All-cause Healthcare Costs Research Articles

Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort analysis.

ObjectiveThe aim was to describe direct health-care costs for adults with SLE in the UK over time and by disease severity and encounter type.MethodsPatients aged ≥18 years with SLE were identified using the linked Clinical Practice Research Datalink–Hospital Episode Statistics database from January 2005 to December 2017. Patients were classified as having mild, moderate or severe disease using an adapted claims-based algorithm based on prescriptions and co-morbid conditions. We estimated all-cause health-care costs and incremental costs associated with each year of follow-up compared with a baseline year, adjusting for age, sex, disease severity and co-morbid conditions (2017 UK pounds).ResultsWe identified 802 patients; 369 (46.0%) with mild, 345 (43.0%) moderate and 88 (11.0%) severe disease. The mean all-cause cost increased in the 3 years before diagnosis, peaked in the first year after diagnosis and remained high. The adjusted total mean annual increase in costs per patient was £4476 (95% CI: £3809, £5143) greater in the year of diagnosis compared with the baseline year (P < 0.0001). The increase in costs per year was 4.7- and 1.6-fold higher among patients with severe SLE compared with those with mild and moderate SLE, respectively. Primary care utilization was the leading component of costs during the first year after diagnosis.ConclusionThe health-care costs for patients with SLE in the UK are substantial, remain high after diagnosis and increase with increasing severity. Future research should assess whether earlier diagnosis and treatment might reduce disease severity and associated high health-care costs.

CML-311: Healthcare Resource Utilization and Associated Costs Among Patients with Chronic Myeloid Leukemia by Line of Therapy in the United States (US) from a Commercial Perspective

Background: Despite advances in therapy, many patients with chronic myeloid leukemia in chronic phase (CML-CP) are refractory or intolerant to tyrosine kinase inhibitors (TKIs). Objective: To assess treatment patterns and economic outcomes among commercially insured patients with CML by line of TKI therapy (LOT). Methods: Adult patients with CML in the US who received ≥1 LOT were identified in the IBM MarketScan Commercial and Medicare Supplement databases (01/01/2001–06/30/2019). Treatment patterns, and all-cause and CML-related healthcare resource utilization (HRU: inpatient [IP] days, days with outpatient [OP] visits, and emergency department [ED] visits) and healthcare costs (medical+pharmacy) were measured by LOT; sensitivity analysis was performed after generic imatinib availability (02/01/2016). HRU was reported using annual incidence rates (IR), and costs (2019 USD, payer’s perspective) were reported per-patient-per-month (PPPM). Costs were stratified for hematopoietic stem cell transplantation (HSCT) status during LOT. Results: From 2001 to 2019, first-generation (1G) TKI (i.e., imatinib) was most prevalent in first-line (1L [N=3,234]; 66.2%), and second-generation (2G) TKIs (i.e., nilotinib, dasatinib, bosutinib) were most prevalent in second-line (2L [N=954]; 83.9%), third-line (3L [N=296]; 74.7%), and fourth-line (4L [N=83]; 69.9%). After 02/01/2016, 2G TKIs were most prevalent in 1L ([N=440]; 57.7%), 2L ([N=208]; 72.6%), 3L ([N=90]; 77.8%), and 4L ([N=29]; 69.0%). Annual IR increased between 1L and 4L: 1.3 to 2.4 for IP days, 23.1 to 31.6 for OP visits, and 0.6 to 0.8 for ED visits. The proportion of CML-related IP days increased from 69% to 80% between 1L and 4L. Mean all-cause costs increased between 1L and 4L from $10,340 (25% from medical) to $19,546 PPPM (47% from medical), with approximately 90% of costs CML-related. Excluding HSCT, mean all-cause costs increased from $10,322 (25% from medical) to $15,073 PPPM (31% from medical). After 02/01/2016, all-cause costs increased between 1L and 4L from $13,312 (21% from medical) to $18,379 PPPM (36% from medical). Excluding HSCT, mean all-cause costs increased from $13,275 (21% from medical) to $18,092 PPPM (35% from medical). Conclusions: Commercially insured patients with CML had increasing HRU and costs as they cycled through TKIs, highlighting the need for new treatments that can help optimize disease management. Sponsorship: Novartis

Trail Conditions and Community Use: Utilizing Geospatial Video to Guide the Adoption of a Spatial-Temporal Trail Audit Tool (STAT).

Physical activity (PA), associated with all-cause mortality, morbidity, and healthcare costs, improves vitamin D absorption, immune response, and stress when completed outdoors. Rural communities, which experience PA inequities, rely on trails to meet PA guidelines. However, current trail audit methods could be more efficient and accurate, which geospatial video may support. Therefore, the study purpose was (1) to identify and adopt validated instruments for trail audit evaluations using geospatial video and a composite score and (2) to determine if geospatial video and a composite score motivate (influence the decision to use) specific trail selection among current trail users. Phase 1 used a mixed-method exploratory sequential core design using qualitative data, then quantitative data for the development of the Spatial-temporal Trail Audit Tool (STAT). Geospatial videos of two Northeast Ohio trails were collected using a bicycle-mounted spatial video camera and video analysis software. The creation of STAT was integrated from Neighborhood Environment Walkability Scale (NEWS), Walk Score, and Path Environment Audit Tool (PEAT) audit tools based on four constructs: trail accessibility, conditions, amenities, and safety. Scoring was determined by three independent reviewers. Phase 2 included a mixed-method convergent core design to test the applicability of STAT for trail participant motivation. STAT has 20 items in 4 content areas computing a composite score and was found to increase trail quality and motivation for use. STAT can evaluate trails for PA using geospatial video and a composite score which may spur PA through increased motivation to select and use trails.

Burden of Pneumonia Among Hospitalized Patients with Influenza: Real-World Evidence from a US Managed Care Population

IntroductionPneumonia is among the most prevalent complications of influenza. The purpose of this study is to quantify the burden of pneumonia among hospitalized patients with influenza.MethodsReal-world retrospective data from 01JAN2014-30JUN2019 (study period) were obtained from Optum’s de-identified Clinformatics® Data Mart Database (2007–2020) for patients who had ≥ 1 diagnosis for influenza during the identification period and ≥ 1 all-cause inpatient visit within 1 day of diagnosis. Cases had ≥ 1 diagnosis claim for an influenza-related pneumonia within the 30 days after the initial influenza diagnosis date. Controls had no evidence of influenza-related pneumonia in the 30 days following the initial influenza diagnosis. Final 1:1 matching was determined using propensity score matching (PSM). Statistical significance between the cohorts was tested.ResultsAfter PSM, there were 4878 hospitalized patients with influenza in each of the case and control groups. During the index hospitalization, cases vs. controls had longer length of stay [Mean (standard deviation): 6.5 (8.3) vs. 1.9 (3.7)], greater intensive care unit (ICU) use (38.4 vs. 16.8%), and greater mechanical ventilation use (invasive: 11.4 vs. 2.3%; non-invasive: 6.8 vs. 2.6%) (all p < 0.001). Cases also had higher readmission rates than controls (12.3 vs. 3.5% within 30 days; 20.0 vs. 6.1% within 90 days; p < 0.001 for both). Post-index date direct all-cause healthcare costs were higher for cases than for controls (median total cost: $18,428 vs. $621 for 30 days; $21,774 vs. $3312 for 90 days; $25,960 vs. $8699 for 6 months; $35,875 vs. $21,619 for 1 year; all p < 0.001).ConclusionsPneumonia as a complication of influenza increases risk of mortality and leads to greater healthcare resource use and direct medical costs among patients hospitalized with influenza. These effects are seen early during the index hospitalization and within the first 30 days after diagnosis, but their impact continues throughout a year of follow-up.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00169-2.

Incremental burden of comorbid major depressive disorder in patients with type 2 diabetes or cardiovascular disease: a retrospective claims analysis

BackgroundThe estimated prevalence of comorbid major depressive disorder (.MDD) is 11% in patients with type 2 diabetes (T2D) and 15–20% in those with cardiovascular disease (CVD). Comorbid MDD continues to be a significant source of economic burden to the healthcare system.MethodsWe assessed the incremental healthcare burden of comorbid MDD in patients with T2D or CVD. This real-world, retrospective, administrative claims study analyzed commercially insured adults with T2D or CVD diagnosed on at least 2 separate claims within 12 months of each other (between January 1, 2011, and September 30, 2018). CVD included congestive heart failure, peripheral vascular disease, coronary heart disease, and cerebrovascular disease. The study compared patients with and without MDD with either T2D or CVD. Study assessments included all-cause healthcare resource utilization (proportion of patients with hospitalization, emergency department [ED] visits, and outpatient visits) and cost.ResultsPatients were matched by propensity score for demographics and baseline characteristics, resulting in similar baseline characteristics for the respective subcohorts. After matching, 22,892 patients with T2D (11,446 each with and without MDD) and 28,298 patients with CVD (14,149 each with and without MDD) were included.At follow-up, patients with T2D and MDD had significantly higher rates of hospitalization (26.1% vs 17.4%, P < 0.0001) and ED visits (55.3% vs 43.0%, P < 0.0001) than those observed in patients without MDD. The total cost for patients with T2D and MDD at follow-up was significantly higher than for those without MDD ($16,511 vs $11,550, P < 0.0001). Similarly, at follow-up, patients with CVD and MDD had significantly higher rates of hospitalization (45.4% vs 34.1%, P < 0.0001) and ED visits (66.5% vs 55.4%, P < 0.0001) than those observed in patients without MDD. Total cost at follow-up for patients with CVD and MDD was significantly higher than for those without MDD ($25,546 vs $18,041, P < 0.0001).ConclusionsPatients with either T2D or CVD and comorbid MDD have higher total all-cause healthcare utilization and cost than similar patients without MDD. Study findings reinforce the need for appropriate management of MDD in patients with these comorbid diseases, which in turn may result in cost reductions for payers.Trial registrationNot applicable.

Employer-sponsored behavioral health program impacts on care utilization and cost.

To examine the impact of an employer-sponsored behavioral health (BH) program on all-cause health care utilization and cost. Retrospective analysis of health insurance claims data obtained from a large employer in western New York covering a 25-month period between 2016 and 2018. Those employees treated by the employer-sponsored BH program were compared against a contemporaneous comparison group of employees of the same employer who had eligible BH diagnoses for the program but were treatedelsewhere. A difference-in-differences method was used to estimate the program's impact on all-cause care utilization (physician office visits and acute care utilization) and total cost of care, including prescription drug costs. Program participation was associated with a reduction of approximately 28% in total cost of care including prescription drug costs (P = .043) over an 18-month period following the initial program encounter, as well as 27% reductions in primary care provider (PCP) visits (P = .001) and non-BH specialist visits (P = .005). No significant impacts were observed for acute care utilization and BH specialist visit rates. The results suggest that the employer-sponsored BH program implementation may have shifted treatments of certain BH conditions away from PCPs and non-BH specialists who may not have the proper training or resources to manage such conditions. Therefore, these results are consistent with the expectation that improved access to BH care is likely to improve efficiency in the health care system via provision of more appropriate care for those who need it.

Alopecia Areata Treatment Patterns, Healthcare Resource Utilization, and Comorbidities in the US Population Using Insurance Claims.

IntroductionAlopecia areata (AA) is an autoimmune disorder causing sudden, non-scarring hair loss. There are currently no drugs approved for AA treatment. This study assessed prevalence of comorbidities, treatments, and healthcare costs and resource utilization among patients with AA in the USA.MethodsPatients diagnosed with AA between January 2011 and December 2018 were identified in IBM MarketScan® Research Databases. Eligible patients had no other hair loss-related disorders and were continuously enrolled with medical and pharmacy benefits at least 12 months before and after AA diagnosis. Descriptive statistics were used to summarize comorbid conditions, treatments related to AA or other autoimmune/inflammatory conditions, and all-cause and AA-specific healthcare costs and resource utilization identified from claims data.ResultsA total of 68,121 patients with AA were identified. Mean (SD) age was 40.3 (17.8) years and 61.0% were female. The most common comorbidities included hyperlipidemia (22.4%), hypertension (21.8%), thyroid disorders (13.1%), contact dermatitis or eczema (10.8%), depression (9.5%), and anxiety (8.4%). Comorbid autoimmune diseases included atopic dermatitis (2.8%), psoriasis (2.1%), chronic urticaria (1.5%), and rheumatoid arthritis (1.1%). During the 12-month follow-up period, 37,995 patients (55.8%) were prescribed treatment for their AA or other comorbid autoimmune/inflammatory disease; 44.9% of treated patients were prescribed therapy within 7 days of AA diagnosis. Of patients receiving treatment, 80.3% received topical steroids and 30.0% received oral steroids. Mean (SD) total healthcare costs were $11,241.21 ($43,839.69) for all-causes and $419.12 ($1534.99) for AA. AA-related expenses were driven by outpatient and prescription costs.ConclusionPatients with AA have a high comorbidity burden and lack of treatment. Current AA treatments, including systemic therapies other than oral steroids, were not frequently utilized in this study population. Healthcare costs incurred by patients with AA went beyond AA-related expenses. Longitudinal data are needed to better understand treatment trajectories and the disease burden in patients with AA.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01845-0.

Retrospective Analysis of Disease Severity, Health Care Resource Utilization, and Costs Among Patients Initiating Belimumab for the Treatment of Systemic Lupus Erythematosus

The goal of this study was to evaluate clinical and economic outcomes associated with the initiation of intravenous (IV) belimumab for the treatment of systemic lupus erythematosus (SLE) in clinical practice in the United States. This retrospective study used administrative claims data from the IBM MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database. Data for patients with SLE who initiated (index) IV belimumab were collected for the 12 months before (pre-index) and the 12 months after (post-index) belimumab initiation. Outcomes included SLE disease severity and flares, all-cause health care resource utilization (HCRU) and health care costs, and hospital-based costs and service visits. Post hoc analyses of total hospital-based costs were conducted to further explore drivers of mean post-index costs. Baseline characteristics (N=908) are as follows: female, 93.4%; mean (SD) age, 45.6 (11.9) years; mean Charlson Comorbidity Index score, 0.9 (2.0); and moderate or severe disease, 94.9%. Disease activity (SLE flare episodes) was significantly reduced between the pre-index and post-index periods (severe flares, 16.4% vs 10.1% [P < 0.0001]; moderate flares, 92.1% vs 85.6% [P < 0.0001]; and mild flares, 77.4% vs 71.1%; [P=0.0003]). The proportion of patients receiving oral corticosteroids (OCS) was reduced between the pre-index and post-index periods, especially among patients at higher OCS thresholds (prednisone-equivalent dose: ≥60 mg/d, 7.3% vs 4.2%; >40 mg/d, 14.1% vs 7.9%). From the pre-index to the post-index period, few differences in HCRU were observed, although all-cause physician office visits, outpatient visits, and unique prescriptions filled increased significantly. In the 12-month post-index period, patients had a mean of 12.2 (9.0) encounters (eg, outpatient visit or prescription) associated with IV belimumab. All-cause total, medical, and pharmacy costs increased from the pre-index to the post-index period. Mean all-cause hospital-based costs increased from the pre-index to the post-index period ($7735 [26,603] vs $11,030 [88,086]; P=0.396). However, the 75th, 90th, and 95th percentile costs decreased from the pre-index to the post-index period ($305, $2107, and $3861, respectively). After initiation of IV belimumab, disease activity (number of moderate and severe SLE flares) and use of OCS were significantly reduced. However, HCRU and costs, including hospital-based costs, were generally greater in the post-index period. Further studies will increase understanding of SLE, with the specific goals of incorporating disease activity measures and long-term outcomes in studies of HCRU, costs, and patient outcomes.

Impact of Earlier Vs. Later Monitoring on Disease Progression and Economic Outcomes Among Patients with Chronic Myeloid Leukemia in the Real-World Setting

Introduction: The National Comprehensive Cancer Network recommends monitoring of patients with chronic myeloid leukemia (CML) beginning at diagnosis. Such testing is necessary for optimal treatment selection, however, patients are often not monitored until later in the course of disease or when clinical symptoms present. In this study, we evaluated the impact of molecular monitoring earlier in the course of disease as compared to later monitoring with the aim to determine a potential association between timing of monitoring and CML disease progression and healthcare resource utilization in a real-world setting in the US.Methods: Patients (≥ 18 years of age) with ≥1 inpatient or ≥2 distinct outpatient (≥30 days apart) diagnoses for CML, January 01, 2006 through June 30, 2016, were identified from the MarketScan® databases. Patients were defined as having disease progression based on the presence of treatments for advanced phase and blast crisis CML. A case control study design was used; cases were defined as patients with disease progression and patients not captured as having progression were identified as controls. Among cases, the index date was defined as the first date of treatment for CML progression and among controls, the index date was a randomly selected date (using simple random sampling) after the first CML diagnosis. Patients were required to have 24 months of continuous medical and prescription insurance coverage prior to the index date (baseline period). Patients were also required to have ≥1 CML monitoring test in the baseline period. Patients with earlier monitoring were identified as those with ≥1 monitoring test during the 7-24 months prior to the index date (Figure); patients with later monitoring were identified as those with ≥1 monitoring test only during the last 6 months prior to the index date and not during the 7-24 months prior to the index date (Figure). Patient demographics and clinical characteristics were evaluated during the baseline period. All-cause healthcare resource utilization and associated costs were evaluated per patient per month (PPPM) during the baseline period and a variable length follow-up period lasting ≥1 day and up to 1 year. Multivariate generalized linear modeling (GLM) was used to evaluate differences in all-cause healthcare costs between the earlier vs. later monitoring cohorts. Multivariate logistic regression was used to evaluate the association between monitoring status and progression.Results: A total of 2,730 CML patients were identified, among which 60% (n=1,633) received earlier monitoring and 40% (n=1,097) received later monitoring only. The two groups were similar in terms of mean age and gender: 56 years vs. 57 years and 56% vs 57% females among patients with earlier vs. later monitoring, respectively. The mean Charlson Comorbidity Index score was lower among patients with earlier vs. later monitoring (3.15 vs. 3.41, p=0.0001), which indicates that patients with earlier monitoring were healthier. The three most frequently observed comorbid conditions of cardiovascular disease, gastrointestinal disease and lipid abnormalities were present in 67%, 62% and 44%, respectively, of patients with earlier monitoring vs. 71%, 66% and 52% of patients with later monitoring. Evidence of progression was present in 8.9% of patients with earlier monitoring, vs. 9.3% of patients with later monitoring. After the multivariable regression model was used to adjust for patient characteristics, patients with earlier vs. later monitoring were shown to be associated with a lower likelihood of CML progression (odds ratio: 0.715, confidence interval (CI) [0.530 - 0.964]; p=0.0280), during the follow-up period. After adjusting for covariates, the mean all-cause healthcare costs (PPPM) for inpatient (hospitalization), outpatient medical service, total (inpatient + outpatient) medical service, outpatient pharmacy and total healthcare were lower for patients with earlier monitoring as compared to those with later monitoring (Table).Conclusion: Patients who are monitored earlier in the course of their disease may have better outcomes and lower total cost of care, as evidenced by the lower likelihood of CML progression and lower healthcare resource utilization in this group as compared to patients with later monitoring only. [Display omitted] DisclosuresJabbour:Bristol-Myers Squibb: Consultancy. Siegartel:Bristol-Myers Squibb: Employment. Lin:Novosys Health: Employment; Bristol-Myers Squibb: Consultancy. Lingohr-Smith:Novosys Health: Employment. Menges:Novosys Health: Employment. Makenbaeva:Bristol-Myers Squibb: Employment.

Economic Burden of Stem Cell Transplant Among Patients with Multiple Myeloma

Introduction: Multiple Myeloma (MM) is a rare hematologic malignancy, accounting for 12% of all hematologic cancers. Conventional treatment includes a combination of induction chemotherapy followed by stem-cell transplantation (SCT) for younger patients without significant renal impairment. While the efficacy of SCT in various clinical settings of MM are frequently explored, real-world data on impact of SCT on healthcare resource use (HRU) and costs among patients with MM are limited. This study compared HRU and costs for MM patients with and without SCT in the US.Methods: This retrospective analysis used the MarketScan administrative claims data to select patients newly diagnosed with MM (ICD-9-CM 203.0x) and at least 18 years of age during 7/1/2006- 9/30/2015 (first MM diagnosis = index date). Continuous health plan enrollment for 12 months prior to (baseline) and >3 months after index date (minimum follow-up) was required. Patients were censored at the earliest of disenrollment, death (inpatient or from the social security administration [SSA] death index), or end of study period (12/31/2015). Per-patient per year (PPPY) all-cause and MM-related HRU and costs were calculated during follow-up and compared between patients with SCT versus [vs.] without SCT. MM-related HRU and medical costs required a MM diagnosis code on the claim (primary discharge diagnosis for hospitalizations, any position on the claim for outpatient services). Costs were adjusted to 2016 USD using the medical component of consumer price index. Propensity scores were used to match patients 1:1 on baseline demographic and comorbid conditions using the nearest neighbor approach to adjust for differences between patients with and without SCT.Results: Of the 14,229 newly diagnosed MM patients selected for analysis, 18.8% (N=2,669) received a SCT, of which 99.9% (N=2,667) were matched to MM patients without a SCT. Matched patients were well balanced on the following criteria: age (mean 56.7 [SD 8.2] and 57.4 [SD 8.5] years); gender (57.4% and 57.5% male); Charlson comorbidity index (mean 1.7 [SD 2.2] and 1.7 [SD 2.1]); baseline individual comorbid conditions (anemia [32.3% and 30.9%], renal impairment [7.0% and 6.5%], bone-related [32.6% and 30.3%], cardiac dysfunction [36.4% and 36.0%]). Total all-cause and MM-related healthcare costs PPPY were $114,242 and $110,116 higher among patients with a SCT (vs. patients without a SCT). Similarly, patients with a SCT (vs. patients without a SCT) incurred $55,663 and $49,803 higher all-cause and MM-related costs for hospitalizations, and $39,852 and $33,883 higher all-cause and MM-related costs for outpatient services. MM treatment costs (drug and administration costs) PPPY were also $26,430 higher among patients with a SCT (vs. patients without a SCT). Higher costs among patients with a SCT were driven by increased HRU for both inpatient and outpatient services across the majority of categories (Table). Among the subset linked to the SSA death index (SCT N= 1,553 and non-SCT N=1,583) the median survival time 907 vs 743 days (p<0.001) among patients with a SCT vs. patients without a SCT and the proportion with a death was 10.4% and 12.8% (p=0.042). The difference in median survival time between groups was less pronounced for patients with an index date in a later year; 2006-2011 vs. 2012-2015 (Table).Conclusions: Results show that among age-, gender-, and comorbidity- matched MM patients, management with SCT is associated with higher all-cause and MM-related HRU and costs and increased survival. An examination of the predictors of management with or without SCT and associated outcomes will inform the relative value of therapeutic strategies for MM patients as well as help optimally triage healthcare resources. [Display omitted] DisclosuresAilawadhi:Pharmacyclics: Research Funding; Novartis: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. Panjabi:Amgen Inc.: Employment, Equity Ownership. Princic:Truven Health Analytics, IBM Company: Employment. Fowler:Truven Health Analytics, IBM Company: Employment. Tran:Truven Health Analytics, IBM Company: Employment. Gatta:Amgen Inc.: Employment, Equity Ownership. Medhekar:Amgen Inc.: Employment, Equity Ownership.

Burden of illness and costs associated with eosinophilic granulomatosis with polyangiitis: evidence from a managed care database in the United States.

BACKGROUND: Data on the clinical and economic burden of eosinophilic granulomatosis with polyangiitis (EGPA) are limited. OBJECTIVE: To assess the real-world clinical and economic outcomes of patients diagnosed with EGPA vs patients with asthma (present in > 90% of EGPA cases) receiving treatment in the United States. METHODS: This retrospective cohort study (HO-17-17742) used administrative claims data (July 1, 2007-May 31, 2017) from the Optum Research Database. Eligible patients were aged at least 18 years at index (first date that patients met the EGPA or asthma cohort definition), with a minimum of 6 months of continuous health plan coverage before the index (baseline) period and 12 months following and including the index date (follow-up period). Patients with EGPA were identified either via published algorithms using claim code combinations for conditions and medications (before October 1, 2015) or via a claim with the EGPA ICD-10-CM code (M30.1, after October 1, 2015). Patients with asthma were identified based on ICD-9-CM and ICD-10-CM diagnosis codes and at least 3 pharmacy asthmarelated medication claims within a year of diagnosis. Outcomes included all-cause health care costs (primary), all-cause health care resource utilization (HCRU), systemic corticosteroid (SCS) use, and EGPA relapses requiring hospitalization and EGPA-related (based on EGPA-related HCRU) relapses during the follow-up period (all secondary). EGPA and asthma cohorts were matched (1:3) via propensity score matching based on demographic, insurance, and index timing covariates. RESULTS: 8,904 patients were included in the matched EGPA (n = 2,226) and asthma (n = 6,678) cohorts (mean [SD] age: 59.7 [14.2] vs 59.6 [14.7] years; Quan-Charlson Comorbidity Index scores: 1.8 [1.7] vs 0.8 [1.4]). During follow-up, mean (SD) all-cause costs ($49,593 [$88,161] vs $21,122 [$40,110]; P < 0.001), all-cause HCRU (P < 0.001), and the proportion of patients with 1 or more SCS claims (72.3% vs 66.9%; P < 0.001) were significantly greater in the EGPA vs asthma cohorts, respectively. Mean daily SCS dose (43.6-45.5 mg/day) was similar between cohorts; patients with EGPA had significantly (P < 0.001) longer periods taking SCS doses at least 4 mg/day (mean [SD]: 64.9 [95.6] vs 14.6 [39.3] days) and at least 7 mg/day (52.8 [82.0] vs 12.1 [30.6] days). 35.2% (n = 784/2,226) and 44.1% (n = 981/2,226) of patients with EGPA experienced a minimum of 1 EGPA relapse requiring hospitalization, and at least 1 EGPA-related relapse, respectively. Mean (SD) total all-cause costs were greater than 3-fold higher in patients with vs without a relapse requiring hospitalization ($92,825 [$128,562] vs $26,087 [$38,082]; P < 0.001) and for patients with vs without an EGPA-related relapse ($78,081 [$120,775] vs $27,145 [$35,584]; P < 0.001). CONCLUSIONS: Patients with EGPA have more comorbidities, greater health care costs and HCRU, and use SCS more frequently than patients with asthma. Additionally, more than one third of patients with EGPA experienced disease relapses over 12 months. These results highlight the high disease burden in patients with EGPA and the need for improved treatment options. DISCLOSURES This study was funded by GlaxoSmithKline (GSK ID: HO-17-17742). Bell is an employee of GSK and holds stock/share options in GSK. Blauer-Peterson is an employee of Optum, which was funded by GSK to conduct the study. Mao was an employee of Optum at the time the study was conducted. The authors report no other potential conflicts of interest. These data have previously been presented as a poster at the American College of Rheumatology/Association of Rheumatology Health Professionals Annual Meeting, Chicago, IL, October 19-24, 2018.

Retrospective Claims Analysis of Treatment Patterns, Relapse, Utilization, and Cost Among Patients with Multiple Sclerosis Initiating Second-Line Disease-Modifying Therapy.

BackgroundReal-world studies of disease-modifying therapies (DMTs) in multiple sclerosis (MS) have reported suboptimal adherence.ObjectiveWe aimed to describe treatment patterns, relapses, healthcare resource utilization, and costs in MS patients experiencing their first observed DMT switch.MethodsIn this retrospective, claims database study, adult patients were selected if they had an MS diagnosis and DMT claim during the study period (1 January 2009–31 March 2019). Patients who switched to a new DMT between 1 January 2010 and 31 March 2018 were included. Adherence, persistence, relapses, and all-cause and MS-related healthcare utilization and costs were reported pre- and post-index.ResultsIn total, 1554 MS patients were identified; the mean age was 46 years and most (74%) were female. The majority of patients switched from an injectable DMT (n = 1116; 71.8%), and patients generally switched to an oral DMT (n = 878; 57%). Among patients who switched DMTs, 46.0% (n = 715) were nonadherent, 42% (n = 645) were nonpersistent, and 21.5% (n = 334) relapsed in the 12 months post-switch. An increase in all-cause and MS-related healthcare costs was observed pre- to post-index for all patients. Cost drivers included outpatient visit costs and pharmacy prescriptions. Compared with patients who switched to an injectable DMT, those who switched to an oral DMT had significantly higher persistence and adherence. No significant difference was observed in post-index relapse or all-cause and MS-related total cost of care.ConclusionLow adherence and poor persistence remain following an initial DMT switch; however, patients who switched to oral DMTs had higher persistence and adherence.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-021-00251-w.

EC3 Economic Burden of Cardiovascular Events in Patients with Chronic Lymphocytic Leukemia Treated with Novel Agents

Novel agent treatments (NATs) have improved survival in chronic lymphocytic leukemia (CLL), but can be associated with increased cardiovascular (CV) events. This analysis examined real-world healthcare costs associated with CV events in CLL patients treated with NATs. Using US-commercial administrative claims data (IBM MarketScan), we compared unadjusted healthcare costs among CLL patients taking NATs with and without a CV event during treatment (CV vs. noCV). Inclusion criteria were adult CLL patients, evidence of NATs (acalabrutinib, duvelisib, ibrutinib, idelalisib, venetoclax) between November 2013-November 2019 (index date=earliest fill date), continuous enrollment for 6-months pre-index (baseline), and no evidence of NATs or trial participation during baseline. Annual all-cause and CV-related healthcare costs (adjusted to 2019 US dollars) were measured in a fixed 12-month follow-up period while per-patient-per-month (PPPM) costs were compared in variable-length pre/post-CV event periods. Of 1,886 CLL patients with NATs, 27.7% experienced a CV event during treatment, occurring a mean(SD) 103.0(93.9) days following NAT initiation. Almost half (47.1%) of CV patients had a CV event pre-index, the majority of which were hypertension. CV patients were older (71.7 vs. 65.8, p<0.001) and had a higher baseline NCI score (1.2 vs. 0.8, p<0.001) than noCV patients. Annual all-cause total healthcare costs were higher in the CV vs. noCV cohort ($203,349 vs. $165,144, p<0.001). Higher annual medical costs ($82,949 vs. $45,293, p<0.001) compensated for numerically lower NAT costs in CV vs. noCV cohort ($110,925 vs. $115,026, p=0.262). Pre-CV event, outpatient pharmacy PPPM costs contributed most to total healthcare costs; post-CV event, PPPM medical costs contributed more: outpatient pharmacy 74.8% vs. 38.8%, hospitalization 7.6% vs. 38.8%, and outpatient services 17.7% vs. 22.4%. In CLL patients with a CV event, higher medical costs compensate for decreased novel agent costs, suggesting increased medical management in addition to NAT discontinuation.

PMU8 The Economic Burden of Thromboembolic Events Among Patients with Immune-Mediated Diseases

Little is known about the economic burden of thromboembolic events [TE] among patients with immune-mediated diseases [IMD]. This study aimed to estimate the healthcare costs associated with TE among patients with IMD. Using the IBM MarketScan Commercial and Medicare-Supplemental Claims databases (2014-2018), adult patients with IMD were classified into two cohorts. Patients with TE (deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke) were matched 1:1: on IMD type, age, sex, and year of IMD to patients without TE. The index date was the date of the first TE following the first IMD diagnosis for patients with TE and was calculated based on time from first IMD diagnosis to index date of the matched patient with TE for patients without TE. The baseline period was the 6-month period prior to index, and the study periods were the 30-day and 1-year periods following index. Outcomes included all-cause and TE-related healthcare costs during the study periods. Unadjusted comparisons were conducted using Wilcoxon signed-rank tests, and adjusted results were estimated using generalized estimating equations, adjusting for baseline demographics and clinical characteristics. There were 9,681 matched pairs (mean age 61.1 years, 63.7% female) included in the study. Patients with TE had higher proportions of comorbidities than patients without TE (i.e., Charlson comorbidity index [1.5 v 0.9], p<0.0001). Adjusted all-cause total healthcare costs in the 30-day and 1-year study periods were higher among patients with TE compared to patients without TE (cost differences: 30-day: $17,574; 1-year: $36,459; both p<0.0001), and were driven by inpatient costs. TE-related costs were $15,955 and $20,239 in the 30-day and 1-year study periods, respectively. Among patients with IMD, TE are associated with a substantial economic burden within the 30-day and 1-year periods following a TE. Risk reduction of TE has both clinical and economic benefits.

PIN15 Real-World Healthcare Costs of Patients Receiving Dolutegravir/Lamivudine and Other Single Tablet Regimens for the Treatment of HIV-1 in the US

Dolutegravir/lamivudine (DTG/3TC) is a two-drug regimen FDA-approved in 2019 and currently, the lowest priced single-tablet regimen (STR) based on wholesale acquisition costs. This study evaluates healthcare costs of DTG/3TC users compared to current standard of care three- or four-drug STRs. This retrospective study used IQVIA PharMetrics® Plus claims (1/1/2015–3/31/2020) from US adult patients with a diagnosis of HIV, ≥1 dispensing of DTG/3TC, ABC/DTG/3TC, BIC/FTC/TAF, EVG/COBI/FTC/TAF, or DRV/COBI/FTC/TAF on or after 04/08/2019 (approval of DTG/3TC for HIV; index date=first dispensing), and ≥6 months of continuous eligibility pre-index. All-cause and HIV-related healthcare costs were reported per-patient-per-month (PPPM) to account for varying lengths of follow-up. Adjusted cost ratios (aCR) were estimated using multivariate models adjusting for differences in baseline characteristics between cohorts. Analyses were further stratified by treatment-naïve and treatment-experienced. A total of 22,061 patients met study criteria (590 DTG/3TC, 4,355 ABC/DTG/3TC, 9,068 BIC/FTC/TAF, 7,081 EVG/COBI/FTC/TAF, and 967 DRV/COBI/FTC/TAF). Mean age was similar across all cohorts (45.6–46.3 years) and mean follow-up period ranged 4.4–9.5 months. Mean all-cause total healthcare costs PPPM were significantly lower for DTG/3TC users compared to users of BIC/FTC/TAF ($3,368 vs. $3,783; aCR:0.77), EVG/COBI/FTC/TAF ($3,368 vs $3,456; aCR:0.70), and DRV/COBI/FTC/TAF ($3,368 vs. $4,029; aCR:0.78; all p<0.001), and similar to users of ABC/DTG/3TC ($3,368 vs. $3,322; aCR:0.97; p = 0.689). Across all comparisons, cost differences were primarily driven by significantly lower pharmacy costs (BIC/FTC/TAF: $2,595 vs. $3,116, aCR:0.76; EVG/COBI/FTC/TAF: $2,595 vs. $2,965, aCR:0.75; DRV/COBI/FTC/TAF: $2,595 vs. $3,558, aCR:0.69; ABC/DTG/3TC: $2,595 vs. $2,760, aCR:0.83; all p < 0.001). Similar trends were observed among the subgroups of treatment-naïve and treatment-experienced patients. Patients treated with DTG/3TC had substantially lower (22–30%) healthcare costs compared to current standard of care STRs, although similar costs to ABC/DTG/3TC, highlighting the economic benefits of its use with sustained management of HIV infection.

PMH6 Healthcare Costs Increase Substantially Following Adjunctive Therapy Among MDD Patients on Antidepressant Monotherapy

BACKGROUND Among patients with major depressive disorder (MDD), inadequate response to antidepressant monotherapy (ADT) is often followed by adjunctive pharmacotherapy or psychotherapy. Little is known about changes in costs following adjunctive therapy. To estimate changes in MDD-specific and all-cause healthcare costs following adjunctive therapy. From a national sample of insurance claims licensed from Decision Resources Group, MDD patients on ADT and added adjunctive therapy between 7/1/2014 and 12/31/2018 were identified. Eligible patients were on ADT for 8+ weeks preceding and following initiation of adjunctive therapy (index); and were stratified by insurance (Medicaid, commercial) and type of adjunctive therapy: “pharmacotherapy,” “psychotherapy,” or both (“dual adjunctive”). Costs were calculated for the six months pre- and post-index, changes in cost were annualized (PPPY) and standardized to 2019$. Pre-post significance testing was based on non-overlapping 95% confidence intervals. Following adjunctive therapy, annual all-cause healthcare costs increased by 2,213, $2,002, and $6,171 for commercially-insured pharmacotherapy (n=129,650), psychotherapy (n=20,037), and dual adjunctive (n=6,229), respectively. Pharmacotherapy patients realized significant increases in pharmacy ($1,129) and outpatient services ($932) and modest decreases ($231) in inpatient costs. Psychotherapy patients realized significant increases in office visits ($1,832) and decreases ($756) in inpatient costs. Dual adjunctive patients realized no decline in acute care costs, and increases in office visits ($2,335), outpatient services ($2,612), and pharmacy ($1,302). Among pharmacotherapy patients, MDD-specific pharmacy costs increased $526 and among psychotherapy patients, MDD-specific office visit costs increased $1,037. Among the 62,166 Medicaid-insured individuals (50,713 pharmacotherapy, 8,097 psychotherapy, and 3,356 dual adjunctive), total healthcare costs increased significantly more: $3,017 (pharmacotherapy); $3,005 (psychotherapy); $8,690 (dual adjunctive). Following adjunctive therapy, costs associated with office visits, outpatient services, and pharmacy increase substantially, and acute care services decrease only modestly. Total healthcare costs increase substantially for all MDD patients but substantially more for Medicaid-insured.

PCV14 Examining the Direct and Indirect Healthcare Cost Among Pulmonary Arterial Hypertension Patients

Pulmonary arterial hypertension (PAH) is a rare, progressive, and fatal disease associated with elevated pulmonary arterial pressure resulting in right heart failure and death. While several studies have estimated the direct cost of PAH, few have estimated indirect costs. This study examined direct and indirect healthcare burden associated with PAH. Prevalent and incident PAH patients aged 18-64 years were identified from the MarketScan Commercial and Health and Productivity management datasets during the identification period (01JAN2016-30NOV2018). Index date was the date of first PAH diagnosis claim (cases). Patients without PAH were selected (controls) and assigned a random index date during the identification period. Controls were matched 1:1 to prevalent and incident PAH cases. Continuous enrollment ≥12 months pre- and ≥1-month post-index date (follow-up) was also required. Per patient per month all-cause healthcare utilization (HCRU), costs, and short-term disability (STD) were examined for cases and controls post-index date until the first observation of end of employment, continuous enrollment, study, or death. Multivariate analysis was performed using the generalized linear model. A total of 1293 prevalent and 455 incident PAH patients were identified. During the follow-up period, prevalent PAH patients had significantly higher total mean all-cause healthcare costs ($9,915 vs $359), and inpatient length of stay (LOS) (0.63 vs 0.02 days) compared with controls. Prevalent PAH patients had higher STD (6.1 vs 1.5 days), and STD-related costs ($1226 vs $277) compared to controls. Incident PAH patients had a significantly higher total mean all-cause healthcare costs ($9,353 vs $336), and inpatient LOS (0.92 vs 0.01 days) compared with controls. Incident PAH patients had higher STD (8.1 vs 1.5 days) and STD-related costs ($1706 vs $263) compared to controls. This study showed that incident and prevalent PAH patients had significantly higher direct and indirect costs and HCRU compared to controls.

808-P: Economic Benefits of Initiating Empagliflozin vs. GLP-1 Receptor Agonists among Patients with Type 2 Diabetes

Background: SGLT-2 inhibitors and GLP-1 receptor agonists (GLP-1RAs) have proven clinical benefit profiles, and the ADA recommends both as treatment options for T2D patients uncontrolled on metformin. There is limited research on whether these clinical benefits translate into differential cost savings. This study sought to assess the all-cause (AC) healthcare costs associated with initiating empagliflozin (EMPA) vs. GLP-1RAs among patients with T2D. Methods: A commercial US claims database was used to identify patients with T2D who newly initiated EMPA or GLP-1 RA from 08/2014-09/2018. Study cohorts (EMPA users and GLP-1RA users) were matched using propensity scores (PSs) (1:1 ratio, caliper: ± 0.05) based on baseline demographic and clinical variables. AC costs were computed on a per patient per month (PPPM) basis during a variable follow-up period of up to 12 months and compared across study cohorts using generalized linear models. A subanalysis comparing AC costs among patients who initiated second-line treatment with EMPA or GLP-1RA after metformin monotherapy was also conducted. Results: PS matching resulted in a sample of 43,588 patients (21,794 patients in each group) whose mean age was 54 years and 63% were male. The total AC PPPM costs were significantly lower for EMPA vs. GLP-1RA users ($1,450 vs. $1,723; Δ = $273; P&amp;lt;0.001), with both pharmacy (Δ = $195; P&amp;lt;0.001) and medical (Δ = $78; P=0.006) costs being significantly lower. Similar results were observed in the subanalysis where initiating EMPA after metformin monotherapy was associated with lower AC PPPM costs compared to GLP-1RA users (Δ = $271; P&amp;lt;0.001). Conclusion: Among patients with T2D, initiating EMPA vs. GLP-1RA was associated with lower AC healthcare costs, where the drivers were both lower medical and pharmacy costs. These findings can inform treatment selection processes that are aimed to optimize T2D management, especially from an economic perspective. Disclosure P. Pimple: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. A. Raju: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Takeda Pharmaceutical Company Limited, Employee; Self; Xcenda LLC, Stock/Shareholder; Self; Teva Pharmaceutical Industries Ltd. E. Farrelly: Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Bristol-Myers Squibb Company, Takeda Pharmaceutical Company Limited, Employee; Self; Xcenda LLC. S. Shetty: Employee; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Funding Boehringer Ingelheim

PRO18 A Systematic Literature Review of the Economic Burden and Cost Drivers in Pulmonary Arterial Hypertension

The aim of this study was to identify cost drivers in Pulmonary Arterial Hypertension (PAH) in the US through a systematic literature review of economic and humanistic burden. A systematic literature review was conducted adhering to methodology published by the Cochrane Collaboration and the National Institute for Health and Clinical Excellence (NICE) in the UK. Population, Intervention & Comparators, Outcomes and Study Design (PICOS) criteria were used to identify resource utilization and economic burden studies in PAH published from credible databases (EMBASE, MEDLINE, MEDLINE In-Process) over the last 10 years. A total of 170 publications were extracted with most publications from the US. Total all-cause costs per patient per month (PPPM) in the US (all costs reported in 2019 $USD) were found to range from $2,494 to $11,037, driven primarily by medical costs. Medical costs accounted for a larger portion of total costs than pharmacy costs within both all-cause ($2,113 to $7,625 PPPM) and PAH-related ($293 to $5,086 PPPM) health care costs; among all-cause medical cost components, inpatient admission costs ($1,115 to $2,146 PPPM) contributed the highest costs, followed by outpatient costs ($954 to $1,944 PPPM). Although total costs increased after initiation of PAH therapies, increased pharmacy costs were partially offset by reduced medical costs ($1,506 to $57,409 decreased annual medical costs from baseline). Management of PAH carries a considerable economic burden with the major cost drivers consisting of primarily medical costs. All-cause costs vary widely in current literature, which may be due to heterogeneity in study population and cost components.

PSY6 Differences in All-Cause Health Care Costs of Alopecia Areata in the United States by Patient Subgroups: A Latent Class Approach

Alopecia areata (AA) is an autoimmune hair-loss disease, with variations in clinical expression, including total scalp (alopecia totalis, AT) and total body hair-loss (alopecia universalis, AU). This study identified subgroups of patients with AA in the US with distinct profiles and their corresponding healthcare costs.