All-cause Healthcare Expenditures Research Articles

Attributable Cost of Adult Respiratory Syncytial Virus Illness Beyond the Acute Phase.

Estimates of the cost of medically attended lower respiratory tract illness (LRTI) due to respiratory syncytial virus (RSV) in adults, especially beyond the acute phase, is limited. This study was undertaken to estimate the attributable costs of RSV-LRTI among US adults during, and up to 1 year after, the acute phase of illness. A retrospective observational matched-cohort design and a US healthcare claims repository (2016-2019) were employed. The study population comprised adults aged ≥18 years with RSV-LRTI requiring hospitalization (RSV-H), an emergency department visit (RSV-ED), or physician office/hospital outpatient visit (RSV-PO/HO), as well as matched comparison patients. All-cause healthcare expenditures were tallied during the acute phase of illness (RSV-H: from admission through 30 days postdischarge; ambulatory RSV: during the episode) and long-term phase (end of acute phase to end of following 1-year period). The study population included 4526 matched pairs of RSV-LRTI and comparison patients (RSV-H: n = 970; RSV-ED: n = 590; RSV-PO/HO: n = 2966). Mean acute-phase expenditures were $42 179 for RSV-H (vs $5154 for comparison patients), $4409 for RSV-ED (vs $377), and $922 for RSV-PO/HO (vs $201). By the end of the 1-year follow-up period, mean expenditures-including acute and long-term phases-were $101 532 for RSV-H (vs $36 302), $48 701 for RSV-ED (vs $27 131), and $28 851 for RSV-PO/HO (vs $20 523); overall RSV-LRTI attributable expenditures thus totaled $65 230, $21 570, and $8327, respectively. The cost of RSV-LRTI requiring hospitalization or ambulatory care among US adults is substantial, and the economic impact of RSV-LTRI may extend well beyond the acute phase of illness.

Attributable Cost of Adult Hospitalized Pneumonia Beyond the Acute Phase.

BackgroundWhile much is known about the cost of community-acquired pneumonia (CAP) during the acute phase of illness, little is known about the potential attributable cost of CAP thereafter.ObjectiveThe aim of this study was to assess long-term attributable costs associated with CAP among adults in US clinical practice.MethodsA retrospective matched cohort design and data from a US private healthcare claims repository were employed. In each month during the study period (2011–2016), adults who were hospitalized for CAP in that month (‘CAP patients’) were matched (1:1, without replacement) on demographic, clinical, and healthcare profiles to adults who did not develop CAP in that month (‘comparison patients’). All-cause healthcare expenditures were tallied for the qualifying CAP hospitalization and during the 30-day period post-discharge (collectively, ‘acute phase’), as well as from the end of the acute phase to the end of the 3-year follow-up period (‘long-term phase’).ResultsThe study population included 43,975 matched pairs of CAP patients and comparison patients. Expenditures averaged $33,380 (95% confidence interval [CI] $32,665–$34,161) for the CAP hospitalization and $4568 (95% CI $4385–$4749) during the 30-day period thereafter (vs. $2075 [95% CI $1989–$2167] in total for the comparison patients). During the long-term phase, all-cause expenditures averaged $83,463 (95% CI $81,318–$85,784) for CAP patients versus $51,017 (95% CI $49,553–$52,491) for comparison patients, and thus attributable expenditures during this phase totaled $32,446 (95% CI $29,847–$35,075). The majority of attributable CAP expenditures (53% of $68,319) occurred during the acute phase, while 21%, 14%, and 12% occurred during the first, second, and third years, respectively, after the acute phase.ConclusionsOur findings provide additional evidence that the cost of CAP requiring hospitalization is high, and that the impact of CAP extends well beyond the expected time for resolution of acute inflammatory signs.Electronic supplementary materialThe online version of this article (10.1007/s41669-020-00240-9) contains supplementary material, which is available to authorized users.

