Total All-cause Healthcare Costs Research Articles

Patient Perspectives on the Burden of Heart Failure with Preserved Ejection Fraction in a US Commercially Insured and Medicare Advantage Population: A Survey Study.

Patient-reported health related quality of life (HRQOL) is not routinely assessed in clinical practice. Little is known about health status outcomes reported by patients with heart failure with preserved ejection fraction (HFpEF) in non-clinical trial settings. To better understand patient burden of HFpEF in terms of HF-specific functional and symptom status, HRQOL, healthcare resource utilization (HCRU) and costs in a US-based commercial and Medicare Advantage insured population. We conducted a cross-sectional survey of patients with HFpEF and linked their survey and administrative claims data. Consenting, eligible patients completed a survey that included the 23-item Kansas City Cardiomyopathy Questionnaire (KCCQ-23) and the PROMIS Global Health-10 (GH-10) questionnaire, as well as clinical and demographic questions. HF medication use, HCRU and costs during the 12-month baseline period before the survey were determined from claims data. Generalized linear regression was used to assess the associations between baseline characteristics and the KCCQ-23 overall summary score. Of 598 survey respondents with survey and claims data, 54.7% were female with mean age 74.0 years. The KCCQ-23 overall summary and clinical summary scores were 64.8 and 63.0, respectively, and the GH-10 physical and mental health summary scores were 39.9 and 45.5. Factors related to lower KCCQ-23 overall summary scores were HF treatment and symptom changes during the past 4-weeks before the survey, hospital admission during the past year, low household income, high comorbidity index, and morbid obesity (BMI>40). Total all-cause healthcare costs were $38,243 during the year prior to the survey, of which 42% were HF-related. Patient-reported outcome measure scores indicated impairment due to HF symptoms and physical limitations in this real-world sample of patients with HFpEF, highlighting a need to assess patient-reported outcomes as well as the clinical and economic outcomes traditionally assessed by clinicians, health systems and payers.

Economic Burden of Fatigue in Inflammatory Bowel Disease.

This retrospective study gathered medical/pharmacy claims data on patients with inflammatory bowel disease (IBD) between January 01, 2000 and March 31, 2019 from the IBM MarketScan commercial claims database to assess the real-world impact of fatigue on healthcare costs in patients newly diagnosed with IBD. Eligible participants were ≥18 years, newly diagnosed with IBD (≥2 separate claims), and had ≥12 months of continuous database enrollment before and after fatigue diagnosis. The date of fatigue diagnosis was the index date; participants were followed for 12 months post-index. Patients with (cases) or without (controls) fatigue were matched 1:1 by propensity score matching. Patients with evidence of prior IBD diagnosis/treatment, or those with a chronic disease other than IBD wherein fatigue is the primary symptom, were excluded. Healthcare resource utilization (HCRU), including hospitalizations, inpatient and outpatient visits, and associated costs were compared between cases and controls. Matched IBD cohorts (21 321 cases/21 321 controls) were identified (42% Crohn's disease [CD] and 58% ulcerative colitis [UC]) with similar baseline characteristics (average age: 46 years; 60% female). Cases versus controls had significantly more all-cause outpatient visits (incidence rate ratio [IRR], 95% confidence intervals [95% CI]: 1.64 [1.61, 1.67], P < .001) and all-cause hospitalizations (IRR [95% CI]: 1.92 [1.81, 2.04], P < .001); as well as significantly higher all-cause total direct healthcare costs (mean: $24 620 vs. $15 324; P < .001). Similar findings were observed for IBD-related outcomes, as well as in CD- and UC-specific subgroups. Presence of fatigue is associated with an increase in HCRU and total medical costs among patients newly diagnosed with IBD.

Comparing the burden of illness in patients with alopecia areata vs atopic dermatitis in the US population from a payer perspective.

