All-cause Healthcare Utilization Research Articles

COVID-19 vaccination safety and associated health care utilization among adults with inflammatory bowel disease – a population-based self-controlled case series analysis

Background and aimsThere is an incomplete understanding of the full safety profiles of repeated COVID-19 vaccinations in patients with inflammatory bowel disease (IBD). Among individuals with IBD, we assessed whether COVID-19 vaccines were associated with serious adverse events of special interest (AESI) and health care utilization [all-cause hospitalizations, Emergency Department (ED) visits, gastroenterology visits, IBD-related visits].MethodsUsing comprehensive administrative health data from Ontario, Canada, adults with IBD who received at least one COVID-19 vaccine from December 2020-January 2022 were included. Self-controlled case series analyses were conducted to evaluate the relative incidence rates of AESI and health care utilization outcomes across post-vaccination risk and control periods.ResultsAmong 88,407 IBD patients, 99.7% received mRNA vaccines and 75.9% received ≥ 3 doses. Relative to control periods, we did not detect an increase in AESI. IBD patients had fewer all-cause hospitalizations during post-vaccination risk periods. Patients experienced more all-cause ED visits after dose 2 [Relative Incidence (RI):1.08(95%CI:1.04–1.12)] but fewer visits after doses 3 [RI:0.85 (95%CI:0.81–0.90)] and 4 [RI:0.73 (95%CI:0.57–0.92)]. There was no increase in gastroenterologist visits or IBD-related health care utilization post-vaccination. There were fewer IBD-related hospitalizations after dose 1 [RI:0.84 (95%CI:0.72–0.98)] and 3 [RI:0.63 (95%CI:0.52–0.76)], fewer IBD-related ED visits after dose 3 [RI:0.81 (95%CI:0.71–0.91)] and 4 [RI:0.55 (95%CI:0.32–0.96)], and fewer outpatient visits after dose 2 [RI:0.91 (95%CI:0.90–0.93)] and 3 [RI:0.87 (95%CI:0.86–0.89)].ConclusionThis population-based study did not detect increased AESI, all-cause or IBD-related health care utilization following COVID-19 vaccination, suggesting a lack of association between vaccination and increased disease activity.

Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study

ObjectivesTo understand the burden associated with pediatric chronic pain (CP) on the healthcare system compared with other costly chronic diseases prior to subspecialty care. Study designIn this retrospective cohort study, we assessed all-cause healthcare utilization and direct healthcare costs associated with pediatric CP (n=91) compared with juvenile-onset arthritis (JA, n=135), inflammatory bowel disease (IBD, n=90), type 1 or type 2 diabetes (T1D, n=475, T2D, n=289), anxiety (n=7,193) and controls (n=273) two and five years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in healthcare utilization and direct healthcare costs associated with CP versus the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. ResultsAfter adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (p<0.01, respectively). CP was significantly associated with higher physician costs than JA, IBD, T1D, T2D, or controls (p<0.01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (p<0.01, respectively). ConclusionCompared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the healthcare system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.

Co-Occurrence of Social Risk Factors and Associated Outcomes in Patients With Heart Failure.

Background Among patients with heart failure (HF), social risk factors (SRFs) are associated with poor outcomes. However, less is known about how co-occurrence of SRFs affect all-cause health care utilization for patients with HF. The objective was to address this gap using a novel approach to classify co-occurrence of SRFs. Methods and Results This was a cohort study of residents living in an 11-county region of southeast Minnesota, aged ≥18 years with a first-ever diagnosis for HF between January 2013 and June 2017. SRFs, including education, health literacy, social isolation, and race and ethnicity, were obtained via surveys. Area-deprivation index and rural-urban commuting area codes were determined from patient addresses. Associations between SRFs and outcomes (emergency department visits and hospitalizations) were assessed using Andersen-Gill models. Latent class analysis was used to identify subgroups of SRFs; associations with outcomes were examined. A total of 3142 patients with HF (mean age, 73.4 years; 45% women) had SRF data available. The SRFs with the strongest association with hospitalizations were education, social isolation, and area-deprivation index. We identified 4 groups using latent class analysis, with group 3, characterized by more SRFs, at increased risk of emergency department visits (hazard ratio [HR], 1.33 [95% CI, 1.23-1.45]) and hospitalizations (HR, 1.42 [95% CI, 1.28-1.58]). Conclusions Low educational attainment, high social isolation, and high area-deprivation index had the strongest associations. We identified meaningful subgroups with respect to SRFs, and these subgroups were associated with outcomes. These findings suggest that it is possible to apply latent class analysis to better understand the co-occurrence of SRFs among patients with HF.