PCV36 HEALTHCARE EXPENDITURES IN PATIENTS RECEIVING PHARMACOTHERAPY WITH APIXABAN OR WARFARIN FOR VENOUS THROMBOEMBOLISM (VTE): A COMPARATIVE STUDY

In the AMPLIFY trial, apixaban was non-inferior to conventional therapy (subcutaneous enoxaparin, followed by warfarin) for treatment of acute VTE, with significantly less bleeding. This observational study compared healthcare expenditures between patients receiving outpatient pharmacotherapy with apixaban versus warfarin for VTE in US clinical practice. A retrospective matched-cohort design and pooled data from four large US private healthcare claims databases (03/2014 – 06/2017) were employed. From the source population including adults who had an initial VTE diagnosis and, within 30 days, began outpatient anticoagulant treatment, patients receiving apixaban were matched 1:1 (without replacement) to those receiving warfarin plus parenteral anticoagulant bridge therapy; matching was performed on the basis of age, study database, VTE characteristics, and propensity score (nearest-neighbor approach). Healthcare expenditures (2017US$) for all causes, major bleeding, and recurrent VTE during (max.) 180-day follow-up period were totaled within each treatment group, and along with corresponding differences, were expressed per patient per month (PPPM); 95% confidence intervals (CIs) were generated via non-parametric bootstrapping. Study population included 17,878 matched pairs of apixaban and warfarin patients; treatment groups were well balanced on baseline characteristics. PPPM (95% CI) all-cause healthcare expenditures were significantly higher among warfarin versus apixaban patients ($4,247 [4,106-4,369] vs. $3,838 [3,683-4,027]; difference = $409 [180-608]), which was attributable to increased expenditures in the inpatient and ambulatory settings ($3,811 [3,679-3,936] vs. $3,194 [3,036-3,388]; difference = $617 [389-816]). PPPM healthcare expenditures for major bleeding were also significantly higher among warfarin patients ($192 [154-244] vs. $130 [101-161]; difference = $62 [18-119]). PPPM expenditures for recurrent VTE were not statistically different between treatment groups ($104 [83-125] vs. $114 [84-156]; difference = -$10 [-57-19]). In this large retrospective observational study of VTE patients receiving outpatient apixaban or warfarin in US clinical practice, all-cause and major bleeding-related healthcare expenditures were significantly higher among patients who received warfarin.

PMH66 DEPRESSION TREATMENT, HEALTHCARE EXPENDITURES, AND DEPRESSION SEVERITY IN PATIENTS WITH DEPRESSION USING PATIENT HEALTH QUESTIONNAIRE-9 SCORES TO ASSESS DEPRESSION SEVERITY

Patient Health Questionnaire-9 (PHQ-9) is a validated tool used to assist clinicians in assessing depression severity. This study’s objective was to characterize treatment for depression and healthcare expenditures among patients administered the PHQ-9. Adult patients with PHQ-9 score between 1/1/2011 and 9/30/2016 were identified using MarketScan Claims and Electronic Medical Records Database (CED). The first PHQ-9 was the index date; 12 months continuous enrollment before and after the index date was required. Depression severity, assessed via PHQ-9 scores, was categorized as minimal (<5), mild (5-9), moderate (10-14), or severe (>14). Depression treatment and all-cause healthcare expenditures during follow-up were assessed and stratified by presence of a pre-existing mental health (MH) diagnosis. 11,066 patients met inclusion criteria; mean patient age was 66 years and 56% of patients were female. 11% of patients had PHQ-9 scores indicating depression (4% mild, 4% moderate, and 3% severe). Patients with a pre-existing MH diagnosis (19%) reported more severe depression compared to those without a pre-existing MH diagnosis (MH: 6% mild, 7% moderate, 6% severe; no MH: 3% mild, 3% moderate 3% severe; p<0.001 for all). Antidepressant treatment was more common in patients with severe depression during follow-up; those with a pre-existing MH diagnosis had the highest rates of treatment (MH: 56% minimal, 76% mild, 83% moderate, 82% severe; no MH: 14% minimal, 48% mild, 62% moderate, 76% severe; p<0.001 for all). Mean all-cause expenditures were similar in patients with mild ($14,983), moderate ($15,403), and severe depression ($15,046); expenditures for each group were significantly higher than expenditures in patients with minimal depression ($11,161; p<0.001 for all). Though 7% patients had severe or moderate depression, a significant proportion received no antidepressant therapy which may represent unmet need. Further research is needed to understand barriers for depression treatment and the impact on healthcare costs.

Body mass index and insulin use as identifiers of high-cost patients with type 2 diabetes: A retrospective analysis of electronic health records linked to insurance claims data.