BACKGROUND: Alopecia areata (AA) is an autoimmune disease characterized by nonscarring hair loss. AA frequently co-occurs with other inflammatory autoimmune conditions, presenting a significant clinical burden. OBJECTIVE: To compare the burden of illness, direct and indirect costs in adult patients with AA vs atopic dermatitis (AD). METHODS: This retrospective cohort study used US administrative claims data from the Merative MarketScan Commercial Claims and Encounters Database to compare commercially insured adults with AA to those with AD. Patients with an AA diagnosis between January 2017 and September 2019 were propensity score matched to patients with AD. Comorbidity burden, medication use, health care resource utilization, health care costs, and indirect costs during a 12-month follow-up period were compared between cohorts. RESULTS: Overall, 25,446 adult patients with AA were selected for the matched analysis with the AD cohort. Patients with AA generally had lower comorbidity burden than patients with AD; mean Deyo-Charlson Comorbidity Index scores were 0.36 (SD = 0.99) and 0.39 (SD = 0.92), for AA and AD, respectively (P = 0.007). Patients with AA had significantly lower proportions of allergic rhinitis, asthma, pruritus, skin infections, and urticaria, but higher proportions of thyroid disease, when compared with patients with AD (all P < 0.001). A smaller proportion of patients with AA had prescriptions for topical (45.3% vs 64.8%; P < 0.001) and oral (20.3% vs 29.6%; P < 0.001) corticosteroids and antianxiety and/or antidepressants (24.7% vs 29.7%; P < 0.001), but a significantly larger proportion for intralesional corticosteroids (triamcinolone) (49.6% vs 21.7%; P < 0.001), compared with patients with AD. Despite a lower comorbidity burden and generally less medication usage in patients with AA, total all-cause health care costs did not significantly differ between the AA and AD cohorts ($10,705 vs $10,816; P = 0.712), and outpatient costs were higher in patients with AA ($6,297 vs $5,859; P = 0.014). Female patients with AA had significantly greater costs for both outpatient and outpatient pharmacy when compared with female patients with AD. Patients with AA were more likely to have a claim for long-term disability (0.6% vs 0.3%; P = 0.001) and higher long-term disability-associated indirect costs ($73 [SD = $1,442] vs $25 [SD = $774]; P = 0.004) compared with patients with AD. CONCLUSIONS: We found similar total health care costs in patients with AA and AD, despite a lower proportion of comorbidities and prescription use in patients with AA. Outpatient costs were also significantly higher overall in patients with AA. Although often dismissed as a cosmetic condition, AA, an autoimmune disease, has a similar level of medical expenditure as AD. DISCLOSURES: This study was funded by Eli Lilly and Company. Mr Fenske and Drs Ding, Morrow, and Smith are employed by Eli Lilly and Company. Drs Manjelievskaia, Moynihan, and Silver are employed by Merative. Drs Manjelievskaia, Moynihan, and Silver were employed by IBM Watson Health at the time of study completion. IBM Watson Health received funding from Eli Lilly and Company to conduct this study.

Work Loss and Direct and Indirect Costs Associated with Parkinson's Disease.

To examine work loss and indirect costs during the three-year periods prior to and following initial diagnosis of Parkinson's disease (PD) in patients and in spouses of PD patients, as well as direct costs of healthcare. This is a retrospective, observational cohort study using the MarketScan Commercial and Health and Productivity Management databases. A total of 286 employed PD patients and 153 employed spouses met all diagnostic and enrollment criteria for short-term disability (STD) analysis (PD Patient cohort and Caregiving Spouse cohort). The proportion of PD patients having a STD claim increased from roughly 5% and plateaued at around 12-14% starting in the year prior to first diagnosis of PD. The mean number of days lost from work due to STD per year increased from 1.4 days in the 3rd year prior to diagnosis to 8.6 days in the 3rd year after diagnosis (corresponding to an increase in indirect costs from $174 to $1104). STD use for spouses of patients with PD was lowest in the year after their spouses were diagnosed and then rose dramatically in the 2nd and 3rd years after the spouse's diagnosis. Total all-cause direct health-care costs increased during the years leading up to PD diagnosis and were highest in the years following diagnosis, with PD-related costs contributing ~20-30% of the total. PD has both a significant direct and indirect financial burden on patients and their spouses when analyzed for 3 years before and after diagnosis.

Clinical and Economic Burden of Systemic Lupus Erythematosus in the Years Preceding End-Stage Kidney Disease Diagnosis: A Retrospective Observational Study.

This study aimed to describe the clinical burden, healthcare resource utilisation (HCRU) and healthcare costs for patients with systemic lupus erythematosus (SLE) in the 12-60months preceding an end-stage kidney disease (ESKD) diagnosis in the USA. This retrospective observational study identified adult patients with SLE with newly diagnosed ESKD between 1March 2012 and 31December 2018 using administrative claims data. Clinical characteristics, mean all-cause HCRU (i.e. any HCRU visit and pharmacy fill) and total all-cause healthcare costs (comprising medical and pharmacy costs in 2019 US dollars) were assessed during the 12months pre-ESKD diagnosis and yearly during the 5years pre-ESKD diagnosis among patients with ≥ 5years of continuous health plan enrolment. Of the 1356 patients included, 51.2% had severe SLE, 71.2% had lupus nephritis (LN) and 20.6% underwent kidney biopsy during the 12months pre-ESKD. The mean (standard deviation [SD]) number of HCRU visits during the 12months pre-ESKD was 78.0 (64.1) per patient. The mean (SD) total healthcare costs per patient in the 12months pre-ESKD diagnosis was $64,887 (106,822), driven by medical costs $51,764 (96,458). The proportions of patients with severe SLE, LN and those undergoing biopsy increased from year5 to year1 pre-ESKD diagnosis. The mean (SD) number of HCRU visits increased from year5 (61.6 [54.0]) to year1 (83.2 [62.1]) pre-ESKD. Mean (SD)total healthcare costs rose year on year from year5 ($34,890 [74,346]) to year1 ($73,236 [114,584]) pre-ESKD. There were substantial clinical burden and healthcare costs among patients with SLE in the 12months pre-ESKD diagnosis. The clinical burden and healthcare costs generally increased with each year approaching ESKD diagnosis. Early interventions for patients with SLE could prevent the development of ESKD, mitigating the burden of the disease.

Healthcare Resource Utilization and Costs of Rivaroxaban Versus Warfarin Among Non-valvular Atrial Fibrillation (NVAF) Patients with Diabetes in a US Population.