Association between physiotherapy utilization and medical healthcare utilization and costs in adults with back pain from Ontario, Canada: a population-based cohort study.

This study examined the association between physiotherapy utilization and subsequent medical healthcare utilization and costs in a population-based sample of adults with back pain in Ontario. We conducted a population-based cohort study of Ontario respondents with back pain (≥18 years) of the Canadian Community Health Survey 2003 to 2010 cycles, linked to health administrative data up to 2018. Physiotherapy utilization was defined as self-reported consultation with a physiotherapist in the past 12 months. A propensity score-matched cohort was conducted to match adults with and without physiotherapy utilization, accounting for potential confounders. We assessed associations using negative-binomial and linear (log-transformed) regression to evaluate outcomes of healthcare utilization (back pain-specific and all-cause) and costs, respectively, at 1- and 5-year follow-up. There were 4343 pairs of matched respondents. Compared with those who did not receive physiotherapy, adults who received physiotherapy were more likely to have back pain-specific physician visits (RR women (5years) = 1.48, 95% CI 1.24-1.75; RR men (5years) = 1.42, 95% CI 1.10-1.84). Women who received physiotherapy had 1.11 times the rate of all-cause physician visits (RR 1year = 1.11, 95% CI 1.02-1.20), and men who received physiotherapy had 0.84 times the rate of all-cause hospitalizations (RR 5years = 0.84, 95% CI 0.71-0.99) than those who did not. There was no association between physiotherapy utilization and healthcare costs. Adults with back pain who received physiotherapy are more likely to have back pain-specific physician visits up to 5-year follow-up than those who did not. Physiotherapy utilization is linked to some sex-based differences in all-cause healthcare utilization but not differences in costs. Findings inform interprofessional collaboration and allied healthcare delivery for back pain in Ontario.

Healthcare utilization and direct medical costs of Huntington’s disease among Medicaid beneficiaries in the United States

AimsTo provide more recent estimates of healthcare utilization and costs in Huntington’s disease (HD) in the Medicaid population.Materials and MethodsThis retrospective analysis used administrative claims data for HD beneficiaries (≥1 HD claim; ICD-9-CM 333.4) from Medicaid Analytic eXtract data files from 1 January 2010–31 December 2014. The date of the first HD claim during the identification period (1 January 2011–31 December 2013) was assigned as the index date. If a beneficiary had multiple HD claims during the identification period, one was randomly chosen as the index date. Beneficiaries were required to be continuously enrolled in fee-for-service plans during the 1-year pre-index and post-index periods. Medicaid beneficiaries without HD were drawn from a 100% random sample and matched (3:1) to those with HD. Beneficiaries were classified by disease stage (early/middle/late). All-cause and HD-related (any utilization related to HD diagnosis or symptoms associated with HD) healthcare utilization and costs were reported.ResultsA total of 1,785 beneficiaries without HD were matched to 595 beneficiaries with HD (139 early-, 78 middle-, and 378 late-stage). The mean (SD) annual total costs were higher for beneficiaries with HD than beneficiaries without HD ($73,087 [$75,140] vs. $26,834 [$47,659], p <.001) and driven by inpatient costs ($45,190 [$48,185] vs. $13,808 [$39,596], p <.001). Total healthcare costs were highest among beneficiaries with late-stage HD (mean [SD] cost: $22,797 [$31,683] for early-stage HD vs. $55,294 [$129,290] for middle-stage HD vs. $95,251 [$60,197] for late-stage HD; p <.001).LimitationsAdministrative claims are intended for billing purposes and subject to coding errors. This study did not address functional status, which may provide further insight to late-stage and end-of-life burden of HD, and indirect costs.ConclusionsMedicaid beneficiaries with HD have higher acute healthcare utilization and costs compared to beneficiaries without HD, which tend to increase with disease progression, indicating that HD beneficiaries at later disease stages have greater burden.

PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY

You have accessJournal of UrologyCME1 Apr 2023PD34-10 IMPACT OF SEPSIS ON ADMISSIONS, RE ADMISSIONS AND MORTALITY FOLLOWING URETEROSCOPY Naeem Bhojani, Brian Eisner, Rutugandha Paranjpe, Benjamin Cutone, Manoj Monga, and Ben H. Chew Naeem BhojaniNaeem Bhojani More articles by this author , Brian EisnerBrian Eisner More articles by this author , Rutugandha ParanjpeRutugandha Paranjpe More articles by this author , Benjamin CutoneBenjamin Cutone More articles by this author , Manoj MongaManoj Monga More articles by this author , and Ben H. ChewBen H. Chew More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-ureteroscopy sepsis is a morbid condition that requires significant healthcare utilization. We investigated all-cause inpatient mortality, rates of intensive care unit (ICU) and inpatient admissions and readmissions. We also examine the yearly trends in sepsis and inpatient mortality in patients undergoing ureteroscopy (URS) in the United States (US). METHODS: Retrospective analyses were conducted using the IBM MarketScan Database to identify patients ≥18 years who underwent URS. Three cohorts were analyzed: non-sepsis (control), non-severe sepsis, and severe sepsis (sepsis + organ dysfunction). All-cause inpatient mortality and healthcare utilization including ICU admissions, inpatient admissions and readmissions were reported. Annual trends for sepsis events and inpatient mortality post-URS were examined from 2015-2019. RESULTS: 109,496 URS patients were identified. 5.6% developed sepsis within 30 days of URS. Of the 5.6%, 4.1% developed non-severe sepsis and 1.5% developed severe sepsis. The 30-day all-cause inpatient mortality for the non-sepsis, non-severe sepsis and severe sepsis cohorts was 0.03%, 0.27% and 2.5%, respectively (p<0.001). Severe sepsis substantially increased the risk of 30-day all-cause inpatient mortality compared to patients who did not develop sepsis (HR: 49.5; 95% CI: 28.9-84.7; p<0.001). ICU admission rates were 1.5%, 19.8% 52.4% for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively (p<0.001). Inpatient admissions were 18.3%, 74.9%, and 76.9% (p<0.001), while readmissions were 7.1%, 12.0%, and 15.9% (p<0.001), for the non-sepsis, non-severe sepsis, and severe sepsis cohorts, respectively. From 2015 to 2019, the annual prevalence of sepsis post URS increased significantly yearly from 4.7%, 5.1%, 5.7%, 6.0%, to 6.6% (p<0.001), however the rate of inpatient mortality remained stable (Figure 1). CONCLUSIONS: Sepsis post-URS significantly increases the risk of 30-day all cause inpatient mortality and leads to a significant increase in hospital admissions, ICU admissions, and readmissions. Over the 5-year study period, the prevalence of sepsis post-URS increased by 40%. Urologists should be aware of the increasing prevalence of this potentially deadly post-operative complication. Source of Funding: Boston Scientific © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e924 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naeem Bhojani More articles by this author Brian Eisner More articles by this author Rutugandha Paranjpe More articles by this author Benjamin Cutone More articles by this author Manoj Monga More articles by this author Ben H. Chew More articles by this author Expand All Advertisement PDF downloadLoading ...

Cost Savings and Reduced Health Care Utilization Associated with Participation in a Digital Diabetes Prevention Program in an Adult Workforce Population.

BackgroundThough in-person delivery of the Diabetes Prevention Program (DPP) has demonstrated medical cost savings, the economic impact of digital programs is not as well understood.ObjectiveThis study examines the impact of a digital DPP program on reducing all-cause health care costs and utilization among 2027 adult participants at 12 months.MethodsA longitudinal, observational analysis of health care claims data was conducted on a workforce population who participated in a digital diabetes prevention program. Differences in utilization and costs from the year prior to program delivery through 1 year after enrollment were calculated using medical claims data for digital DPP participants compared to a propensity matched cohort in a differences-in-differences model.ResultsAt 1 year, the digital DPP population had a reduction in all-cause health care spend of US$1169 per participant relative to the comparison group (P = 0.01), with US$699 of that savings coming from reduced inpatient spend (P = 0.001). Cost savings were driven by fewer hospital admissions and shorter length of stay (P < 0.001). No other significant results in cost differences were detected. There was a trend toward savings extending into the second year, but the savings did not reach statistical significance.ConclusionsThese results demonstrated significant short-term health care cost savings at 1 year associated with digital DPP program delivery.

An Evaluation of a Care Coaching and Provider Referral Intervention for Behavioral Health Needs

To evaluate changes in health care spending and utilization associated with a telehealth-based care coach-supported and behavioral health (BH) provider referral intervention in the United States. Observational retrospective cohort study with propensity score matching of treated and control groups. Difference-in-differences (DID) analysis was used to calculate per-member per-month (PMPM) savings and changes in utilization in a treated group relative to matched controls over 36 months. The study included 1800 adults with substance use disorder (SUD), anxiety, or depression who were eligible for the intervention. Treated members (n = 900) graduated from the program. Matched control members (n = 900) were eligible but never enrolled. Primary outcomes included all-cause and disease-attributable health care cost and utilization PMPM, categorized by place of service. There were statistically significant reductions in total all-cause medical costs of $485 PMPM (P < .001) and a 66% pre-post reduction in inpatient encounters, with $488 PMPM DID savings for inpatient admissions (P < .001) among the treated cohort compared with the control cohort over 36 months. Conversely, there were statistically significant cost increases ($110 PMPM; P < .001) for all-cause office visits in the treated cohort compared with the control cohort. Similar results were seen in SUD-attributable and BH-attributablecosts. Although the results could be affected by unmeasured confounding, they suggest that care coaching interventions that offer BH provider referrals may produce long-term savings, reductions in avoidable utilization, and increases in targeted services to treat BH conditions. Rigorous evaluations are needed to confirm these findings.

Characteristics and clinical manifestations of monkeypox among people with and without HIV in the United States: a retrospective cohort.

To compare characteristics and clinical manifestations of monkeypox (MPX) between people with and without HIV in the United States. Retrospective cohort study using TriNetX, a federated research network. Patients 18 years and older with MPX were identified based on the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis code B04 and divided into two groups: people with HIV (PWH) and people without HIV. Differences in baseline characteristics, clinical manifestations, and all-cause healthcare utilization were examined between groups. Outcomes were reported before and after propensity score matching. Of 322 cases of MPX included, 29% ( n = 93) were PWH. Baseline characteristics were similar, but PWH were more likely to identify as Black or African American persons (24% vs. 11%, P = 0.0303) or as Hispanic or Latino persons (24% vs. 11%, P = 0.0345) and more likely to report lifestyle factors affecting health status. Rash and rectal pain were more common in PWH (25% vs. 11%, P < 0.01, and 25% vs. 10%, P < 0.001, respectively). In addition, PWH had higher rates of anal or rectal abscesses (11% vs. 0%, P < 0.0001), phimosis (11% vs. 0%, P < 0.0001), and pneumonia (11% vs. 0%, P < 0.0001). More PWH required urgent care visits (53% vs. 29%, P < 0.0001) and hospitalizations (11% vs. 4%, P = 0.0314), but not emergency department visits (42% vs. 58%, P = 0.0085). PWH had higher rates of clinical manifestations and required greater utilization of healthcare resources for any reason compared with those without HIV.

Comorbidities, Healthcare Utilization, and Costs Associated With Alopecia Totalis and Alopecia Universalis in the United States

Background: Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. Extensive forms of AA include alopecia totalis (AT; complete scalp hair loss) or alopecia universalis (AU; complete scalp, face, and body hair loss). Limited information exists about the cost and healthcare burden of AT and AU. Methods: Using a large US administrative healthcare claims database, two mutually exclusive patient cohorts were identified: AA cohort: ≥1 diagnosis of AA; AT/AU cohort: ≥1 diagnosis of AT/AU between January 1 and December 31, 2017. Baseline characteristics measured at first AA diagnosis (index date) and all-cause healthcare utilization and costs identified in the 1-year post-index period were compared between AT/AU and non-AT/AU AA cohorts. Results: 14,340 patients with AA were identified, including 1,224 patients with AT or AU. Compared with patients with non-AT/AU AA (n=13,116), patients with AT/AU were older (mean age 43.1 vs 40.6 years, P&lt;0.0001) and more were female (68.1% vs 62.9%, P&lt;0.0001). More patients with AT/AU had baseline comorbidities (atopic disease [28.3% vs 24.1%], anemia [10.4% vs 7.4%], autoimmune disorders [9.6% vs 5.5%]; P≤0.001 for all). Post-index patients with AT/AU had higher per person per policy year healthcare resource utilization and costs (P≤0.001) and total adjusted annual mean costs (P&lt;0.05). Over 50% more patients with AT/AU received immunosuppressive agents than patients with non-AT/AU AA. Conclusion: Patients with AT/AU had higher rates of comorbidities and greater healthcare resource utilization medical costs than patients with non-AT/AU AA, suggesting that improved insight into the patterns of specific comorbid conditions is needed.

Distinct care trajectories among persons living with arthritic conditions: A two-year state sequence analysis.

Developing solutions to optimize care trajectories (CareTs) requires examining patient journeys through the health care system. This study aimed to describe CareTs among people living with arthritis and evaluate their association with self-reported health outcomes. Analyses were conducted using the TorSaDE Cohort (n = 102,148), which connects the 2007 to 2016 Canadian Community Health Surveys (CCHS) with Quebec administrative databases (longitudinal claims). CareTs of participants living with arthritis according to CCHS (n = 16,631), over the two years before CCHS completion, were clustered using state sequence analysis (months as a time unit). CareT group membership was then put in association with self-reported outcomes (pain intensity and interference, self-perceived general and mental health). The analysis revealed five CareT groups characterized predominantly by: (1) arthritis-related visits to a specialist (n = 2,756; 16.6%), (2) arthritis-related emergency department visits (n = 2,928; 17.6%), (3) very high all-cause health care utilization and arthritis-related hospitalizations (n = 1,570; 9.4%), (4) arthritis-related medical visits to general practitioners and specialists (n = 2,708; 16.3%), (5) low all-cause health care utilization (n = 6,669; 40.1%). Multivariable results revealed that CareT group membership was associated with higher levels of pain interference (CareT group #3 vs. #5: OR: 1.4, 95%CI: 1.1-1.8) and fair/poor self-perceived general health (CareT group #1 vs. #5: OR: 1.551, 95%CI: 1.319-1.824; #2 vs. #5: OR: 1.244, 95%CI: 1.062-1.457; #3 vs. #5: OR: 1.771, 95%CI: 1.451-2.162; #4 vs. #5: OR: 1.481, 95%CI: 1.265-1.735). Sate sequence analysis is an innovative method of studying CareTs and valuable for making evidence-based decisions taking into account inter- and intra-individual variability.

Predictors and Health Care Utilization of Sepsis Post-Ureteroscopy in a U.S.-Based Population: Results from the Endourological Society TOWER Collaborative.

Purpose: To investigate the incidence, predictive factors, and health care utilization of sepsis post-ureteroscopy (URS) in patients enrolled in commercial insurance plans. Materials and Methods: A retrospective claims analysis was conducted using the IBM® MarketScan® commercial database. Patients ≥18 years were included if they had URS between January 2015 and October 2019 and developed sepsis within 30 days of URS. Multivariate logistic regression was used to identify various clinical and demographic predictors of sepsis post-URS. All-cause health care utilization (i.e., inpatient admissions and intensive care unit [ICU] stays) and all-cause health care costs up to 1 month post-septic event were measured. Results: Among the 104,100 URS patients meeting the inclusion criteria, 5.5% developed sepsis. Patients with diabetes (odds ratio [OR] = 1.52; p < 0.0001), older age (age 55-64 vs 18-34; OR = 1.35; p < 0.0001), baseline sepsis (OR = 3.51; p < 0.0001), baseline inpatient visits (OR = 1.17; p = 0.0012), and higher Elixhauser comorbidity scores (OR = 1.09; p < 0.0001) had a significantly higher likelihood of developing sepsis post-URS. In septic patients, 94.8% required inpatient care and 35% were admitted to the ICU. Mean hospital stay for septic patients was 6.86 days. Average all-cause health care cost per patient at 1 month in the septic cohort was $49,625 vs $17,782 in the nonseptic cohort indicating an incremental all-cause cost of $31,843 (p < 0.0001). Conclusions: A total of 5.5% of commercially insured patients undergoing URS developed sepsis post-URS. Diabetes, older age, baseline sepsis, baseline inpatient visit, and higher comorbidity score were all found to be independent predictors of post-URS sepsis. Patients with sepsis post-URS had higher health care utilization and costs indicating that sepsis is both a significant clinical and economic event.

Effect of Medically Tailored Meals on Clinical Outcomes in Recently Hospitalized High-Risk Adults.

Background:Inability to adhere to nutritional recommendations is common and linked to worse outcomes in patients with nutrition-sensitive conditions.Objectives:The purpose of this study is to evaluate whether medically tailored meals (MTMs) improve outcomes in recently discharged adults with nutrition-sensitive conditions compared with usual care.Research Design:Remote pragmatic randomized trial.Subjects:Adults with heart failure, diabetes, or chronic kidney disease being discharged home between April 27, 2020, and June 9, 2021, from 5 hospitals within an integrated health care delivery system.Measures:Participants were prerandomized to 10 weeks of MTMs (with or without virtual nutritional counseling) compared with usual care. The primary outcome was all-cause hospitalization within 90 days after discharge. Exploratory outcomes included all-cause and cause-specific health care utilization and all-cause death within 90 days after discharge.Results:A total of 1977 participants (MTMs: n=993, with 497 assigned to also receive virtual nutritional counseling; usual care: n=984) were enrolled. Compared with usual care, MTMs did not reduce all-cause hospitalization at 90 days after discharge [adjusted hazard ratio, aHR: 1.02, 95% confidence interval (CI), 0.86–1.21]. In exploratory analyses, MTMs were associated with lower mortality (aHR: 0.65, 95% CI, 0.43–0.98) and fewer hospitalizations for heart failure (aHR: 0.53, 95% CI, 0.33–0.88), but not for any emergency department visits (aHR: 0.95, 95% CI, 0.78–1.15) or diabetes-related hospitalizations (aHR: 0.75, 95% CI, 0.31–1.82). No additional benefit was observed with virtual nutritional counseling.Conclusions:Provision of MTMs after discharge did not reduce risk of all-cause hospitalization in adults with nutrition-sensitive conditions. Additional large-scale randomized controlled trials are needed to definitively determine the impact of MTMs on survival and cause-specific health care utilization in at-risk individuals.

Primary Care Behavioral Health Integration and Care Utilization: Implications for Patient Outcome and Healthcare Resource Use.

Behavioral health (BH) integration in primary care (PC) can potentially improve outcomes and reduce cost of care. While different models of integration exist, evidence from real-world examples is needed to demonstrate the effectiveness and value of integration. This study aimed to evaluate the outcomes of six PC practice sites located in Western New York that implemented a primary care behavioral health (PCBH) integration model. To assess the impact of PCBH on all-cause healthcare utilization rates. A retrospective observational study based on historical multi-payer health insurance claims data. Claims data were aggregated on a per-member-per-month basis to compare utilization rates among the patients in the PC practice sites that had implemented PCBH to those in the sites that had not yet done so. The sample included 6768 unique adult health plan members between October 2015 and June 2017 with at least one BH diagnosis code who were attributed to one of the six newly integrated PC practice sites. Under the PCBH integration model, BH specialists were embedded in PC practice sites to treat a wide range of BH conditions. Rates of all-cause ED visits and hospital admissions, along with rates of PC provider and BH provider visits. PCBH implementation was associated with reductions in the rates of outpatient ED visits (14.2%; p < 0.001) and PC provider visits (12.0%; p < 0.001), as well as with an increased rate of BH provider visits (7.5%; p = 0.018). PCBH integration appears to alter the treatment patterns among patients with BH conditions by shifting patient visits away from ED and PC providers toward BH providers who specialize in treatment of such patients.

PRIMUS - Prompt Initiation of Maintenance Therapy in the US: A Real-World Analysis of Clinical and Economic Outcomes Among Patients Initiating Triple Therapy Following a COPD Exacerbation.

PurposePatients with chronic obstructive pulmonary disease (COPD) may experience moderate (requiring outpatient care) or severe (requiring hospitalization) disease exacerbations. Guidelines recommend escalation from dual to triple therapy (inhaled corticosteroid + long-acting beta agonist + long-acting muscarinic antagonist) after two moderate or one severe exacerbation in a year. This study examined whether prompt initiation of triple therapy lowers risk of future exacerbations and reduces healthcare costs, compared to delayed/very delayed triple therapy after an exacerbation.Patients and MethodsThis retrospective observational study of US healthcare claims included patients ≥40 years old with COPD who initiated triple therapy (1/1/2011–3/31/2020) after ≥2 moderate or ≥1 severe exacerbation in the prior year. The earliest of the second moderate or first severe exacerbation was the index date. Patients were stratified by triple therapy timing: prompt (≤30 days post-index), delayed (31–180 days), very delayed (181–365 days). COPD exacerbations, all-cause and COPD-related healthcare utilization and costs were assessed during 12 months post-index (follow-up). Multivariable regression estimated the effect of each 30-day delay in triple therapy on the odds of exacerbations, number of exacerbations, and costs during follow-up, controlling for patient characteristics.ResultsA total of 24,770 patients were included: 7577 prompt, 9676 delayed, 7517 very delayed. Each 30-day delay of triple therapy was associated with 11% and 7% increases in the odds of any exacerbation and a severe exacerbation, respectively (odds ratio [95% CI]: 1.11 [1.10–1.13] and 1.07 [1.05–1.08]), a 4.3% (95% CI: 3.9–4.6%) increase in the number of exacerbations, a 1.8% (95% CI: 1.3–2.3%) increase in all-cause costs, and a 2.1% (95% CI: 1.6–2.6%) increase in COPD-related costs during follow-up.ConclusionPromptly initiating triple therapy after two moderate or one severe exacerbation is associated with decreased morbidity and economic burden in COPD. Proactive disease management may be warranted to prevent future exacerbations and lower costs among patients with COPD.

The prevalence, burden of disease, and healthcare utilization of patients with eosinophilic granulomatosis with polyangiitis in Japan: a retrospective, descriptive cohort claims database study.

To estimate eosinophilic granulomatosis with polyangiitis (EGPA) prevalence and disease burden in patients with newly diagnosed EGPA in Japan. This retrospective descriptive cohort study (GSK ID: 209751, HO-18-19652) used administrative claim data from patients (aged ≤74 years) with EGPA (study period: January 1, 2005-December 31, 2017), identified from their first ICD-10 code for EGPA (index). Data were examined during the 12 months before (baseline) and 12 months following the index date (follow-up). EGPA prevalence, respiratory comorbidities, all-cause healthcare utilization, and oral corticosteroid (OCS) use were assessed. EGPA prevalence (95%CI) increased from 4.2 (0,23.7)/million people (2005) to 38.0 (31.8,45.1)/million people (2017), was generally more common in females versus males, and increased with age. Of the 45 patients with newly diagnosed EGPA, 57.8% had acute bronchitis and 42.2% had upper respiratory tract infections during baseline. During follow-up, 60.0% of patients were hospitalized at least once and 77.8% used OCS (OCS dependent [≥80% of days]: 73.1%). In Japan, EGPA prevalence increased over time, was generally more common in females, and increased with patient age. EGPA burden was high; respiratory comorbidities were common, and most patients required hospitalization and OCS use. Our data suggest additional EGPA treatment options are needed.

The Effect of Back Pain on Health Care Utilization and Costs

Introduction: We assessed the effect of self-reported back pain on health care utilization and costs in a population-based sample of Ontario adults.&#x0D; Methods: We conducted a population-based matched cohort study of Ontarian respondents aged ≥18 years of Canadian Community Health Survey (CCHS) from 2003-2012. CCHS data were individually linked to health administrative data to measure health care utilization and costs up to 2018. We propensity-score matched (hard-matched on sex) adults with self-reported back pain to those without back pain, accounting for sociodemographic, health-related, and behavioural factors. We evaluated back pain-specific and all-cause health care utilization and costs from healthcare payer perspective adjusted to 2018 Canadian dollars. Poisson and linear (log-transformed) models were used to assess healthcare utilization rates and costs. &#x0D; Results: After propensity-score matching, we identified 36,806 pairs (21,054 for women, 15,752 for men) of CCHS respondents with and without back pain (mean age 51 years; SD=18). Compared to propensity-score matched adults without back pain, adults with back pain had two times the rate of back pain-specific visits (women: rate ratio [RR] 2.06, 95% CI 1.88-2.25; men: RR 2.32, 95% CI 2.04-2.64), 1.1 times the rate of all-cause physician visits (women: RR 1.12, 95% CI 1.09-1.16; men: RR 1.10, 95% CI 1.05-1.14), and 1.2 times the costs (women: 1.21, 95% CI 1.16-1.27; men: 1.16, 95% CI 1.09-1.23). Incremental annual per-person costs were higher in adults with back pain versus those without (women: $395, 95% CI $281-$509; men: $196, 95% CI $94-$300), corresponding to $532 million for women and $227 million CAD for men annually in Ontario.&#x0D; Conclusions: Adults with back pain had considerably higher health care utilization and costs compared to adults without back pain. These findings provide the most recent, comprehensive, and high-quality estimates of the health system burden of back pain to inform healthcare policy and decision-making. New strategies to reduce the substantial burden of back pain are warranted.

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.

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.