To study the association of body mass index (BMI) and insulin use with type 2 diabetes-related healthcare expenditures (T2D-HE). Retrospective study using de-identified electronic health records linked to insurance claims data. Study included a prevalence-based sample of overweight or obese patients with antihyperglycaemic-treated T2D. Patients had ≥1 A1c measurement in 2014 (last observed = index A1c), ≥1 BMI measurement within ±90 days of index (average BMI = baseline BMI), and continuous enrolment for 180 days before (baseline) through 395 days after index (day 30-395 = follow-up). BMI was categorized as: 25 to 29.9 kg/m2 = overweight; 30 to 34.9 kg/m2 = obese class I (OCI); 35 to 39.9 kg/m2 = OCII; ≥40 kg/m2 = OCIII. Multivariable regressions were used to examine one-year follow-up T2D-HE as a function of BMI, insulin use, an interaction term between BMI and insulin use, and patient demographics. Study included 13 026 patients (mean age = 63.6 years; 48.1% female; 29.5% overweight, 31.6% OCI, 20.3% OCII, 18.6% OCIII; 25.3% insulin users). Baseline insulin use rates monotonically ranged from 19.7% in overweight patients to 33.0% in OCIII patients (P < 0.001). Together, BMI and insulin use were jointly associated with one-year follow-up T2D-HE, which monotonically ranged from $5842 in overweight patients with no insulin to $17 700 OCIII insulin users, P < 0.001. Within each BMI category, insulin users' one-year T2D-HE was at least double that of non-users. Additional analyses of all-cause healthcare expenditures yielded consistent results. BMI and insulin use represent simple stratifiers for identifying high-cost patients. OCIII insulin users incurred the greatest annual healthcare expenditures; these patients may be an ideal group for targeted interventions.

Factors related to and economic implications of inhospital death in German lung cancer patients - results of a Nationwide health insurance claims data based study

BackgroundWhen patients die in a hospital their quality of life is lower than when they die at home or in a hospice. Despite efforts to improve palliative care supply structures, still about 60% of lung cancer patients die in a hospital. Studies have examined factors related to inhospital death in lung cancer patients, yet none used data of a representative German population, additionally including economic aspects. This study aimed to identify factors related to inhospital death in German lung cancer patients and analysed resulting costs.MethodsWe analysed a dataset of health insurance claims of 17,478 lung cancer patients (incident 2009) with 3 year individual follow-up. We grouped patients into inhospital death and death elsewhere. Studied factors were indicators of healthcare utilization, palliative care, comorbidities and disease spread. We used logistic regression models with LASSO selection method to identify relevant factors. We compared all-cause healthcare expenditures for the last 30 days of life between both groups using generalized linear models with gamma distribution.ResultsTwelve thousand four hundred fifty-seven patients died in the observation period, thereof 6965 (55.9%) in a hospital. The key factors for increased likelihood of inhospital death were receipt of inpatient palliative care (OR = 1.85), chemotherapeutic treatments in the last 30 days of life (OR = 1.61) and comorbid Congestive Heart Failure (OR = 1.21), and Renal Disease (OR = 1.19). In contrast, higher care level (OR = 0.16), nursing home residency (OR = 0.25) and receipt of outpatient palliative care (OR = 0.25) were associated with a reduced likelihood. All OR were significant (p-values< 0.05). Expenditures in the last 30 days of life were significantly higher for patients with inhospital death (€ 6852 vs. € 33,254, p-value< 0.0001).ConclusionFindings suggest that factors associated with inhospital death often relate to previous contact with hospitals like prior hospitalizations, and treatment of the tumour or comorbidities. Additionally, factors associated with dying elsewhere relate to access to care settings which are more focused on palliation than hospitals. From these results, we can derive that implementing tools like palliative care into tumour-directed therapy might help patients make self-determined decisions about their place of death. This can possibly be achieved at reduced economic burden for SHIs.

Relationships between antiparkinson medication nonadherence, regimen modifications, and healthcare utilization and expenditures.

To examine 1) the effect of prior antiparkinson drug (APD) nonadherence on subsequent APD regimen modifications; and 2) the influence of modifications on healthcare utilization and costs by patients with Parkinson's disease (PD). This retrospective cohort study included 7052 PD patients with ≥2 APD prescriptions who initiated a modification of APD regimens in 2007. Modification was assessed as changing from one APD to another and/or adding a new APD to an existing regimen. Nonadherence was measured using Medication Possession Ratio <0.8. Discrete-time survival analyses were used to estimate the effect of prior nonadherent behavior on initiating APD modifications. Generalized linear models were used to estimate the effect of initiating medication modifications on subsequent 3-month medical use and costs. Initiation of APD modifications in any given month was higher among patients who were nonadherent to APDs in the preceding month (adjusted hazard ratio [HR]=1.23), compared to their adherent counterparts. Modifications significantly predicted higher risk of all-cause and PD-related hospitalizations (adjusted relative risk [RR]=1.22 and 1.83, respectively), home health agency utilization (RR=1.18 and 1.52), and use of physician services (RR=1.14 and 1.41), as well as higher total all-cause healthcare expenditures (mean=$1064) in any given 3-month interval. Prior nonadherence to APDs might influence initiation of APD modification. APD modifications were associated with increased health care utilization and expenditures, with the caveats that indications of modifications and disease severity may still play roles. Prescribers should consider patients' medication adherence when changing APD regimens to lower the costs of medical services.

Healthcare Resource Utilization And Costs Of Spinal Cord Injury With Neuropathic Pain In A Medicare Population

Objective: Evaluation of healthcare resource utilization (HRU) and costs in patients with neuropathic pain (NeP) secondary to spinal cord injury (SCI) in a Medicare population. Methods: Using data from the MarketScan Medicare Database between January 1, 2006 and June 30, 2011, patients with NeP following SCI (SCI-NeP cohort) were identified based on an ICD-9-CM diagnostic code indicative of SCI, and NeP (index event) within 12 months based on ICD-9-CM code 338.0x (central neuropathic pain) or a claim for an NeP-related antiepileptic or NeP-related antidepressant drug, and propensity score-matched to SCI patients without NeP (SCI-only). Pre-index demographic and clinical characteristics were compared between the cohorts. HRU and expenditures were compared for 12 months post-index. Generalized linear models and ordinary least squares models evaluated the association between characteristics and outcomes. Results: The matched cohorts included 1,418 patients (approximately 54% male, mean age 77 years). During the 12-month follow-up period, SCI-NeP patients showed significantly greater use of evaluated medications (P < 0.01), and significantly higher HRU (P < 0.05), including 20% and 18% increased odds of hospitalization and emergency department visits, respectively. Mean (SD) total all-cause healthcare expenditures for this period adjusted for covariates showed an annual incremental economic burden of $6,808 (95% confidence interval $4,143, $9,764) per patient with NeP. Conclusions: Medicare patients with NeP secondary to SCI have significantly higher HRU and costs relative to SCI patients without NeP. Medicare patients represent a population with special needs regarding therapeutic choices that may benefit from an integrated approach to NeP management.

Using observational analysis of multiple sclerosis relapse to design outcomes-based contracts for disease-modifying drugs: a feasibility assessment

Objective:To assess predictors and costs of multiple sclerosis (MS) relapse, a potential outcome measure in payer-manufacturer risk-sharing agreements for disease-modifying drugs (DMDs).Methods:A retrospective cohort analysis of medical/pharmacy claims was used. Study patients had ≥1 DMD (interferon beta, glatiramer, natalizumab) claim, without DMD claims in a 6-month pre-period before DMD initiation; were aged 18–64 years and continuously enrolled from the pre-period through a 24-month post-period; and had ≥2 MS medical claims during the 30-month study period. Post-period relapse cohorts included: (1) severe (hospitalization with MS diagnosis); (2) moderate (outpatient services including intravenous methylprednisolone); and (3) none. Poisson regression modeled severe relapse frequency, logistic regression modeled ≥1 severe relapse, and generalized linear modeling predicted healthcare costs. Tested predictors included demographics, insurance type, index DMD, pre-period health status, and DMD medication possession ratio (MPR).Results:Severe relapse was experienced by 14.5% and moderate relapse by 13.8% of 2291 patients. In logistic regression, severe relapse was predicted by plan type; age (odds ratio [OR] = 1.018, 95% confidence interval [CI] = 1.005–1.031); pre-period Charlson Comorbidity Index (OR = 1.307, 95% CI = 1.166–1.464); pre-period proxy measure indicating impaired activities of daily living (OR = 1.470, 95% CI = 1.134–1.905); pre-period MS hospitalization (OR = 2.174, 95% CI = 1.537–3.074); and DMD non-adherence (MPR OR = 0.101, 95% CI = 0.068–0.151). Poisson regression results were similar. Predicted mean [standard deviation] all-cause healthcare expenditures were tripled for patients with severe compared with moderate relapse ($48,173 [$8665] and $13,334 [$1929], respectively).Limitations:Commercially insured patients from a single payer; use may have been inconsistent with approved indications; proxy relapse measure may have misclassified patients.Conclusions:Severe MS relapses requiring hospitalization, although affecting less than 15% of patients initiating DMD treatment, are associated with high medical costs. The only actionable predictor of severe relapse identified in observational analysis was MPR, raising questions about the feasibility of using observational data to guide outcomes-based contracting.

Abstract P2-14-07: Evaluation of Aromatase Inhibitor failure and total healthcare expenditures among post-menopausal women with metastatic ER+/HER2− breast cancer in the US

Abstract Aromatase Inhibitors (AIs) have replaced tamoxifen as first-line therapy for post-menopausal women with metastatic, ER+ breast cancer (BC). However, little information is available on the real-world use of AIs. This retrospective administrative claims study compared healthcare expenditures of post-menopausal women with metastatic ER+/HER2− BC treated with AIs and experiencing 0 or ≥ 1 AI failures (AIF). Women ≥ 55 years of age newly diagnosed with stage IV BC (index) were identified in the 2006–2010 Thomson Reuters MarketScan databases and followed until the earliest of chemotherapy, combination therapy, end of enrollment, or end of study (03/31/2011). ER+/HER2− disease was defined as any endocrine therapy (ET: tamoxifen, fulvestrant) or AI (anastrozole, letrozole, or exemestane) use and no trastuzumab, lapatinib or toremifene use anytime in the 6-month pre-or variable length post-index periods. Those with post-index AI use except where use followed chemotherapy or combination therapy were retained for analysis. AIF post-index was defined as a switch to an alternative AI, ET, chemotherapy, or combination therapy. All-cause healthcare expenditures, defined as total provider payments (insurer + patient + COB) were examined by type of service and in total, and expressed as per patient per month (PPPM). A series of log-gamma regressions were used to examine the relationship between AIF and PPPM expenditures as a form of cost ratios (CRs), adjusting for potential confounding factors such as patient demographic and clinical characteristics. Among 4,249 eligible patients, 36% had ≥1 AIF. At index, AIF patients were more likely to have liver (8% vs. 5%), lung (11% vs. 8%), and bone metastases (60% vs. 49%), all p &amp;lt; 0.01; as likely to have brain metastases (6.5% vs. 6.6%, p = 0.880); and less likely to have metastases to other sites (39% vs. 48%, p &amp;lt; 0.001). Median days of follow-up were 395 for AIF and 466 for no AIF patients. Post-index, patients with AIF had significantly higher total unadjusted PPPM healthcare expenditures ($6507 vs. $3974), and across all service types including inpatient stays ($2529 vs. $1369), radiation treatments ($465 vs. $238), diagnostic radiology ($889 vs. $599), laboratory tests ($333 vs. $196), and other non-office visit outpatient services ($1546 vs. $932), all p &amp;lt; 0.001. Regression analysis showed that metastases to the lung (CR 1.32 CI: 1.17–1.50), brain (CR 1.76, CI: 1.54–2.01), liver (CR 1.96 CI: 1.67–2.30), bone (CR 1.53 CI: 1.40–1.68), and other sites (CR 1.41 CI: 1.29–1.55) at diagnosis significantly increased PPPM expenditures compared to having metastases at another site while controlling for AIF status and other confounders, while AIF also significantly increased costs (CR 1.50 CI: 1.39–1.61). Using the bootstrap approach, incremental adjusted PPPM costs in women with AIF relative to those with no AIF was estimated at $2051 (CI: $1666-$2426, p &amp;lt; 0.001). In real world practice, almost 40% of women with ER+/HER2− metastatic BC treated with AIs failed at least 1. AIF was associated with expenditures 50% higher than patients with no AIF. Furthermore, substantial costs were associated with metastases regardless of the site. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-14-07.