The healthcare resource utilization (HRU) and costs of oral anticoagulant-naïve patients with non-valvular atrial fibrillation (NVAF) and diabetes initiated on rivaroxaban or warfarin in the United States (US) has not been previously evaluated. This retrospective study used data from the Optum's de-identified Clinformatics® Data Mart Database (1 January, 2012 to 30 September, 2021) to evaluate the HRU and costs of adult patients with NVAF and diabetes newly initiated on rivaroxaban or warfarin (on or after January 2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs (USD 2021) were assessed per patient-year (PPY) post-treatment initiation. Weighted cohorts were compared using rate ratios (RR) from Poisson regression models, odds ratios (OR) from logistic regression models, and cost differences; 95% confidence intervals (CI) and p values were generated using non-parametric bootstrap procedures. After IPTW, 17,881 and 19,274 patients initiated on rivaroxaban and warfarin were included, respectively (mean age: 73years; 40% female). During 12months of follow-up, the rivaroxaban cohort had lower all-cause HRU PPY across all components, including lower rates of inpatient stays (RR: 0.84, 95% CI 0.81, 0.88), outpatient visits (RR: 0.67, 95% CI 0.66, 0.68), and 30day hospital readmission (OR: 0.75, 95% CI 0.66, 0.83; all p<0.001) compared to the warfarin cohort. Moreover, rivaroxaban was associated with medical cost savings PPY (mean cost difference: -$9306, 95% CI -$11,769, -$6607), which compensated for higher pharmacy costs relative to warfarin (mean cost difference: $5518, 95% CI $5193, $5839), resulting in significantly lower all-cause total healthcare costs for rivaroxaban versus warfarin (mean cost difference: -$3788, 95% CI -$6258, -$1035; all p<0.001). Among NVAF patients with diabetes in a real-world US setting, rivaroxaban was associated with lower healthcare costs compared to warfarin.

SA8 Impact of the COVID-19 Pandemic on Health Care Resource Utilisation and Costs in COPD in England: A Population-Based Study

Delivery of medical care for chronic diseases has been disrupted by the COVID-19 pandemic. We describe all-cause and COPD-related healthcare resource utilisation (HCRU) and costs among patients with COPD during the initial period of the COVID-19 pandemic in England. This was a retrospective dynamic cohort study of English COPD patients (FEV1/FVC<0.7) aged ≥35 years, for the period from Mar 2018 until Aug 2020 using primary care and linked hospital data. We assessed monthly all-cause and COPD-related HCRU and total direct healthcare costs over the study period and compared the months of the early pandemic (April–Aug 2020) to prior years. In total, 119,512 COPD patients were included (mean [SD] age: 69.6 [10.6] years, 54.1% males). Mean monthly all-cause face-to-face primary care, secondary care outpatient, and inpatient attendances were lower in April 2020 compared with April 2019, with reductions of 62.8%, 38.5%, and 57.1%, respectively. Mean monthly all-cause telephone primary care consultations increased 211.1% between April 2019 and April 2020. Mean total all-cause healthcare costs were 25.4% lower in April 2020 compared with April 2019. Mean monthly COPD-related face-to-face primary care, secondary care outpatient and hospital attendances, were lower in April 2020 compared with April 2019, with reductions of 78.9%, 25.0% and 60.0%, respectively. Mean monthly COPD-related telephone primary care consultations increased 300.0% between April 2019 and April 2020. Mean total COPD-related healthcare costs were 44.4% lower in April 2020 compared with April 2019. The levels of healthcare interactions following April 2020 did not return to pre-pandemic levels by the end of the observation period. All-cause and COPD-related primary care and secondary care outpatient attendances and hospital admissions decreased among patients with COPD during the COVID-19 pandemic. Telemedicine became a more frequently used channel for accessing healthcare during the early pandemic for COPD patients. Funding: GSK (214629).

Comparison of utilization and cost of healthcare services and pharmacotherapy following implantation of vagus nerve stimulation vs. responsive neurostimulation or deep brain stimulation for the treatment of drug-resistant epilepsy: analyses of a large United States healthcare claims database

Aim Vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) all are options for drug-resistant epilepsy (DRE). However, little is known about how the choice of neurostimulation impacts subsequent healthcare costs. Materials and methods We used a large US healthcare claims database to identify all patients with epilepsy who underwent neurostimulation between 2012 and 2019. Eligible patients were identified and stratified based on procedure received (VNS vs. RNS/DBS). VNS patients were matched by propensity scoring to RNS/DBS patients. Use and cost of healthcare resources and pharmacotherapy were ascertained over the 24-month period following neurostimulation, incorporating all-cause and epilepsy-related measures. Disease-related care was defined based on diagnoses of claims for medical care and relevant pharmacotherapies. Results Seven hundred and ninety-two patients met all selection criteria. VNS patients were younger, were prescribed a higher pre-index mean number of anti-seizure medications (ASMs), and had higher pre-index levels of use and cost of epilepsy-related healthcare services. We propensity matched 148 VNS patients to an equal number of RNS/DBS patients. One year following index date (inclusive), mean total all-cause healthcare costs were 50% lower among VNS patients than RNS/DBS patients, and mean epilepsy-related costs were 55% lower; corresponding decreases at the two-year mark were 41% and 48%, respectively. Limitations Some clinical variables, such as seizure frequency and severity, quality of life, and functional status were unavailable in the database, precluding our ability to comprehensively assess differences between devices. Administrative claims data are subject to billing code errors, inaccuracies, and missing data, resulting in possible misclassification and/or unmeasured confounding. Conclusions After matching, VNS was associated with significantly lower all-cause and epilepsy-related costs for the two-year period following implantation. All-cause and epilepsy-related costs remained statistically significantly lower for VNS even after costs of implantation were excluded.

Health Care Resource Utilization and Costs of CAR T Therapy in Patients with Large B-Cell Lymphoma: A Retrospective US Claims Database Analysis

Introduction: Despite its association with promising clinical outcomes, chimeric antigen receptor T-cell (CAR T) therapy may not be a feasible treatment option for some patients with relapsed or refractory large B-cell lymphoma (LBCL). Although more patients have been referred to CAR T therapy in recent years, many patients are still not treated due to anticipated costs and logistical challenges, particularly in the community setting (Gajra et al, Immunotherapy 2020). Because of long manufacturing times, patients often require bridging therapy prior to CAR T and a subset of patients die on bridging therapy without ever receiving CAR T (Chow et al, Am J Hematol 2020). Furthermore, more than one-half of patients relapse within 1 year of receiving CAR T therapy (Spiegel et al, Blood 2021). It is important to understand the clinical and economic burden associated with CAR T therapy. We assessed health care resource utilization (HCRU) and all-cause health care (medical and medication) costs from 30 days prior to through 90 days after infusion with tisagenlecleucel or axicabtagene ciloleucel CAR T therapy in patients with diffuse large B-cell lymphoma (DLBCL), the most common non-Hodgkin lymphoma (NHL) subtype, or primary mediastinal large B-cell lymphoma (PMBCL), another aggressive NHL subtype. Methods: This observational, retrospective cohort study analyzed MarketScan (IBM, Armonk, NY) administrative claims data for adult patients with DLBCL and PMBCL who received CAR T infusion therapy between October 1, 2017 and March 31, 2021, and who had continuous enrollment 6 months before and at least 90 days after the CAR T treatment date (index date). Those with mantle cell lymphoma or follicular lymphoma were excluded. Hospital length of stay (LOS) and HCRU from 30-days prior to 90-days post-infusion for inpatient and outpatient hospital visits and other facility visits were examined. All-cause medical, medication, and health care costs per patient were reported in 2021 US dollars. Results: A total of 106 patients (DLBCL, n=92; PMBCL, n=14) who received CAR T therapy (mean age, 55 years; men, 59%; commercial payer, 87%; CAR T brand information available, n=20 patients) were included in the analysis. A majority of patients (78 [74%]) had at least 5 outpatient hospital visits in the 30 days prior to CAR T therapy. Many were reported as having received bridging and/or lymphodepletion treatment prior to CAR T infusion (81 [76%]). CAR T therapy was administered in an inpatient setting for 92 patients (87%) with a mean (SD) LOS of 18.4 (11.3) days and a mean (SD) cost of $341,217 ($245,564) within 90 days. Among those receiving CAR T inpatient, 41 (45%) had intensive care unit (ICU) admissions during their stay. In the 90 days post-CAR T infusion, most patients (92 [87%]) had at least 5 outpatient hospital visits. Subsequent inpatient admissions occurred in 30 patients (28%), with a mean (SD) LOS of 12 (12.44) days and a mean (SD) cost of $83,952 ($105,961) within 90 days after CAR T infusion. From 30 days prior to 90 days after infusion, the mean (SD) total all-cause health care costs per patient, including those associated with CAR T therapy, were $511,139 ($293,631) (Figure). Conclusions: While CAR T therapy may be a treatment option as LBCL patients progress, patients face a considerable clinical and economic burden. Both the HCRU prior to infusion and after infusion included frequent outpatient hospital visits. Additionally, in this analysis, inpatient hospitalizations were the primary driver of HCRU and costs of CAR T therapy. Most patients received CAR T therapy on an inpatient basis, requiring prolonged stays. Nearly half of patients were admitted to the ICU and more than a quarter experienced secondary inpatient stays. Costs associated with the logistically challenging CAR T therapy within a month leading up to the infusion and up to 3 months post-infusion are substantial, averaging half a million dollars per patient, indicating a significant burden, given that a majority of the patients relapse within a year. These findings underscore the need for an accessible, off-the-shelf, and efficacious therapeutic option for LBCL patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Healthcare Resource Utilization and Costs of Relapsed or Refractory Patients with Chronic Lymphocytic Leukemia or Small Lymphocytic Lymphoma Treated with Ibrutinib

Introduction: Chronic lymphocytic leukemia (CLL) is the most common type of leukemia among adults in the United States (US). First-line (1L) treatment includes targeted treatments like the Bruton's tyrosine kinase inhibitor ibrutinib. While treatment with ibrutinib can result in durable responses and improved survival, patients who progress while on ibrutinib have been shown to have a poor prognosis. However, there is currently limited literature describing the economic burden associated with ibrutinib failure. Therefore, this study was conducted to compare the healthcare resource utilization (HRU) and costs between patients with and without relapse/refractoriness (R/R) to ibrutinib in the US. Methods: Data from Optum Clinformatics DataMartTM (01/2007-03/2020) were used to identify adult patients with ≥2 medical encounters with a diagnosis code for CLL or small lymphocytic lymphoma (SLL) on different dates, ≥1 pharmacy claim for ibrutinib therapy as a single-agent or combination therapy (first dispensing was the index date), and ≥12 months of continuous enrollment pre-index date (baseline period). Patients with a diagnosis for mantle cell lymphoma or with evidence of anticancer therapy (antineoplastic, radiation, or cell therapy) during baseline were excluded. Patients were categorized as R/R to ibrutinib if they received treatment with another antineoplastic after switching/discontinuing ibrutinib; all remaining patients were considered not R/R to ibrutinib (i.e., remained on ibrutinib for the whole observation period, restarted ibrutinib, or discontinued ibrutinib treatment without initiating a different antineoplastic). Patients who died on ibrutinib or within 6 months of discontinuation without subsequent antineoplastic therapy were excluded. All-cause and CLL/SLL-related HRU and healthcare costs incurred from the index date to the earliest of death, end of data availability or insurance coverage were evaluated and then compared in the population R/R and not R/R to ibrutinib using adjusted rate ratios for HRU and adjusted cost differences for costs. P-value and 95% confidence interval (CI) were obtained from non-parametric bootstrap procedures. Results: Among 1,126 patients treated with ibrutinib, mean age was 72.5 years and 38.8% were female. Patients had a mean Quan-Charlson Comorbidity index of 3.4. Over 1.8 years of observation, patients treated with ibrutinib had mean (SD) 0.47 (0.80) all-cause inpatient stays, 0.67 (1.50) emergency room (ER) visits, and 28.4 (18.1) outpatient visits, resulting in $148,758 (77,099) per patient-year total all-cause healthcare costs. CLL/SLL-related HRU amounted to 0.37 (0.69) inpatient stays, 0.19 (0.48) ER visits, and 12.0 (10.8) outpatient visits, resulting in $29,079 (51,165) per patient-year CLL/SLL-related medical costs. A total of 207 patients were R/R to ibrutinib (mean age: 73.4 years; 40.1% female) and 919 were not R/R to ibrutinib (mean age: 72.3 years; 38.5% female). Over a mean observation of 2.4 years (R/R) and 1.8 years (not R/R), patients R/R to ibrutinib had significantly more all-cause inpatient stays (rate ratio [95% CI] = 1.92 [1.57, 2.37]; P<0.001), ER visits (1.81 [1.31, 2.61]; P<0.001), and outpatient visits (1.51 [1.38, 1.65]; P<0.001) than patients not R/R to ibrutinib (Table). This led to $16,427 (95% CI: 4,627, 28,103) significantly higher incremental all-cause healthcare costs per patient-year in the R/R cohort versus not R/R (P=0.006). Similarly, rates of CLL/SLL-related inpatient stays (rate ratio [95% CI] =1.91 [1.51, 2.40]; P<0.001), ER visits (1.93 [1.43, 2.66]; P<0.001), and outpatient visits (1.80 [1.62, 2.02]; P<0.001) were significantly higher among patients R/R to ibrutinib versus not R/R (Table). This resulted in $38,252 (95% CI: 30,505, 48,023) significantly higher incremental CLL/SLL-related medical costs per patient-year in the R/R cohort versus not R/R (P<0.001). Conclusions: In this US real-world study, patients with CLL who were treated with ibrutinib incurred substantial HRU and costs. This burden was shown to be even larger for patients who were R/R to ibrutinib, with CLL/SLL-related healthcare resource use being nearly twice higher for R/R compared to non-R/R patients. These findings highlight the unmet treatment need for patients with CLL who are R/R to ibrutinib. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Healthcare costs and utilization associated with pain among breast cancer survivors: a propensity score matched cohort study using SEER-Medicare data.

To assess healthcare costs and utilization of treatment-related pain among breast cancer survivors. A retrospective matched cohort study using Surveillance Epidemiology and End Results SEER-Medicare linked data was conducted. The study population included older breast cancer survivors continuously enrolled in Medicare parts A, B, and D in the baseline and 1-year follow-up periods. Survivors with pain were matched to survivors without pain using PSM. Incremental all-cause healthcare costs associated with pain were calculated using a two-part model. Incremental healthcare utilization of inpatient hospitalizations, ER, outpatient, and physician services were estimated using the negative binomial model. The study included 101,120 non-metastatic breast cancer patients between July 2007 and September 2013. The final analytical cohort after matching included 5891 survivors in both groups. The incremental annual all-cause total healthcare costs per patient were higher in survivors with pain as compared to survivors without pain (Δ = 4379.00 (95% CI: 4308.00-4448.80). The main cost drivers were hospitalizations at 71%, followed by ER at 16% and physician services at 9% for survivors diagnosed with pain. Annual all-cause healthcare resource utilization was also found to be higher in survivors with pain as compared to survivors without pain across all categories of use. Similar trends were observed when stratified by surgery type and subgrouped by pain type and pain-related costs. This study provided baseline data that can be used for future cost-effectiveness analysis studies and burden of illness studies. Treatment-related costs have a substantial burden on healthcare costs andthe utilization of Medicare.

Incremental Healthcare Cost Implications of Retreatment Following Ureteroscopy or Percutaneous Nephrolithotomy for Upper Urinary Tract Stones: A Population-Based Study of Commercially-Insured US Adults.

This study describes the incremental healthcare costs associated with retreatment among adults undergoing ureteroscopy (URS) or percutaneous nephrolithotomy (PCNL) for upper urinary tract stones (UUTS). The IBM® MarketScan® Commercial Database was used to identify adults aged 18-64 years with UUTS treated with URS or PCNL between January 2010 and December 2019. Patients had 12 months of continuous insurance coverage before (baseline) and after (follow-up) the first (index) procedure. The primary outcome was total all-cause healthcare costs measured over the 365-day follow-up period, not inclusive of index costs. Generalized linear models were used to estimate the incremental costs associated with retreatment within 90 (early) or 91-365 days post-index (later) relative no retreatment. The models adjusted for demographics, comorbidities, stone(s) location, treatment setting, procedural characteristics (eg, 1-step vs 2-step PCNL) and index year. Approximately 23% (27,402/119,800) of URS patients were retreated (82% had early retreatments). The adjusted mean total cost was $10,478 (95% CI: $10,281-$10,675) for patients with no retreatment, $25,476 (95% CI: $24,947-$26,004) for early retreatment ($14,998 incremental increase, p<0.01), and $32,868 [95% CI: $31,887-$33,850] for later retreatment ($22,391 incremental increase, p<0.01). Approximately 36% (1957/5516) of PCNL patients were retreated (78% had early retreatments). The adjusted mean total cost was $13,446 (95% CI: $12,659-$14,273) for patients with no retreatment, $37,036 [95% CI: $34,926-$39,145]) for early retreatment ($23,570 incremental increase, p<0.01), and $35,359 (95% CI: $32,234-$38,484) for later retreatment ($21,893 incremental increase, p<0.01). Retreatment during the first year following URS or PCNL was needed in 23% and 36% of patients, respectively, and was associated with an economic burden of up to $23,500 per patient. The high rate of retreatment and associated costs demonstrate there is an unmet need to improve mid- to long-term results in URS and PCNL.

Real-World Analysis of Treatment Patterns, Healthcare Utilization, Costs, and Mortality Among People with Biliary Tract Cancers in the USA.

IntroductionPeople with advanced biliary tract cancers (BTCs) have a 5-year survival of approximately 2% in the USA. Most cases are inoperable or require systemic treatment following surgery. This study adds to current literature by describing treatment patterns, healthcare resource utilization (HCRU), costs, and mortality among people with BTCs.MethodsAdults diagnosed with BTCs were identified in the Merative MarketScan administrative claims databases from 1 January 2016 to 30 June 2020. Descriptive analysis was used to measure treatment patterns (i.e., regimen types, therapy duration) during three lines of therapy (LOT). All-cause and disease-related HCRU and costs were measured per-patient-per-month (PPPM) during the entire follow-up and in each LOT. Mortality was reported among the subset linked to the National Death Index (NDI).ResultsThere were 2648 eligible people with BTCs [mean age 64.0 (standard deviation [SD] 12.4) years, 51.5% female, average follow-up 11.9 (SD 11.1) months]. Treatment was received by 56.3% (n = 1490), and 20.9% (n = 5534) and 7.1% (n = 187) moved on to a second and third LOT, respectively. The average treatment duration decreased across LOTs, from 3.8 (SD 3.1) months in LOT1 to 2.6 (SD 2.4) months in LOT3. Gemcitabine + cisplatin was the most common regimen in LOT1 (44.6%). Total all-cause mean healthcare costs PPPM increased after LOT1 (mean $21,517, $29,721, and $28,557, for LOT1, LOT2, and LOT3, respectively) and the majority (71.2%) were related to BTCs. Of people with BTCs linked to the NDI (n = 2168), 66.1% died and average time to death was 11.3 (SD 11.2) months.ConclusionsThese findings, showing a high rate of mortality, a decrease in treatment duration, and an increase in costs as people progress after LOT1, add recent data to current literature highlighting the unmet need for more effective treatment options for people with BTCs.

S823 The Impact of Treatment Switch Among Prevalent Patients With Crohn’s Disease Treated With a First-Line Biologic: A U.S. Retrospective Claims Database Study

Introduction: Treatment switching often occurs with biologic use among patients with Crohn’s disease (CD) and has been associated with worsened clinical symptoms and functional impairment. However, little is known about its impact on healthcare resource utilization (HRU) and costs. This study assessed the economic burden associated with treatment switching among adults with CD in the United States (US). Methods: Data from the IBM® MarketScan® Commercial Subset (10/01/2015-03/31/2020) were used to identify adult patients newly diagnosed with CD (at least 2 CD diagnoses at least 30 days apart) and that were treated with a first line biologic (prescription fill/injection) on or after their CD diagnosis. The index date was defined as the date of the first line biologic. Patients were classified into the switchers or non-switchers cohort based on whether or not they switched to another biologic or 5-aminosalicylic acid or immunomodulator during the 12-month study period after the index date. Mean time to treatment switch was estimated using Kaplan-Meier analyses. All-cause HRU and healthcare costs (2020 USD) during the study period were described and compared (unadjusted) overall and for the 2 cohorts. Results: Among 4,006 patients included in the study, 640 were switchers and 3,366 were non-switchers. Overall, mean age was 39.5 years and 50.9% were female. Rates of treatment switch were 7.1% at 6 months and 16.0% at 12 months (Figure). Additionally, rates of prolonged corticosteroid use (at least 90 days) was higher in switchers compared to non-switchers (31.6% vs 8.2%; p< 0.01). Switchers also had higher rates of inpatient admissions (25.9% vs 12.6%; p< 0.01), emergency department visits (41.6% vs 35.4%; p< 0.01), and number of outpatient visits (22.8 vs 17.0; p< 0.01) compared to non-switchers (Table). Similarly to HRU, total all-cause healthcare costs were higher among switchers than non-switchers ($95,689 vs $81,027; p< 0.01), which was mainly driven by higher medical costs ($24,135 vs $14,416; p< 0.01). Among age groups, switchers 30-39 years incurred the highest total cost ($100,676 vs 78,265, p< 0.01). Conclusion: In this real-world study, patients with CD who switched biologic treatments, which is a marker of inadequate treatment, incurred significantly higher HRU and healthcare costs. These findings suggest a potential unmet need with current treatment options and highlight the impact of switching biologics on the economic burden of patients with CD.Figure 1.: Kaplan-Meier analysis for time to switch CI: confidence interval Table 1. - All-cause HRU and healthcare costs incurred during the study period Number of patients, N Switchers (N=640) Non-switchers (N=3,366) All-cause HRU, N (%) Inpatient admission 166 (25.9%) 423 (12.6%) Inpatient days, mean ± SD [median] 2.5 ± 6.4 [0.0] 1.1 ± 4.6 [0.0] Emergency department visits 266 (41.6%) 1,192 (35.4%) Days with outpatient visits 639 (99.8%) 3,331 (99.0%) Number of days with outpatient visits, mean ± SD [median] 22.8 ± 17.0 [19.0] 17.0 ± 16.3 [13.0] Healthcare costs (2020 USD), mean ± SD [median] Total (medical + pharmacy) $95,689 ± $52,295 [$85,713] $81,027 ± $50,743 [$72,464] Medical $24,135 ± $39,519 [$9,434] $14,416 ± $33,575 [$4,847] Inpatient $11,491 ± $31,526 [$0] $5,279 ± $22,861 [$0] Outpatient $10,906 ± $17,172 [$5,956] $7,909 ± $17,732 [$3,687] Emergency department $1,738 ± $4,666 [$0] $1,228 ± $5,330 [$0] Pharmacy (including biologics) $71,554 ± $35,174 [$66,355] $66,611 ± $39,793 [$62,937] HRU: healthcare resource utilization; SD: standard deviation; USD: United States dollar.

Burden of chemotherapy in patients with relapsed/refractory acute myeloid leukemia in the United States: a retrospective claims database study

ABSTRACT Background Real-world estimates of relapsed or refractory (R/R) acute myeloid leukemia (AML) chemotherapy episode costs are scarce. We quantified chemotherapy episode–related costs and healthcare resource use (HRU) in R/R AML. Research Design and Methods This real-world, retrospective analysis of United States claims from IQVIA’s PharMetrics® Plus database (October 2008-September 2019) identified adults with R/R AML and ≥1 chemotherapy episode. Chemotherapy episode (ie, low- [LIC] or high-intensity [HIC] chemotherapy) costs and HRU were determined using inpatient, outpatient, and pharmacy claims. Results Mean (SD) and median total all-cause healthcare costs per R/R AML chemotherapy episode were $230,799 ($300,770) and $129,117. Mean (SD) and median adjusted direct R/R AML chemotherapy episode costs were $116,384 ($151,425) and $63,298, with increases noted from the first to the second and subsequent episodes and with HIC. Hospitalizations were the major cost driver; 64.1% of patients had ≥1 hospitalization and 36% required an intensive care unit stay. Conclusions R/R AML chemotherapy episode costs were high, with higher costs reported with HIC and increasing lines of chemotherapy. Hospitalizations were a main cost driver. Novel therapies with comparable or improved effectiveness and decreased need for hospitalizations versus chemotherapy may help alleviate the clinical and economic burden of R/R AML.

Economic and humanistic burden of ovarian cancer in the United States (392)

Economic and humanistic burden of ovarian cancer in the United States (392)

Healthcare resource utilization and costs in individuals with Huntington’s disease by disease stage in a US population

