Annual All-cause Healthcare Costs Research Articles

Healthcare resource utilization and related cost among hospitalized patients with prurigo nodularis: a retrospective cohort study using Italian health claims data.

Prurigo nodularis (PN) is a chronic, inflammatory skin disease characterized by intense itch. Little evidence exists on the burden of PN in Italy. This real-world analysis aimed to investigate the healthcare resource consumption and related direct costs of patients hospitalized for PN. The analysis utilized the administrative databases of healthcare units that cover approximately 12 million inhabitants across Italy. Adult patients were included by ICD-9-CM=698.3 (lichen simplex chronicus; neurodermatitis circumscripta; PN) as proxy of PN diagnosis, from 01/2010 to 09/2021, and had 1 year of data availability before (baseline) and after (follow-up) hospitalization (index date). These patients were 1:2 matched by age, sex, and index date (year) to adults without such hospitalization in the baseline period (matched non-PN controls). The analysis comprised 295 PN-hospitalized patients, matched with 590 non-PN individuals (mean age 63.2 years, 43.7% female). At baseline, patients had a greater comorbidity burden than non-PN controls, including higher prevalence of hypertension (56.6% vs. 36.6%, respectively), dyslipidemia (26.4% vs. 18.0%), diabetes (24.4% vs. 12.5%) and mental health conditions (14.9% vs. 7.8%). During 1-year follow-up, PN-hospitalized patients had significantly higher resource consumption than matched controls, in terms of mean number of prescriptions most commonly prescribed in PN patients (5.1 vs. 1.9, P<0.001), other drugs (11.7 vs. 6.5, P<0.001), all-cause hospitalization (1.4 vs. 0.1, P<0.001) and outpatient services (5.4 vs. 2.5, P<0.001). Mean annual all-cause healthcare costs for patients over 1-year follow-up were € 3847 total (€ 875 drugs, € 2652 hospitalization, € 320 outpatient services), higher than those for the matched controls, of € 711 total (P<0.001) (€ 353 drugs, € 228 hospitalization, € 130 outpatient services). Patients hospitalized for PN had a higher comorbidity burden at baseline and greater healthcare resource consumption during 1-year follow-up compared to matched controls, with a 5.4-fold increase in all-cause healthcare costs, indicating substantial clinical burden and remaining unmet need in these patients.

Developing Topics.

This study aims to detect direct cost savings with early detection of Alzheimer's disease (AD) and related dementias. We hypothesize that earlier diagnosis of AD can reduce direct healthcare costs and unnecessary utilization. A retrospective case-control study is conducted using Optum Market Clarity Claims/EHR linked dataset on Medicare Advantage population from Jan 1 2011 to Dec 31 2020. Based on whether the patient was diagnosed with prior Mild Cognitive Impairment (MCI) before progressing to an AD diagnosis per ICD-9/10 cm diagnosis codes, AD patients are categorized into early vs. late diagnosis (for those who were identified in the MCI stage vs not). Both groups are compared on annual all-cause healthcare costs and frequency of encounters longitudinally spanning across 6 years pre-index period and 3 years post-index with AD diagnosis date as the index date. To understand the impact of early diagnosis, we estimated total cost, medical service cost and drug cost post-index within the first 3 years by risk adjustment on baseline demographics, comorbidities, procedures, lab tests, and visits prior to AD diagnosis using propensity score weighting. Early-diagnosed patients (N = 421) have a lower utilization rate of inpatient skilled nursing facility, nursing home and hospitalization than late-diagnosed patients (N = 2817) after being diagnosed with AD. We also observed average medical service cost savings in all 3 years post-index, ranging from $320 to $2556 per patient per year. Per cost allocation analysis, medical service cost savings are observed in inpatient, emergency room, inpatient SNF, urgent care, nursing home/assisted living, and observation unit. Risk adjusted cost savings with statistical significance are observed in year 3 post-index. The mean cost difference between late and early diagnoses: total cost ($15472.11), medical service ($15013.7) and medication cost ($1601.61). The study highlights opportunities for earlier diagnosis and suggests long-term healthcare savings for AD patients who have been diagnosed at MCI stage compared to patients who were directly diagnosed with AD. Further research is needed to drill down into the driver of cost savings and whether it is attributable to disease management of MCI or other complications.

PMON64 Economic Burden of Growth Hormone Deficiency in a US Adult Population

Abstract Background Growth hormone deficiency (GHD) is a rare disorder currently treated in adults with daily injections of somatropin. Adults with GHD have a diminished quality of life, central adiposity, which may put them at risk for metabolic syndrome and cardiovascular disease, and decreased bone mineral density. Treatment of adults with GHD is associated with improvement in metabolic impairment and quality of life. Poor adherence to or lack of treatment with somatropin is associated with reduced or lack of efficacy and increased costs. This study analyzed healthcare costs and daily somatropin use among adults with GHD who had Medicaid or commercial health insurance in the US. Methods Adult patients with a GHD diagnosis between January 1, 2008, and December 31, 2017 were identified in the IBM Marketscan Medicaid and Commercial Databases (index date = first diagnosis). Patients with GHD were directly matched (1: 3) to controls without GHD (or other short stature-related disorder) on age, gender, plan type, region, and race (Medicaid only). Baseline comorbidities and medications were measured during the 12 months pre-index. All-cause and GHD-related healthcare costs and somatropin use were measured during the variable follow-up period. Results The 2,579 Medicaid and 24,373 commercial patients with GHD who met the study inclusion criteria were matched to 7,728 Medicaid and 73,119 commercial controls. Little variation was observed between the demographic makeup of adult patients with and without GHD, demonstrating effective matching. Participants were evenly split between male and female. Median age at index was 37 years for Medicaid patients and 48 years for commercial patients. Mean follow-up time was 41 and 31 months for Medicaid patients and controls, and 35 and 37 months for commercial patients and controls, respectively. Compared to controls, GHD patients were disproportionately affected by comorbidities, including endocrine conditions (&amp;gt;68% in GHD cases vs. ≤10% in controls), metabolic conditions (&amp;gt;93% in GHD cases vs. ≤39% in controls), hepatic and renal function conditions (18-23% in GHD cases vs. &amp;lt;10% in controls), and cardiovascular disease (41-53% in GHD cases vs. &amp;lt;29% in controls), and were disproportionately treated with concomitant medications. Mean annual all-cause healthcare costs were 4.6 times greater ($42,309 vs. $9,146) for Medicaid GHD patients than controls and 4.1 times greater ($30,111 vs. $7,376) for commercial GHD patients than controls. For Medicaid GHD patients, inpatient costs were a primary driver ($22,385 vs. $3,494 for controls), while outpatient costs made up the largest proportion for commercial patients ($13,083 vs. $4,057 for controls). Few patients were treated with somatropin therapy in both Medicaid (5.8%) and commercial (9.5%) GHD cohorts. Conclusion Adult patients with GHD experience a substantial comorbidity and economic burden compared to non-GHD controls. Adult GHD remains primarily untreated and presents a significant healthcare burden. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Geographical variation in kidney function testing and associations with health care costs among patients with chronic kidney disease and type 2 diabetes.

Clinical practice guidelines recommend at least annual testing of estimated glomerular filtration rate (eGFR) and urine albumin-creatinine ratio (uACR) for patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). This study assessed the adequacy of eGFR and uACR testing in this patient population across the United States. Observational real-world study. Adults with CKD and T2D were identified from the Optum Clinformatics database (2015-2019). The eGFR and uACR tests were assessed nationally and by state. The proportions of tested patients and patients receiving adequate monitoring per clinical practice guidelines were analyzed during the 1-year period after T2D and CKD diagnosis, along with all-cause health care costs. Among 101,057 adults with CKD and T2D, 94.1% had at least 1 eGFR test and 38.7% had at least 1 uACR test over 1 year. Only 20.3% of patients had adequate uACR monitoring; this was much lower than observed for adequate eGFR monitoring (86.6%). The eGFR testing rates were high across states (range, 79.5% [Colorado] to 97.3% [Alabama]); conversely, uACR testing rates were uniformly lower and showed wider variation (range, 14.0% [Maine] to 58.9% [Hawaii]). Mean annual all-cause health care costs were $28,636 and increased with CKD GFR stage. Lower uACR testing rates were associated with higher health care costs at the state level (Pearson r = -0.55; P < .01). In the United States, uACR testing is underutilized, with large geographical variations in testing rates noted between states. Lower uACR testing rates were associated with higher health care costs. The lack of sufficient uACR testing raises concerns about CKD management in patients with T2D.

Health care costs and resource utilization among commercially insured adult patients with hemophilia A managed with FVIII prophylaxis in the United States.

BACKGROUND: Standard of care for patients with severe hemophilia A (HA) is life-long prophylaxis with factor VIII (FVIII) concentrate or other hemostatic agents. Published literature highlights a wide range of treatment costs for patients with HA. OBJECTIVE: To estimate average annual health care costs and resource utilization for a cross-section of adult patients managed with FVIII concentrate prophylaxis using recent data from a large US commercial claims database. METHODS: Adult males with 1 or more claim with HA diagnosis, continuous commercial plan enrollment, and 4 or more FVIII prescription dispenses during 12 months were identified from IBM MarketScan Research Database from January 2013 to September 2019, excluding those with FVIII inhibitors, an HIV/AIDS diagnosis, or diagnosis and treatment for hepatitis B or C. Patients were classified as using FVIII prophylaxis if they met any of the following definitions: (1) 6 or more FVIII dispenses, (2) a gap of 60 days or less between dispenses, and (3) at least 273 days supply in the 12-month period. Additionally, subgroups of patients meeting each individual definition were examined, with some patients included in all 3 subgroups. RESULTS: The overall cohort included 411 patients who met 1 or more of the 3 definitions, with a mean age of 28.9 years. Subgroups of 401, 325, and 237 patients met the first, second, and third FVIII prophylaxis definitions, respectively. Per-patient mean (SD) annual all-cause health care costs were $654,571 ($380,762) in the overall cohort and ranged from $650,065 ($382,196) to $759,661 ($387,040) among subgroups. Cost of FVIII concentrate accounted for more than 96% of total costs in the overall cohort and in each subgroup. Cost of FVIII in the overall cohort varied according to type of concentrate, with the highest among patients who were treated with both standard and extended half-life (SHL and EHL) FVIII ($784,945), followed by EHL FVIII only ($708,928), SHL FVIII only ($647,800), and plasma-derived FVIII ($535,614). The most common treatment type was SHL FVIII only (45.7% of all patients). In the overall cohort, the majority had 1 or more outpatient visits (94.9%), while emergency department visits, hospital admissions, and home health visits occurred less frequently (27.0%, 7.1%, and 7.1%, respectively). CONCLUSIONS: Commercially insured patients with HA incur substantial all-cause annual health care costs, with FVIII concentrate accounting for a majority of costs. DISCLOSURES: This study was funded by BioMarin Pharmaceutical Inc, which was involved in the protocol development, analysis plan development, data interpretation, manuscript preparation, and publication decisions. All authors contributed to protocol development, analysis plan development, data interpretation, and manuscript development and maintained control over the final content. Thornburg has received professional fees from BioMarin Pharmaceutical, CSL Behring, Genentech, Novo Nordisk, Sanofi Genzyme, HEMA Biologics, and Spark Therapeutics and institutional research funding from BioMarin Pharmaceutical, Novo Nordisk, and Sanofi Genzyme. Adamski, Cook, and Sendhil are employees of Analysis Group, a consulting company that was contracted by BioMarin Pharmaceutical to conduct this study and develop the manuscript. Vembusubramanian is a former employee of Analysis Group. Hinds, Chen, and Sammon are employees and shareholders of BioMarin Pharmaceutical. Solari is a former employee of BioMarin Pharmaceutical. Garrison has received consulting fees from BioMarin Pharmaceutical and Analysis Group. Croteau has received professional fees from BioMarin Pharmaceutical, Bayer, CSL Behring, HEMA Biologics, and Pfizer and institutional research funding from Novo Nordisk and Spark Therapeutics.

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

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

Cost-of-Illness Progression Before and After Diagnosis of Multiple Sclerosis: A Nationwide Register-Based Cohort Study in Sweden of People Newly Diagnosed with Multiple Sclerosis and a Population-Based Matched Reference Group.

BackgroundMultiple sclerosis (MS) is a chronic disease associated with increased healthcare utilisation and productivity losses.ObjectiveThe objective of this study was to explore the progression of healthcare costs and productivity losses before and after diagnosis of MS in comparison to that of a population-based matched reference group.MethodsWe conducted a nationwide, Swedish register-based cohort study of working-aged people with MS diagnosed in 2010–12 (n = 1988) and population-based matched references without MS (n = 7981). Nine years of observation spanned from 4 years prior (Y−4) to 4 years (Y+4) after the year of diagnosis (Y0). Differences in annual all-cause healthcare costs (inpatient and specialised outpatient healthcare as well as pharmacy-dispensed prescribed drugs) and costs of productivity loss (days with sickness absence and disability pension) were estimated between the people with MS and references using t tests with 95% confidence intervals. The average excess costs of MS were estimated using generalised estimating equation models.ResultsPeople with multiple sclerosis had higher costs before the diagnosis of MS and also thereafter. The mean differences in healthcare costs and productivity losses between the people with MS and matched references in Y−4 were 216 EUR (95% confidence interval 58–374) and 1540 EUR (95% confidence interval 848–2233), with larger cost excesses observed in later study years. Summarising the 9 study years, people with MS had fivefold higher excess healthcare costs than references, and more than twice as high productivity losses.ConclusionsExcess healthcare costs and productivity losses occur already before the diagnosis of MS and increase with time. The excess costs findings before diagnosis could suggest that an earlier diagnosis might lead to reduced excess costs of MS over time.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40273-021-01035-4.

Healthcare utilization and costs among patients with psoriasis and psoriatic arthritis in the USA-a retrospective study of claims data from 2009 to 2020.

To compare healthcare resource utilization and costs among patients with psoriasis, psoriatic arthritis (PsA), and a control group of patients without psoriasis and PsA in the USA. The IBM® MarketScan® Commercial Database was used to identify three adult patient groups from 1/1/2009 through 4/30/2020: (1) Psoriasis: ≥ 2 diagnoses ≥ 30 days apart for psoriasis (no PsA diagnoses); (2) PsA: ≥ 2 diagnoses for PsA; (3) Control: no psoriasis or PsA diagnoses in their entire claims records. Patients with comorbid rheumatoid arthritis, ankylosing spondylitis, Crohn's disease, or ulcerative colitis were excluded from the analyses. Controls were matched 1:1 to psoriasis and PsA patients based on age, gender, index year, and number of non-rheumatological comorbidities. Healthcare resource utilization and costs (in 2019 USD) were evaluated descriptively and through mixed models for five years of follow-up. A total of 142,531 psoriasis and 21,428 PsA patients were matched to the control group (N = 163,959). Annual all-cause healthcare costs per patient were $7,470, $11,062, and $29,742 for the control, psoriasis, and PsA groups, respectively. All-cause healthcare costs increased over time and were significantly greater among PsA vs. psoriasis (p < 0.0001) and the control groups (p < 0.0001). Across all categories of healthcare resources, utilization was greatest among patients with PsA and lowest in the control group. Annual healthcare costs and resource utilization were significantly higher with PsA compared with psoriasis and the control group, confirming the substantial economic burden of PsA. The cost disparity between these patient groups highlights a continued unmet medical need. Key Points • Patients with PsA incurred significantly greater healthcare resource utilization and costs than patients with psoriasis and patients without psoriasis and PsA. • Significantly greater costs and healthcare resource utilization were also observed among patients with psoriasis compared with patients without psoriasis and PsA.

The Economic Burden of Tenosynovial Giant Cell Tumors Among Employed Workforce in the United States

To assess the economic burden of tenosynovial giant cell tumor (TGCT) among US employed workforce. Patients with TGCT medical claims (N = 1395) and matched controls (1:10) without TGCT claims (N = 13,950) were identified from the OptumHealth Care Solutions, Inc. database (January 1, 1999 to March 31, 2017). Adjusted regression models were used to compare healthcare resource utilization, time lost from work, and associated costs between cohorts. In patients with TGCT, the rates of inpatient admissions, emergency room visits, outpatient visits, and work loss days were 2.8, 1.5, 2.2, and 2.6 times those of matched controls, respectively (all P < 0.001). Total annual all-cause healthcare costs and work loss-related costs were $9368 and $2708 higher for TGCT patients than for matched controls, respectively (all P < 0.001). TGCT was associated with a significant healthcare and work loss burden on US employers.

Evaluation of machine learning methodology for the prediction of healthcare resource utilization and healthcare costs in patients with critical limb ischemia-is preventive and personalized approach on the horizon?

Critical limb ischemia (CLI) is a severe stage of peripheral arterial disease and has a substantial disease and economic burden not only to patients and families, but also to the society and healthcare systems. We aim to develop a personalized prediction model that utilizes baseline patient characteristics prior to CLI diagnosis to predict subsequent 1-year all-cause hospitalizations and total annual healthcare cost, using a novel Bayesian machine learning platform, Reverse Engineering Forward Simulation™ (REFS™), to support a paradigm shift from reactive healthcare to Predictive Preventive and Personalized Medicine (PPPM)-driven healthcare. Patients ≥ 50years with CLI plus clinical activity for a 6-month pre-index and a 12-month post-index period or death during the post-index period were included in this retrospective cohort of the linked Optum-Humedica databases. REFS™ built an ensemble of 256 predictive models to identify predictors of all-cause hospitalizations and total annual all-cause healthcare costs during the 12-month post-index interval. The mean age of 3189 eligible patients was 71.9years. The most common CLI-related comorbidities were hypertension (79.5%), dyslipidemia (61.4%), coronary atherosclerosis and other heart disease (42.3%), and type 2 diabetes (39.2%). