and timely, including measures to reduce alcohol and drug abuse, tort reform, price transparency, the recognition of charitable activity, and the reduction of bureaucracy. And some of their recommendations touch on some of America’s most polarizing and knottiest social issues, for instance, immigration reform. The debate about such matters, though informed by medical professionals, will require a Herculean consensus-building effort at the national and international levels, far beyond the reach of the health care community. Unfortunately, many of their other, more medically focused ideas are unpopular, not well grounded, or both. To explore just a few of these, start with the delinking of employment and health insurance. This is the so-called Dutch plan, named after a dramatic reshaping of health care initiated in the Netherlands in 2006 whereby employers converted from the actual provision of health insurance coverage to the financial subsidization of independently obtained employee coverage. Private health plans have to sell community-rated policies to all, and every citizen must purchase insurance, aided by government assistance as needed. In the United States, the Dutch plan gained early bipartisan backing from Sens Ron Wyden of Oregon and Robert Bennett of Utah. Introduced as the Healthy Americans Act, the legislation garnered little support. Senator Wyden (D, Ore) has since shifted his interest to a voucher approach in collaboration with Rep Paul Ryan (R, Wis). Senator Bennett lost his reelection bid in 2008. In addition to a scarcity of legislative interest, the Healthy Americans Act bumped into another reality: for those fortunate enough to have it, most employees and companies like employer-based insurance. Workers prize the volumebased purchasing leverage, not to mention the tax savings, and corporations treasure the ability to provide a valued benefit, especially in a competitive labor market. Health savings accounts can be a source of substantial savings, but unfortunately usually not to those who need it most: the sick. Why such a limited benefit? Consider that 70% of the population consume less than 10% of health care resources (20% spend nothing annually). But 5% are responsible for more than 50% of spending, and that group can exhaust a health savings account very quickly, even one accumulated over a lifetime. Thus, such savings accounts are helpful to the healthy and well-to-do, but few others. Vouchers for health care insurance invariably peg their growth to general metrics such as the Consumer Price Index, not actual health care costs. For decades, medical expenses have annually far outstripped the overall cost of living, so vouchers become increasingly inadequate over time. A reduction of state coverage mandates shows up on a lot of these lists and in political speeches always

Real-life costs and effects of an implementation program to increase thrombolysis in stroke

We have shown that a Breakthrough Series-based implementation program increases the number of patients with acute ischemic stroke treated with alteplase 4.5% in real-life settings. It is unclear whether such an implementation program is cost-effective. The practice study includes 12 randomized hospitals and 5,515 patients. Its present cost-effectiveness analysis involves 1,657 patients with ischemic stroke admitted within 4 hours from onset. Defined primary outcomes are thrombolysis rate and actual health care costs up to 3 months, including additional implementation efforts. Secondary outcomes are lifetime quality-adjusted years (QALYs) and lifetime costs of individual trial patients, using a validated probabilistic, disability-stratified stroke life table. Differences in outcome include 95% confidence intervals (CI), adjusted for intracluster correlation. The thrombolysis rate in the intervention group was 44.3% vs 39.8% in the control group (difference 4.5%; 95% CI 3.1% to 5.9%. Mean costs per patient at 3 months (euros were converted to 2010 USD) were $9,192 USD in the intervention group and $9,647 USD in the control group (difference -$455 USD; 95% CI -$232 to -$679 USD). Lifetime QALYs in the intervention group were 3.89 and in the control group 3.84 (difference 0.05; 95% CI -0.04 to 0.14). The mean lifetime costs in the intervention group were $22,994 USD against $24,315 USD in the control group (difference -$1,321 USD; 95% CI -$1,722 to -$921 USD). A Breakthrough Series implementation program of thrombolysis increases thrombolysis. It saves short- and long-term health care costs due to lower hospital admission and residential costs, increasing stroke care efficiency.

Six Climate Change–Related Events In The United States Accounted For About $14 Billion In Lost Lives And Health Costs

The future health costs associated with predicted climate change-related events such as hurricanes, heat waves, and floods are projected to be enormous. This article estimates the health costs associated with six climate change-related events that struck the United States between 2000 and 2009. The six case studies came from categories of climate change-related events projected to worsen with continued global warming-ozone pollution, heat waves, hurricanes, infectious disease outbreaks, river flooding, and wildfires. We estimate that the health costs exceeded $14billion, with 95percent due to the value of lives lost prematurely. Actual health care costs were an estimated $740million. This reflects more than 760,000 encounters with the health care system. Our analysis provides scientists and policy makers with a methodology to use in estimating future health costs related to climate change and highlights the growing need for public health preparedness.

The Health Care Costs of Violence Against Women

The aim of this study is to analyze the health care costs of violence against women. For the study, we used a register-based approach where we identified victims of violence and assessed their actual health care costs at individual level in a bottom-up analysis. Furthermore, we identified a reference population. We computed the attributable costs, that is, the excess health care costs for victims compared to an identified reference population of nonvictims. Only costs within the health care sector were included, that is, somatic and psychiatric hospital costs, costs within the primary health care sector and costs of prescription pharmaceuticals. We estimated the attributable health care costs of violence against women in Denmark, using a generalized linear model where health care costs were modeled as a function of age, childbirth, and exposure to violence. In addition we tested whether socioeconomic status, multiple episodes of violence, and psychiatric contacts had any impact on health care costs. We found that the health care costs were about €1,800 higher for victims of violence than for nonvictims per year, driven mostly by higher psychiatric costs and multiple episodes of violence.

Cost-effectiveness of substituting dual-energy CT for SPECT in the assessment of myocardial perfusion for the workup of coronary artery disease

PurposeWe compared cost-effectiveness and potential lifetime benefits of using dual-energy computed tomography (DECT) for myocardial perfusion assessment instead of single photon emission computed tomography (SPECT) for the workup of coronary artery disease (CAD). Materials and methodsA decision and simulation model was developed to estimate cost and health effects of using DECT myocardial perfusion imaging instead of SPECT for identifying patients in need of invasive imaging and possible revascularization. The model was based on the performance indices of stress/rest DECT compared with stress/rest SPECT for detecting myocardial perfusion deficits in 50 patients (mean age 61±10 years) with CAD. Stress/rest perfusion and delayed enhancement cardiac MRI served as reference standard. For DECT a reimbursement of US$1700 was assumed but costs of cardiac MRI were not included in the model. All other actual healthcare costs in these patients were derived from MUSC's hospital billing system. ResultsCompared with cardiac MRI, DECT (versus SPECT) had 90% (85%) sensitivity and 71% (58%) specificity for identifying patients with obstructive CAD. Compared with the no imaging and no treatment strategy, routine SPECT gained 13.49 quality-adjusted life-years (QALYs) with an incremental cost-effectiveness ratio (ICER) of US$3557 (in 2010) per QALY. In comparison, DECT ICER was lower (US$3.191 per QALY, p=0.0002) and an additional 0.64 QALYs was obtained (total of 14.13 QALYs) if compared with the SPECT strategy as well as the no imaging and no treatment strategy. ConclusionUsing DECT as the first-line imaging test for myocardial perfusion for the workup of patients with CAD has the potential to provide gains in QALYs, while lowering costs if compared to routine myocardial perfusion SPECT.

The Economic Value of a Wellness and Disease Prevention Program

The objective of this study was to determine the economic impact of the Hawaii Medical Service Association's health promotion/disease prevention program. A retrospective analysis of health risk, health claims, and cost was performed using a mixed model factorial design for the years 2002-2005 that compared program participants to nonparticipants. All analyses were adjusted for preexisting observed differences based on sex, age, baseline morbidity, and health care costs between participants and nonparticipants using propensity score matching method and/or covariates as appropriate. After analyzing data from more than 166,000 HMSA members over a 4-year period, participants were found to incur consistently lower costs. Predictive modeling of upward cost trajectories relative to actual health care costs for participants and risk-matched nonparticipants indicated a savings of $350 per participant per year. Those who participated in additional wellness programming demonstrated additional cost savings. This study illustrates the economic value of a comprehensive health promotion program.

Comments on “Health economic evaluation in lumbar spinal fusion. A systematic literature review anno 2005”

The authors have presented an interesting review dealing with a hot topic: cost-effectiveness in spine surgery. In the field of healthcare management, full health economic evaluations including cost-effectiveness analyses (CEA) and cost-utility analyses (CUA) are increasingly requested by those responsible for fund allocation. In both CEA and CUA, the cost difference between two treatment alternatives is illustrated in the numerator, and the difference in treatment effects in the denominator. The result is given as a ratio reflecting the extra cost per extra effect unit gained by using one treatment instead of another, the incremental cost effectiveness ratio (ICER). Thus, CEA and CUA relate to our ambition to select the best available treatment for the money available, and could therefore serve as a bridge of understanding among clinicians, managers, healthcare policy-makers and politicians. Two reviewers, one health economist and one clinician were reported to be involved in the study, which should be accepted as a minimum. The used methodology is accurate, making use of a merged instrument for assessing the quality of the included studies [2, 8, 9]. Few relevant health economic studies dealing with CEA in the field of lumbar spinal fusion were found, which accurately reflects the current state of affairs. One British study, which should be analysed according to the method used in the current paper, was recently published [6]. All but two studies reported ICER from the perspective of the healthcare sector (in this case, hospitals). The authors therefore chose to exclude results from a societal perspective. However, it should be noted that the healthcare perspective is mainly of concern to local healthcare administrators, while most other parties are interested in the societal perspective, where the economic implications of being off work are also considered. Since this is far more costly than the actual healthcare costs [3], future studies would benefit from including also the societal perspective. One problem with CEA and CUA is the use of different methods in collecting information on costs, as well as different outcome instruments and measuring techniques and also somewhat different study populations. This is one reason why it has so far been difficult to use results from CEA/CUAs to decide on priorities among specific treatment options in the surgical field. The situation is somewhat different in the pharmaceutical field where reported cost-effectiveness is frequently used to support or reject reimbursement of drugs [4]. Consequently, the authors stress the importance of raising the awareness of health economic evaluations and agreeing on methodological issues. The Panel on cost-effectiveness in the US has dealt with this challenge for approximately 10 years [7], and the Spine Society of Europe (SSE) also recently addressed it, when a Health Economic task force including clinicians, economists, epidemiologists and statisticians, was established in 2004. Besides discussing theoretical issues on methodology and how to analyse and present data, this group will be able to give practical advice on protocols and outcome instruments. Recently they also decided to arrange instructional courses in health economics. In conclusion, the authors are to be congratulated for helping to put health economic analyses in the field of spine surgery on the agenda, and hopefully, future clinical studies will more often include a health economic evaluation related to clinical outcome. If a CUA is feasible it would be advantageous to include that, using a preference-based outcome instrument, like the EQ5D or SF-6D [1, 5]. These instruments are used to measure patient perceived changes in quality of life after a given treatment (utility), and if these differences are correlated with time, they can be expressed in terms of gains or losses in quality-adjusted life years (QALYs). Reporting costs per QALY will make it possible to discuss priorities among different treatment options—not only within the same diagnostic entity, but even among different diagnostic entities. This will increase interest in these analyses within the profession as well as among fund holders. However, the ethical concerns inherent in health economic evaluations should not be taken lightly, and must be discussed and analysed continuously by the profession.

Medical and Economic Benefit of a Comprehensive Infection Control Program That Includes Routine Determination of Microbial Clonality

Nosocomial infections are a major part of the problem of reemerging pathogens causing infectious diseases, affecting 5% of patients hospitalized in the United States during 1995. We assessed the medical and economic effects on the overall nosocomial infection rate of an intervention that provided an enhanced, integrated infection control program, including an in-house molecular typing laboratory capability to rapidly assess microbial clonality. Data on nosocomial infections for 24 months prior to the change in approach to infection control were compared with data from the 24 months immediately following implementation of the new program. Infections per 1,000 patient-days and percentage of hospitalized patients in whom nosocomial infection developed were assessed. Overall, nosocomial infections per 1,000 patient-days decreased more than 10% (P = .027), and percentage of patients with nosocomial infection decreased 23% during the post-intervention period compared with the previous control 24 months. This translated to a mean reduction of some 270 patients per year with nosocomial infection, and lowering of actual health care costs for our institution by $4,368,100 over the 2 years of the intervention.

Design, Development and Implementation of a Multidisciplinary Diabetes Disease Management Programme

Disease management initiatives are becoming increasingly popular in the US as a way for managed-care plans to care for their members with chronic conditions. Diabetes is one of the most expensive chronic conditions, both in terms of human lives and actual healthcare costs. Managed-care plans are adopting different approaches to caring for their members with diabetes. The experience of one organisation shows that a population management approach to caring for people with diabetes is the best way to improve clinical outcomes and reduce healthcare costs for managed-care organisations in the short term.

Cancer chemoprevention: principles and prospects.

Cancer chemoprevention can be defined as prevention of cancer by the administration of one or more chemical entities, either as individual drugs or as naturally occurring constituents of the diet. For several reasons, chemoprevention has received growing consideration as a means of cancer control. In the USA, the 5 year survival rate of cancer patients is currently 51 % overall (1). Among those organ sites with exceptionally low 5 year survival rates are lung (13%), ovary (39%), stomach (16%), esophagus (9%) and pancreas (3%) (1). Clearly, the considerable advances that have occurred in earlier detection and treatment of cancer have done little to improve the prognosis for patients diagnosed with cancer at certain organ sites. Thus, the aggressive prevention of cancer should be a cornerstone of any cancer control policy. Primary cancer prevention requires removal of exposure of individuals to etiologic agents. However, numerous subpopulations at high risk for certain types of cancer may already have received considerable exposure to such agents, and many human cancers cannot be ascribed to specific etiologic agents. Thus, preventative strategies that do not require prior knowledge of specific etiologic factors have great appeal. Additionally, the cost of chemopreventative programs in a given population should be considerably less than the actual health care costs incurred by any fraction of that population that develops cancer. Hence, chemoprevention of cancer may become a major weapon in the anticancer arsenal.

The aging of the aged: challenges for gerontology & geriatrics in the United States.

It comes as no surprise that global graying will be one of the most pressing issues of the coming century. The most rapidly growing age group in all developed countries is the one with persons aged 85 and older. Often referred to as the "oldest old", the aging of the aged reflects a universal concern being experienced in the United States as well as in other industrialized countries, such as Japan. This paper addresses the challenges that such changes present for gerontology and geriatrics. Contextual projections of population trends and of life expectancy, as well as actual health care costs and estimated government health care expenditures will be compared for the United States and for Japan. Among the geriatric challenges being confronted are (1) the need to separate aging from disease, (2) the need for more geriatric centers and available geriatricians to serve the aged, (3) the introduction of health care strategies of prevention and case management, (4) responses to the notion of health care rationing, and (5) the ultimate importance of research ranging from the biological and molecular to the behavioral, social, and health service delivery. Global aging presents a gerontological imperative that may best be understood by examining policy recommendations and future policy decisions.