Aims To quantify healthcare resource utilization (HRU) and costs by disease stage in individuals with Huntington’s disease (HD) in a US population. Materials and methods This retrospective cohort study used administrative claims data from the IBM MarketScan Commercial, Multi-State Medicaid, and Medicare Supplemental Databases between 1 January 2009 and 31 December 2018. Individuals with an HD claim between 1 January 2010 and 31 December 2017 were selected. Index date was the date of first HD diagnosis. Individuals were required to have continuous enrollment for ≥ 12 months pre-index, 3 months post-index, and have no pre-index HD claims. All-cause HRU and costs per patient per month (PPPM) (overall and stratified by disease stage) were assessed for individuals with HD. Results A total of 2,669 individuals with HD were identified. Of these, 1,432 (53.7%), 689 (25.8%), and 548 (20.5%) had early-, middle-, and late-stage HD at baseline, respectively. Mean HRU PPPM by post-index HD stage increased with disease stage for outpatient visits, pharmacy claims, and HD-related pharmacy claims (p < 0.05 for all). Mean inpatient visits and emergency room visits PPPM were highest in individuals with middle-stage HD (p <0.05 for all). Mean total all-cause healthcare cost PPPM for individuals with HD was $2,889, and it was significantly higher in middle-stage individuals, at $7,988, compared with early- and late-stage individuals, at $3,726 and $5,125, respectively; p <0.0001. Limitations In the absence of disease staging information in administrative claims data, staging was based on the presence of clinical markers in claims. Our evaluations didn’t include the indirect costs of HD, which may be substantial as HD typically affects people at their peak earning potential. Conclusions HRU and costs of care are high among individuals with HD, particularly among those with middle- and late-stage disease. This indicates that the disease burden in HD increases with disease stage, highlighting the need for interventions that can slow or prevent disease progression.

Real-world healthcare resource utilization and costs among patients with multiple myeloma in the United States.

e18811 Background: The economic burden of multiple myeloma (MM) has been shown to increase with more advanced lines of therapy (LOTs). Given the rapidly evolving treatment landscape of MM, this study aimed to describe the current real-world healthcare resource use (HRU) and costs among patients with MM across LOTs. Methods: A commercial insurance claims database was used to identify patients with ≥2 MM diagnoses who initiated a LOT containing an antineoplastic agent for MM between 1/2016 and 2/2021, had continuous insurance coverage ≥6 months before and ≥60 days after first line (1L) initiation, and never received stem cell transplant. LOTs were defined based on agents used within a 60-day period. End of LOT was defined when patients switched treatment, or after a treatment gap of 90 days. HRU and costs (in 2021 USD) were reported for the duration of each LOT (from initiation of LOT to initiation of a subsequent LOT or end of coverage). Results: 1492 patients initiated 1L, 681 initiated 2L, 359 initiated 3L and 188 initiated 4L. Mean age at 1L initiation was 66.6 years. Mean duration of LOT (10.7, 9.4, 8.1 and 10.2 months in 1L, 2L, 3L and 4L, respectively) was longer in 1L than in subsequent LOTs. All-cause monthly outpatient (OP) and inpatient (IP) visits were stable across LOTs (5.0-5.6 OP visits; 0.21-0.32 IP visits). However, mean monthly all-cause costs were lowest in 1L (15.9% - 34.9% lower) as compared to subsequent LOTs ($23.6K in 1L, $29.7K in 2L, $27.3K in 3L and $31.8K in 4L; Table). Conclusions: In this study, the duration of LOT was the longest among 1L patients. Total all-cause healthcare costs were the lowest in 1L than in more advanced LOTs. This suggests that selection of 1L best treatment regimen upfront that prolongs time to disease progression could reduce the overall economic burden of MM.[Table: see text]

Healthcare Costs of Multiple Myeloma Patients with Four or More Prior Lines of Therapy, Including Triple-Class Exposure in the United States.

The treatment of multiple myeloma (MM) remains a challenge as patients eventually progress through several lines of therapy (LOTs), requiring use of multiple MM drug classes. In this retrospective US claims-database study, we examined the healthcare costs of patients with MM who received ≥ 4 prior LOTs, including triple-class exposure (TCE). Adult patients with MM were selected from the IBM MarketScan Commercial and Medicare claims databases (1 January 2012-30 June 2021). Eligible patients were required to have received at least four prior LOTs, and TCE (i.e., received a proteasome inhibitor, immunomodulatory drug, and anti-CD38-targeted monoclonal antibody) after the first-observed diagnosis of MM. The index date was defined as the initiation date of the first subsequent LOT after meeting the eligibility criteria for the study, and this date had to be after 1 January 2017 to capture contemporary cost estimates. The primary outcome measurements were all-cause and MM-related healthcare costs after the index date. The study population included 68 patients with MM (63% men), with a mean age of 59.8years. Mean duration from first-observed MM diagnosis until index date averaged 46.7months. During a mean follow-up of 21.9months, total all-cause healthcare costs averaged US$757,386 per patient (equivalent to US$34,610 per patient per month). MM-related healthcare costs (US$670,561 per patient) contributed on average 88.5% to the total all-cause healthcare costs; the majority (67.2%) of MM-related healthcare costs were attributed to drug and infusion costs (US$450,952 per patient). In this retrospective US claims-database study, patients with MM with ≥ 4 prior LOTs, including TCE, continued to experience high healthcare costs that were mostly attributable to anti-myeloma drugs and their administration.

Association between asthma control and healthcare costs: Results from a German linked data study.

Background: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.Methods: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACTTM questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACTTM score.Results: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACTTM score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACTTM score<20) Patients with uncontrolled asthma had significantly more hospitalizations (p = .035) and medication prescriptions (p < .001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; p = .004) and all-cause care (€4695 vs. €4117; p = .009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (p = .008), total asthma-related costs (p = .008), and costs of medication prescriptions (p = .001). However, no significant association was found for all-cause (p = .062) and asthma-related hospitalization costs (p = .576).Conclusion: Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden.