Analysis Of Resource Utilization Research Articles

Resource Use Efficiency Among Aerobic and Conventional Rice Farms in Eastern Dry Zone of Karnataka: A Comparative Analysis

The efficiency with which farmers use available resources is very important for agricultural production. This study examines the comparative resource use efficiency (RUE) between aerobic and conventional rice farms in Eastern Dry Zone (Zone-5) of Karnataka. Cross-sectional data were collected from 100 rice cultivating farmers (50 in Aerobic farms and 50 in Conventional farms) using snow ball sampling technique. Cobb-Douglas production function, Marginal analysis of resource utilization, Data Envelopment Analysis (DEA) were some of the analytical tools used in the study. The mean aerobic farm size was 0.43 ha while in Conventional rice, it was 0.63 ha. The physical water use efficiency (WUE) in aerobic farms (3.84 q/acre inch) was higher than conventional farms (1.64 q/acre inch). Also, the economic WUE was higher in aerobic farms (1643.54 `/acre inch) compared to conventional farms (269.41 `/acre inch). RUE indicated that, resources were not optimally utilized in both Aerobic Rice Cultivation (ARC) and Conventional Rice Cultivation (CRC). Bullock labour, machine labour, seeds and irrigation were underutilized in ARC, whereas, FYM was underutilized in CRC indicating that usage of additional amount of these inputs leads to increase in the returns. The DEA revealed that aerobic rice cultivating farms were more technically and economically efficient compared to conventional rice cultivating farms. Effective policies to promote and create awareness about aerobic rice can boost the rice production and productivity sustainably. The focus should be given to optimal allocation of resources which enhances the farm productivity and returns

Structural path decomposition analysis of resource utilization in China, 1997–2017

With the ever-increasing population and rapid economic development in China, the demand for natural resources has grown substantially. To improve the efficient utilization of resources, it is necessary to know comprehensively the flow and use of natural resources among sectors. The paper uses the environmentally extended input-output analysis (EEIOA) and structural path analysis (SPA) methods to conduct a depth analysis of the flow and use paths of resource consumption in China from 1997 to 2017 in 42 sectors to determine the key supply chains and key sectors, and we also apply the structural path decomposition (SPD) method to investigate the key path changes that drive resource consumption and the key factors that lead to consumption changes in each path. The results show that the crucial supply chain path for the largest resource consumption was “Manufacture of non-metallic mineral products →Construction”, and the flow increased from 1371 million tons in 1997 to 8173 million tons in 2017, the factor production structure was the major driving factor for consumption increase on this path. In addition, the proportion of resources consumed by the agricultural sector decreased during the research period, and consumption intensity was the main driving factor for its consumption decrease. In order to reduce domestic resource consumption as much as possible, policymakers can start with the construction sector to improve the efficient utilization of resources and adjust production structure.

A Geographical Analysis of Resource Utilization and Its Impact on Landuse Pattern in Perambalur District Using Geo-Spatial Technology

The objectives of this paper are to simulate the location of the land use change due to the open mining activities from the cement industries. In this study first we estimate the existing land use distribution with the help of remote sensing data. Remote sensing technology reduces cost and time to a great extent with better accuracy to that of conventional surveying. To analysis the land cover above the sand stone with lime stone and clay as shown in the geology map and overlay this region on the land use map and crop the region and estimation given land use area going for the open mining in the study area. The existing land use, its spatial distribution and changes are essential pre-requisite for planning and land management strategies hold key for development of any region. The study of land use is necessary for proper utilization of land resources of a region.

Managing Acute Myeloid Leukemia in Older Patients: Are We Making Progress? An Analysis of Treatment Patterns and Healthcare Resource Utilization

▪BACKGROUND: Despite advances in the understanding of disease pathogenesis, improved treatment strategies, and evidence of better survival with treatment, a large proportion of older patients (pts) with acute myeloid leukemia (AML) remains untreated and has poor outcomes. The aim of this study is to describe current treatment patterns in pts with AML aged <60, 60-64, and ≥65 years (yrs), and assess healthcare resource utilization (HRU) in pts with AML aged <65 and ≥65 yrs in a real-world claims database.METHODS: AML pts were retrospectively identified in the MarketScan® Research Database (Truven Health) including both Commercial and Medicare Supplemental claims databases between 01/2011 to 07/2016. Pts with ≥2 AML diagnoses, ≥1 bone marrow procedure (the first AML diagnosis following the procedure was defined as the index date), and ≥12 months of continuous eligibility (baseline period) prior to the index date were included. Exclusion criteria were ≥1 diagnosis for AML relapse or remission on or before the bone marrow procedure, ≥2 diagnoses for another blood cancer, and ≥1 allogeneic hematopoietic stem cell transplantation before the bone marrow diagnosis procedure. Furthermore, pts aged ≥65 yrs at the index date were excluded if they had ≥1 claim for intensive chemotherapy at any time. The observation period spanned from index date up to the first of health plan disenrollment or the end of data availability. To accommodate different age cut-offs in accordance with National Comprehensive Cancer Network treatment guidelines, top treatments (excluding hormonal therapy agents) received post-AML diagnosis were reported in pts aged <60, 60-64, and ≥65 yrs. Listings that lacked codes for specific chemotherapy agents, but offered adequate International Classification of Diseases codes were included and reported as “unknown antineoplastic agents”. HRU, including days of hospital stay, days with outpatient services, days with emergency room visits, days with hospice care, and days with durable medical equipment use, was evaluated in pts <65 and ≥65 yrs old. To account for varying length of follow-up among pts, HRU was reported per patient per month.RESULTS: After applying the selection criteria, 2,954 AML pts were identified: 1,492 pts ≥65 yrs old (mean [SD] age: 76.8 [7.0]; 36.6% were ≥80 yrs old; mean [SD] follow-up: 212 [255] days) and 1,462 pts <65 yrs old (mean [SD] age: 51.8 [11.5]; mean [SD] follow-up: 350 [350] days), including 468 (32.0%) aged 60-64 yrs and 994 aged <60 yrs. Pts <60 yrs old received the most therapeutic interventions (i.e., ≥1 antineoplastic agent, ≥1 blood transfusion, or ≥1 hematopoietic stem cell transplant), followed by pts 60-64 and pts ≥65 yrs old (Fig. 1). Type of antineoplastic agents (excluding hormonal therapy agents) received varied by age group with “other antineoplastic agent” (other than HMAs and excluding hormonal therapy agents) and “unknown antineoplastic agent” more commonly used in younger pts. Hypomethylating agents (HMAs) were more commonly used in older pts (Fig. 1). In pts aged <60, 60-64, and ≥65 yrs treated with ≥1 HMA, azacitidine was given in 56.2%, 59.8%, and 55.7% of pts and decitabine was given in 50.5%, 47.1%, and 51.2%, respectively. In pts <60 yrs who received “other antineoplastic agents”, tretinoin (31.2%), cytarabine (30.6%), and arsenic trioxide (22.4%) were most commonly used. Pts 60-64 yrs old received cytarabine (30.7%), hydroxyurea (20.5%), and tretinoin (17.3%) as most common agents. Pts ≥65 yrs old received most commonly hydroxyurea (53.4%) and cytarabine (14.3%). Post-AML diagnosis, pts ≥65 yrs old had half the monthly all-cause average number of inpatient days compared to pts <65 yrs old (mean [SD]: 3.74 [5.28] vs. 7.74 [7.14]). Differences in the number of days with outpatient services (mean [SD]: 5.64 [4.62] vs. 5.27 [4.25]) or emergency room visits (mean [SD]: 0.22 [0.52] vs. 0.10 [0.30]; Fig. 2) were smaller.CONCLUSION: This study revealed that >40% of older AML pts (≥65 yrs) did not receive any antineoplastic therapy. This group also had fewer inpatient days compared to younger AML pts (<65 yrs old). These results show that despite medical advances, a large proportion of older AML pts remains either untreated or undertreated, revealing important unmet needs and suggesting that AML treatment has to face a much-needed expansion to improve disease management in this population. [Display omitted] DisclosuresLafeuille:Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd: Research Funding; Janssen Scientific Affairs, LLC: Research Funding. Sundaram:Johnson & Johnson, LLC: Equity Ownership; Janssen: Employment. Hoehn:Janssen: Employment; Johnson & Johnson, LLC: Equity Ownership. Emond:Janssen Scientific Affairs, LLC: Research Funding. Romdhani:Janssen Scientific Affairs, LLC: Research Funding. Lefebvre:Janssen Scientific Affairs, LLC: Research Funding.

Economic Burden of Treatment Episodes in Acute Myeloid Leukemia (AML) Patients in the US: A Retrospective Analysis of a Commercial Payer Database

Background:AML, a clonal disorder of hematopoietic stem cells, is estimated to affect 21,380 new U.S. patients in 2017. Detailed real-world cost estimates and comparisons of key AML treatment episodes such as high intensity chemotherapy (HIC), low intensity chemotherapy (LIC), hematopoietic stem cell transplant (HSCT) and relapsed-refractory (R/R) patient episodes in the US commercially insured population are scarce and difficult to assemble. This analysis examined the healthcare resource utilization and direct healthcare costs in various AML treatment episodes.Methods:Using a large US healthcare claims database (PharMetrics Plus™) and linked charge detail master (CDM) hospital data, incident adult patients with ≥ 2 outpatient or ≥ 1 inpatient claim with an AML diagnosis between 1/1/2008 and 3/31/2016 were identified. To assure adequate data capture, patients were required to have continuous health plan enrollment for ≥ 6 months pre and ≥ 3 months post the first diagnosis date. Episodes evaluated include HIC induction (evidence of inpatient high dose cytarabine+anthracycline use within 3 months of diagnosis), HIC consolidation (evidence of cytarabine +/- anthracycline use within 2 months following prior HIC), LIC (evidence of low-intensity cytarabine, anthracycline, 5-azacytidine, decitabine, clofarabine , hydroxyurea or gemtuzumab ozogamicin in the outpatient setting within 3 months of diagnosis), HSCT (transplant specific diagnosis/procedure codes) and R/R patients (record of an ICD-9 diagnosis code (205.02) for relapsed AML after a prior treatment of HIC, LIC, or HSCT). Patients could contribute to more than one study episode, except HIC induction and LIC, which were mutually exclusive episode groups. Healthcare resource utilization and cost accrual began with treatment episode initiation and ended with initiation of a different AML care episode (active treatment or secondary supportive care) or end of follow-up. All cost and length of episode data are reported as mean (SD), at the population level.Results:The final study sample consisted of 1,542 HIC induction (mean age 47.0 years), 591 consolidation (mean age 47.0 years), 628 LIC (mean age 64.9 years), 1,000 HSCT (mean age 51.4 years) and 119 R/R patients (mean age 56.3 years). Total mean (SD) episode cost was highest in HSCT $329,621 ($288,707) with mean follow-up of 6.4 months; followed by HIC induction ($198,528 ($190,757)) with mean follow-up of 2.1 months; R/R cost of $145,634 ($213,724) with mean follow-up of 7.6 months; and HIC consolidation cost of $73,304 ($72,812), mean follow-up 1.5 months (Table 1). The episode cost was the lowest in LIC at $53,081($56,715), 2.0 month follow-up. For HSCT, hospitalization costs were $244,801 ($247,492), while physician office visit costs accrued at $6,017 ($12,809) and outpatient pharmacy costs of $11,398 ($25,996); 26.9% of patients had at least one emergency room (ER) visit that did not lead to hospital admission at a cost of $1,037 ($10,877). All HIC induction required hospitalization and accounted for the most of the HIC cost $178,891 ($294,500), with $2,843 ($3,831) attributed to physician's office visits and $2,868 ($4,574) for outpatient pharmacy; 28.6% had ER visit at a cost of $331 ($2,514). Hospitalization occurred in 74.8% of R/R patients at a cost of $101,420 ($185,548); physician's office visits and outpatient pharmacy costs were $3,340 ($3,872) and $6,108 ($11,348), respectively; 38.7% of patients had at least one ER visit at a cost of $683 ($1,900). For HIC consolidation episodes, hospitalization was the most costly component at $55,301 ($67,139), with $999 ($1,243) for physician's office visits and $2,269 ($4,043) for outpatient pharmacy; 26.1% had ER visit at a cost of $267 ($1,416). Although LIC patients had a relatively low hospitalization rate (35.8%), hospitalization was a major cost component at $17,764 ($43,614); while physician's office visit costs were $1,478 ($2,390) and outpatient pharmacy costs were $2,554 ($4,996), and 27.7% of patients had at least one ER visit at a cost of $340 ($1,214).Conclusions:This resource utilization and direct healthcare cost analysis establishes a substantial economic burden associated with various AML treatment episodes, notable during the HIC induction, HSCT and R/R episodes in the US. Hospitalization is a major cost driver across all episodes. New therapeutic strategies associated with less economic burden are needed. [Display omitted] DisclosuresPandya:Astellas Pharma Global Development: Employment. Chen:QuintilesIMS: Employment. Groves:QuintilesIMS: Employment. Bui:Astellas Pharma Global Development: Employment. Horvath:Astellas Pharma Global Development: Employment. Wade:QuintilesIMS: Employment.

Real-world analysis of patient characteristics, treatment outcomes, and healthcare resource utilization across Europe in patients with newly diagnosed multiple myeloma ineligible for stem cell transplantation who received lenalidomide- or bortezomib-based regimens

We aimed to compare real-world outcomes, resource use, and costs for patients with newly diagnosed multiple myeloma (NDMM) treated with continuous first-line (1 L) lenalidomide or fixed bortezomib in Europe. We performed a multicenter, retrospective, observational chart review of transplant-ineligible NDMM patients across 7 countries. Of 453 eligible patients, 220 received 1 L lenalidomide-based regimens; 105 (47.7%) received second-line (2 L) treatment, of which 50 (47.6%) received 2 L bortezomib. 233 patients received 1 L bortezomib-based regimens; 142 (60.9%) had 2 L treatment, of which 104 (73.2%) received 2 L lenalidomide. Patients receiving 1 L lenalidomide-based regimens had better progression-free survival than patients receiving 1 L bortezomib-based regimens (p = .002) and a longer time to 2 L or third-line treatment (both p < .05). Total treatment-associated monthly costs for patients receiving 1 L lenalidomide-based regimens (n = 171, €2,268.55) were significantly greater than for 1 L bortezomib-based regimens (n = 188, €1,724.77) (p < .001) over the follow-up period (median, 38.7 months).

Quantitative analysis of density dependent resource utilization, cannibalism, and competition of the red swamp crayfish (Procambarus clarkii) in rice-crayfish cocultures without supplementary food

A 90-day, integrated rice-crayfish coculture experiment using net enclosures (8 m × 10 m each) was performed to determine resource utilization, cannibalism, and inter-sexual competition in the red swamp crayfish (Procambarus clarkii) at four stocking densities (4 ind/m2, 6 ind/m2, 9 ind/m2, and 12 ind/m2). The results were as follows: (1) With increasing stocking density of crayfish, the relative contribution of animal feed sources to male and female crayfish diets initially decreased and then increased, whereas the contributions of plant feed sources and detritus as a feed source initially increased and then decreased. There was no significant difference in the diets of female and male crayfish between 4 ind/m2 and 12 ind/m2; plants (> 50%) were predominant, followed by animal feed (> 20%), cannibalism (~ 18%), and detritus (> 6%). At 6 ind/m2 and 9 ind/m2, the contributions of feed sources for both male and female diets were as follows: plants (> 60%), animal feed (> 15%), detritus (> 10%), and cannibalism (< 8%). The trophic and spatial niche area per individual unit (SEA/density, SEA·m2/ind) of female and male crayfish decreased as stocking density increased. (2) With increasing stocking density, the contribution of cannibalized feed sources to crayfish initially decreased (from 4 ind/m2 to 6 ind/m2) and then increased (from 6 ind/m2 to 12 ind/m2). The SEA f,m (representing the similarity of diets between female and male crayfish and, therefore, the potential for inter-sexual competition) initially increased with stocking density (from 4 ind/m2 to 9 ind/m2) and then decreased (from 9 ind/m2 to 12 ind/m2). This indicated that cannibalism might reduce the competition between sexes for natural resources. (3) Based on the high trophic and spatial niche area per individual unit (SEA·m2/ind; female = 0.37 and male = 0.88), low contributions of cannibalized feed sources (female = 5.88 ± 2.62% and male = 7.97 ± 3.44%), and low degree of inter-sexual competition (SEA f,m = 0.25), 6 ind/m2 (crayfish tail weight 9.60 g) was identified as the optimal stocking density for P. clarkii in rice fields without supplementary artificial feed.

Abstract No. 467 Analysis of healthcare cost and resource utilization associated with thermal ablation of renal cell carcinoma

To compare hospital expenditures and resource utilization associated with radiofrequency (RFA), cryoablation (CA), and microwave (MWA) for cT1N0M0 renal cell carcinoma (RCC) A retrospective evaluation was conducted in 470 of computer tomography (CT)-guided thermal ablations of biopsy-proven RCC treated with between October 2006 and June 2019. Components of direct and indirect costs were tabulated and compared across the three different ablation modalities. Deterministic sensitivity analysis was performed to evaluate the effect of the individual cost components in the overall cost of ablative treatment. In-hospital resource utilization incurred from the start of the procedure to 30 days after hospital discharge was examined for each ablative technique. Continuous variables were analyzed using the one-way ANOVA test, and categorical variables were analyzed using Pearson’s chi-squared test and the Kruskal-Wallis test. A total of 470 T1N0M0 RCCs with a mean size of 3.2 cm (range, 0.5–6.9 cm) were treated with MWA (n = 86, 18%), RFA (n = 344, 73%) or CA (n = 40, 9%). Baseline patient or tumor characteristics did not differ significantly between the three groups. The median cost of MWA was significantly lower than that of RFA and CA with a cost advantage of $3835 and $2714, respectively (P = 0.0001). The number of ablation probes used was a major determinant of the overall cost, and MWA used the least number of probes (P = 0.0001). Additionally, MWA was associated with the lowest utilization of procedure room time, anesthesia medications, and radiation dose when compared to RFA and CA (P = 0.001, P = 0.001, and P = 0.001, respectively). Hospital spending and resource utilization in the 30 days immediately after the procedure are similar among the three ablative techniques. Microwave ablation is associated with lowest procedural costs and resource utilization compared to RFA and CA for the treatment of T1 RCC. These findings may incentivize wider use of MWA to optimize value-based care in ablation practice.

Resource Efficient Deployment and Data Aggregation in Pervasive IoT Applications (Smart Agriculture)

Aims: Internet of Things (IoT) is the evolution of the Internet designed to sense, collect, analyze and distribute the data via IoT devices that form its core component. An important aspect of pervasive IoT applications is its resource-constrained devices. Most of the real-time Edge-IoT applications generate a huge amount of data, which add to the resource consumption in these devices. To save resources in such applications, efficient node deployment and data aggregation techniques can be used. This paper presents the design and modeling of node deployment and data aggregation in Edge-IoT applications along with the homogeneous and heterogeneous network scenarios for smart agriculture. Objectives: To save resources in such applications, efficient node deployment and data aggregation techniques can be used. This paper presents the design and modeling of node deployment and data aggregation in Edge-IoT applications along with the homogeneous and heterogeneous network scenarios for smart agriculture. Methods: For heterogeneous scenarios, we propose a clustering approach, Superior Aggregator Resource Efficient Clustering (SAREC), to address the resource constraints in pervasive Edge-IoT applications. The comparison of homogeneous and heterogeneous networks is based on LEACH and SAREC protocols, respectively. Results: The results show that SAREC is 25% more efficient in energy utilization and network lifetime than LEACH. The results also show that SAREC is more efficient in terms of storage and processing time as compared to LEACH. Conclusion: Node deployment is an important aspect in determining the architecture, which plays an important role in resource management in pervasive applications of IoT. The IoT nodes are distributed in a selected geographical location and the topology of the network is pre-decided to form an Edge-IoT network. In such an environment, the nodes are deployed to sense, aggregate and analyze the data. This paper presents a pervasive Edge-IoT network along with the mathematical modeling consisting of deployment and aggregation models. An Edge-IoT network for smart agriculture has been deployed and analysis of resource utilization has been performed in homogeneous and heterogeneous scenarios of the network. The resource limitations in pervasive IoT network motivated us to develop a SAREC approach for such Edge-IoT applications that optimizes the use of resources. The comparison of the proposed SAREC protocol is made with respect to LEACH protocol on the basis of energy, network lifetime, number of alive nodes, storage and processing time. The results show that SAREC protocol is 25% more efficient in energy utilization and network lifetime than LEACH. It is also evident from the results that the SAREC is more efficient in terms of storage and processing time as compared to LEACH.

Clinical outcomes and resource utilization analysis in patients with rheumatoid arthritis undergoing endoscopic retrograde cholangiopancreatography.

Background and AimThe literature is lacking on associations of endoscopic retrograde cholangiopancreatography (ERCP) related outcomes in rheumatoid arthritis (RA) patients. The aim of this study is to evaluate the effects of RA on clinical outcomes and hospital resource utilization in patients undergoing ERCP.MethodsThe National Inpatient Sample database was used to identify hospitalized patients who had underwent an ERCP study from 2012 to 2014 using International Classification of Diseases‐Ninth Edition (ICD‐9) codes. Primary outcomes were mortality, hospital charges, and length of stay. Secondary outcomes were ERCP‐related complications. Chi‐squared tests for categorical data and independent t‐test for continuous data were utilized. Multivariate analysis was performed to assess the primary outcomes.ResultsThere was 83 890 ERCP procedures performed, of which 970 patients had RA. In patients with RA, 74.2% were female, and the average age was 65.7 years. RA primary outcomes of mortality rate and hospital cost were lower and statistically significant. There was no statistically significant difference in secondary outcomes except for lower cholecystectomy rates in RA patients.ConclusionWith a high inflammatory state, it was hypothesized that RA would be associated with worse outcomes after ERCP. Yet, the primary outcomes of mortality and hospital cost were found to be lower than controls, with no difference in secondary outcomes. We posit that immunosuppressants used to treat RA provides a protective effect to overall complications with ERCP.

Catheter Ablation for Hospitalized Atrial Fibrillation Patients with Reduced Systolic Function: Analysis of Inpatient Mortality, Resource Utilization and Complications.

Randomized trials have shown improvement in hard clinical end points when catheter ablation (CA) is employed as a management strategy for certain atrial fibrillation (AF) patients with heart failure and reduced ejection fraction (HFrEF). Limited data, however, exist in this realm outside the controlled clinical trial settings. We sought to determine real-world data on mortality and complications after utilization of CA in such patients. Data were derived from National Inpatient Sample from January 2008 to August 2015. Patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Baseline characteristics and outcomes were compared among HFrEF and AF patients undergoing CA or not. Propensity matching was done to mitigate selection bias and balance confounding variables. Various CA related complications were assessed. Logistic regression was done to determine predictors of mortality in our study cohort. A total of 2,569,919 patients were analyzed and a total of 7773 patients underwent CA. Mortality was significantly better in CA group in both unmatched (1.2% vs. 4.9%, p < 0.01) and propensity matched cohorts (1.2% vs. 3.6%, p < 0.01). Overall complication rate was 10.2% in CA cohort and primarily driven by cardiac and neurological etiologies. In regression analysis, CA remained a strong predictor of reduced mortality (OR 0.301, 95% CI 0.184-0.494). CA is associated with improved mortality in admitted AF patients with concomitant HFrEF. Overall complication rate after CA was modest at 10.2%. Consideration can be given to the utilization of this therapeutic modality in hospitalized AF patients with concomitant HFrEF.

Longitudinal Analysis of Anemia Severity, Treatment and Healthcare Resource Utilization Among Patients with Primary Cold Agglutinin Disease in a Large US Database

Introduction Cold agglutinin disease (CAD) is a serious and rare autoimmune hemolytic anemia driven by cold agglutinin autoantibodies, which bind to red blood cells and activate the classical complement system to initiate hemolysis and anemia (Berentsen S. Hematology Am Soc Hematol Educ Program 2016). There is limited evidence on the individual and societal impact of CAD. A retrospective study of 27 patients in a US healthcare institute demonstrated fluctuations in severity of anemia over the course of the disease, and significant utilization of healthcare resources (Mullins M et al. Blood Adv 2017). The objective of this study was to understand the long-term characteristics and disease burden in patients with primary CAD from a large US Electronic Health Record (EHR) database. Methods This retrospective observational cohort study included adult patients from the Optum© EHR database between January 1, 2007 and September 30, 2019 who had ≥1 medical encounter with an autoimmune hemolytic anemia-related diagnosis code, ≥3 documentations (on different dates) of CAD and ≥1 hemoglobin (Hb) value &amp;lt;12 g/dL. The index date was defined as the first mention of CAD; all patients were required to have a 12-month baseline period prior to this. To limit the study to patients with primary CAD, patients were excluded if they had ≥1 medical encounter with mycoplasma, cytomegalovirus and Epstein-Barr at the index date, or ≥1 medical encounter with lymphoma, MALT lymphoma, chronic lymphoid leukemia, Waldenstrom macroglobulinemia or myeloma during the baseline period. Anemia severity (defined as the lowest Hb value in each study period), utilization of CAD-related therapies, blood transfusions and all-cause healthcare resource utilization (HCRU) were analyzed at baseline and at 6-month follow-up intervals. Although no treatment is approved in CAD, corticosteroids, immunoglobulin, rituximab, immunosuppressants, antineoplastic and biologics were considered as CAD-related therapies to reflect usual practice. Results were stratified by anemia severity category (severe [Hb &amp;lt;8 g/dL], moderate [Hb 8.0-10 g/dL], mild [Hb 10.1-&amp;lt;12 g/dL] or no anemia [Hb ≥12 g/dL]) during each follow-up interval. Severe hemolysis was defined as elevated LDH and/or elevated bilirubin. Results A total of 610 adults with primary CAD were included in the study (mean [SD] age 67.9 [14.5] years, 65.4% female). The mean (SD) duration of follow-up was 48.1 (30.6) months; 90% of patients had ≥12 months of follow-up. At baseline (0-6 months prior to first mention of CAD), 47.6% of patients had elevated bilirubin levels and 63.1% had elevated lactate dehydrogenase (LDH) levels. A high proportion of patients with CAD experienced severe or moderate anemia at baseline and in the 6 months post-baseline; this proportion tended to be lower, but still substantial, throughout the follow-up period (Table). Frequency of moderate/severe anemia or severe hemolysis events per patient year was also higher in the first 6 months: 5.70 (95% CI: 5.00, 6.49), compared with 2.92 (2.30, 3.71) and 2.43 (1.89, 3.11) events at months 19-24 and months 31-36, respectively. The median number of CAD-related treatments per patient was high in all CAD patients at 6 months and remained high during the follow-up period (Table). The most common therapies used (excluding blood transfusion) were corticosteroids, antineoplastics and biologics. The mean number of blood transfusions per patient was higher in the severe anemia category at all follow-up intervals. The number of hospitalizations and emergency room visits were generally higher in patients with increased anemia severity; outpatient visits were high in all CAD patients and remained so over the study period (Table). Conclusion This observational cohort study followed a large sample of primary CAD patients with a 4-year mean follow-up. The results highlight the long-term substantial burden of CAD on patients and healthcare systems, which generally increased with higher severity of anemia. Three years after diagnosis, the number of moderate to severe anemia or hemolysis events remained high in CAD patients, despite off-label CAD management. The need for blood transfusions was still substantial in the severe anemic population 3 years after diagnosis. This longitudinal analysis illustrates the unmet medical needs in primary CAD. Disclosures Wilson: Sanofi: Current Employment, Current equity holder in publicly-traded company. Joly:Sanofi: Current Employment, Current equity holder in publicly-traded company. Miles:Aetion Inc.: Current Employment, Other: Employee of software company that received funding from Sanofi for the current study. Kuang:Aetion Inc.: Current Employment, Other: Employee of software company that received funding from Sanofi for the current study. Pham:Sanofi: Consultancy; Alexion: Other: Speaker.

Cost and Healthcare Utilization in Relapsed/Refractory Diffuse Large B-Cell Lymphoma: A Real-World Analysis of Medicare Beneficiaries Receiving Chimeric Antigen Receptor T-Cell Vs. Autologous and Allogeneic Hematopoietic Cell Transplants

Introduction: Patients with relapsed or refractory diffuse large B-cell lymphoma (DLBCL) can be treated with 3 resource intense options: autologous hematopoietic cell transplant (Auto-HCT), allogeneic HCT (Allo-HCT), or autologous anti-CD19 chimeric antigen receptor T-Cell (CAR T) therapy after two or more lines of systemic therapy, depending on the clinical scenario. Our aim was a comparative analysis of healthcare resource utilization (HCRU) and associated costs for matched samples of Medicare patients for treatment planners, payers, and policy-makers. Methods: This study utilized a retrospective, observational cohort design. Data were derived from the Center for Medicare and Medicaid Services (CMS) 100% Medicare Fee-for-Service (FFS) Part A and B claims data. Part D data for the study period were not yet available, so pharmacy claims for oral medications were not evaluated. Patients with DLBCL were included if they received CAR T or Auto-HCT between 10/1/2017 and 3/31/2019 or Allo-HCT between 7/1/2012 and 3/31/2019. Patients with more than 1 CAR T or HCT were excluded. The index date was the date of initiation of the procedure. To allow for evaluation of patient characteristics and treatments pre- and post-procedure, patients must have been continuously enrolled in Medicare FFS for 6 months prior to (PRE) and after (POST) the index date. Patients who died during the POST period were included. The 3 cohorts CAR T, Auto-HCT, and Allo-HCT were matched on baseline clinical characteristics using 1:1 propensity score matching with a caliper of 0.05, with Auto-HCT and Allo-HCT patients assumed to be clinically distinct populations offered at different lines of therapy and so were matched to CAR T patients separately. Due to limitations of the data, we were not able to match patients by line of therapy. Baseline characteristics were age, gender, race, census region, dual eligibility status (i.e. Medicare plus Medicaid), ECOG-PS (derived from claims using a validated, published method), Charlson-Deyo Comorbidity Index (CCI) and recent history of DVT/PE or cytopenias. Measures of HCRU were all-cause hospitalizations, outpatient, and emergency department (ED) visits. Costs were total paid amounts. HCRU and cost data were calculated for the 6 months PRE and POST, but do not include the utilization and costs associated with the index procedure itself. Results: The CAR T/Auto-HCT analysis included 175 patients each, while the CAR T/Allo-HCT analysis included 142 patients each. All cohorts had a median age of 69-70, with slightly more females, mostly ECOG 0-1, and were predominantly white. Only 10-15% were dual eligible. Although all groups had a median CCI of 4, the CAR T/Auto-HCT patients yielded slighter higher mean comorbidity scores (5.2-5.4) than CAR T/Allo-HCT (4.8). For the CAR T/Auto-HCT comparison (Table 1a), Auto-HCT utilization was higher than CAR T on all acute care hospitalization measures and mean total medical costs were 35% higher ($85,382 vs. $63,081, respectively) during PRE. During POST, all measures were lower than PRE for both groups including total medical costs ($25,277 and $33,876, respectively). The reductions were greater for Auto-HCT than for CAR T, resulting in Auto-HCT having lower POST utilization and costs than CAR T for all measures except % of patients with outpatient encounters. Allo-HCT utilization was higher than CAR T on all PRE measures including cost ($92,119 and $70,105, respectively, Table 1b) except ED visits. For POST vs. PRE, CAR T HCRU and costs declined ($34,477) similarly to that in the Auto-HCT comparison. But for Allo-HCT, acute care length of stay increased at POST compared to PRE, and total medical costs were relatively unchanged ($82,847) POST. POST HCRU and cost differences between these groups are not attributable to different survival rates, as no differences were seen. Conclusions: In this observational descriptive analysis, HCRU and costs for Auto-HCT patients were higher during the 6 months pre-HCT compared to a matched group of CAR T patients but were lower during the 6 months post-HCT. For a matched group of Allo-HCT patients, however, the post-HCT period showed HCRU and costs that were equal to or higher than pre-HCT and were higher than CAR T during the same period. Understanding the relative HCRU and costs associated with these 3 procedures common to relapsed/refractory DLBCL will allow for better HCR planning. Disclosures Mohammadi: Kite, A Gilead Company: Research Funding. Purdum:Kite, A Gilead Company: Current Employment; Gilead Sciences: Current equity holder in publicly-traded company. Wong:Kite, A Gilead Company: Research Funding. Schroeder:Kite, A Gilead Company: Research Funding. Kilgore:Kite, A Gilead Company: Research Funding. Shah:Janssen Pharmaceutica: Research Funding; Amgen: Research Funding.

Analysis of Frontal Sinus Fracture Management and Resource Utilization.

Frontal sinus fractures require a large amount of force and often occur in the context of a major trauma. Many patients with these fractures are assessed in an emergent setting where stabilization takes precedence. Delayed diagnosis and treatment of a sinus fracture can result in life-threatening conditions, such as a cerebrospinal fluid (CSF) leak. A number of different treatment algorithms have been proposed, highlighting the complexity of frontal sinus fracture management. The goal of this study is to determine how patients with frontal sinus fractures were treated at Texas Tech University Health Sciences Center and what complications arose as a result of the fracture and subsequent management strategy. Over 9 years, there were 69 reported cases. A total of 63 of these occurred in males (91.3%) versus 6 (8.7%) in females. The majority occurred after a motor vehicle collision (MVC) or a motorcycle collision (MCC). A total of 51 cases were unilateral fractures and 18 were bilateral fractures. Five patients (7.2%) had CSF leakage and 64 (92.8%) did not have CSF leakage. One patient with CSF leakage (20.0%) was managed operatively. Of the 64 patients without CSF leakage, 4 (6.3%) were managed operatively. All operative patients were managed by cranialization. Complications included vision changes, facial pressure, anosmia, facial paresthesia, pneumocephalus, and mucus retention cysts. Vision changes were the most common complication. There did not appear to be any significant difference in complications between the CSF leakage groups, indicating that non-operative management remains a viable option in the management of frontal sinus fractures.

Comparative analysis of resource utilization in integrative anthroposophic and all German pediatric inpatient departments

BackgroundIntegrative Medicine (IM) combines conventional and complementary therapies. It aims to address biological, psychological, social, spiritual and environmental aspects of patients’ health. During the past 20 years, the use and request of IM in children and adults has grown.Anthroposophic Medicine (AM) is an IM approach frequently used in children in Germany. From both public health and health economic perspectives, it is relevant to investigate whether there are differences in the resource utilization between integrative pediatric departments (IPD) and the entirety of all pediatric departments.MethodsStandard ward documentation data from all German integrative anthroposophic pediatric departments (2005–2016; N = 29,956) is investigated and systematically compared to data of the entirety of all pediatric departments in Germany derived from the Institute for the Hospital Reimbursement System (2005–2016, N = 8,645,173). The analyses focus on: length of stay, Diagnosis Related Groups (DRG), Major Diagnosis Categories (MDC), and effective Case Mix Index (CMI).ResultsThe length of stay in the IPD (M = 5.38 ± 7.31) was significantly shorter than the DRG defined length of stay (M = 5.8 ± 4.71; p < .001; d = − 0.07) and did not exceed or undercut the DRG covered length of stay. Compared to the entirety of all pediatric departments (M = 4.74 ± 6.23) the length of stay was significantly longer in the in the IPD (p <. 001; d = 0.12). The effective CMI in IPD and all pediatric departments were identical (M = 0.76). The frequencies of DRG and MDC differed between IPD and all pediatric departments, with higher frequencies of DRGs and MDCs associated with chronic and severe illnesses in the IPD.ConclusionsTreatment within integrative anthroposophic pediatric departments fits well in terms of the DRG defined conditions concerning length of stay, even though integrative pediatric patients has an increased length of stay of averagely 1 day, which is most likely associated to time consuming, complex integrative treatment approaches and to a certain extend to higher amount of chronic and severe diseases.

S0915 Clinical Outcomes and Resource Utilization Analysis in Patients With Rheumatoid Arthritis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Nationwide Inpatient Sample Analysis

S0915 Clinical Outcomes and Resource Utilization Analysis in Patients With Rheumatoid Arthritis Undergoing Endoscopic Retrograde Cholangiopancreatography: A Nationwide Inpatient Sample Analysis

Severe Pelvic Fracture in the Elderly: High Morbidity, Mortality, and Resource Utilization.

Severe pelvic fractures (PF) in the elderly are common and analysis of outcomes and resource utilization are lacking. Using the National Trauma Databank (2007-2016), 13267 patients aged ≥65years with severe PF (Abbreviated Injury Scale [AIS] pelvis ≥3; AIS 3 = 10388; AIS 4 = 2124; AIS 5 = 805) were studied. Demographic data, management, resource utilization, complications, and mortality were analyzed for each group. Data are represented as % or median interquartile range (IQR). Multivariate logistic regression analyzed risk factors for mortality, Intensive Care Unit (ICU) admission, and ventilator use. Median age was 77, and most of them were females (59%). Falls occurred in 52%, motor vechicle crash in 21.5%, and pedestrian struck in 11.6%. Median injury severity score was 16 (IQR: 9,27). Shock on admission (9.4%) increased with injury severity. Glasgow Coma Scale < 8 occurred in 8%. Blood transfusion increased with injury severity (17%, 29%, and 51%). Angiography occurred in 9%, external fixation in 4%, internal fixation in 16%, and pelvic packing in 1%, the majority in the AIS 5 group. Overall, 46% required ICU admission and 30% underwent mechanical ventilation; median Hospital Length of Stay was 6 (IQR 4,11), ICU length of stay was 5 (IQR 2,10), and median ventilator days were 4 (IQR 1-11). Mortality rate was 13.3% (AIS 3 = 10%, AIS 4 = 19%, and AIS 5 = 44%).Severe PF in the elderly is associated with high resource utilization, complications, and mortality.

Financial impact of delayed graft function in kidney transplantation.

Increased utilization of suboptimal organs in response to organ shortage has resulted in increased incidence of delayed graft function (DGF) after transplantation. Although presumed increased costs associated with DGF are a deterrent to the utilization of these organs, the financial burden of DGF has not been established. We used the Premier Healthcare Database to conduct a retrospective analysis of healthcare resource utilization and costs in kidney transplant patients (n=12097) between 1/1/2014 and 12/31/2018. We compared cost and hospital resource utilization for transplants in high-volume (n=8715) vs low-volume hospitals (n=3382), DGF (n=3087) vs non-DGF (n=9010), and recipients receiving 1 dialysis (n=1485) vs multiple dialysis (n=1602). High-volume hospitals costs were lower than low-volume hospitals ($103946 vs $123571, P<.0001). DGF was associated with approximately $18000 (10%) increase in mean costs ($130492 vs $112598, P<.0001), 6 additional days of hospitalization (14.7 vs 8.7, P<.0001), and 2 additional ICU days (4.3 vs 2.1, P<.0001). Multiple dialysis sessions were associated with an additional $10000 compared to those with only 1. In conclusion, DGF is associated with increased costs and length of stay for index kidney transplant hospitalizations and payment schemes taking this into account may reduce clinicians' reluctance to utilize less-than-ideal kidneys.

Retrospective database analysis of healthcare resource utilization and costs in patients who develop post-transplant lymphoproliferative disease within the first year following allogeneic hematopoietic stem cell transplants

Aims Healthcare resource utilization (HRU) and costs in post-transplant lymphoproliferative disease (PTLD) patients following allogeneic hematopoietic stem cell transplant (HCT) were evaluated in the USA. Methods MarketScan Commercial and Medicare Supplemental database claims from 01 July 2010 to 31 December 2017 were analyzed. Patients eligible for analysis received allogeneic HCT between 01 January 2011 to 31 December 2015, had ≥6 months of continuous enrollment before HCT, and had ≥1 claim for PTLD or ≥1 inpatient or ≥2 outpatient claims for a clinically-relevant lymphoma within 1 year following HCT (PTLD index = first claim of diagnosis). Patients with clinically-relevant lymphomas within 6 months before HCT were excluded. HRU and total paid amounts were assessed from the week before the HCT through 1-day pre-PTLD index (HCT to PTLD) and monthly from PTLD index through 1-year post-PTLD index. HRU is reported as mean (SD). Results were also provided by survival status. Results Overall, 92 patients were eligible for analysis. From HCT to PTLD, 98.9% of patients were hospitalized, with 1.7 (1.2) hospitalizations/patient. The average length of stay was 25.3 (22.2) days/patient. From HCT to PTLD, 98.9% of patients had outpatient services with 233.7 (261.1) services/patient and 91.3% of patients had a prescription fill with 32.9 (26.0) prescriptions/patient. In the first month post-PTLD index, 51.2% of patients were hospitalized. Mean paid amounts were $399,470/patient (range $7542–$1.7 M) from HCT to PTLD. Cumulative mean paid amounts 1-year post-PTLD were $429,043/patient. Total cost/patient/month was ∼7 times higher in patients who died (n = 49; $232,591) than those who lived (n = 43; $33,677). Costs were mainly driven by hospitalizations. Limitations Limitations include those inherent to retrospective analyses (i.e. miscoding, lack of clinical detail). Conclusions HRU and costs from HCT to PTLD were high and more than doubled within 1-year post-PTLD. PTLD patients who died had ∼7 times higher costs than those who lived, driven by hospitalizations. Effective treatments are needed to reduce the burden of PTLD.

Analysis of resource utilization in pediatric snake bites: An 11-year analysis

Analysis of resource utilization in pediatric snake bites: An 11-year analysis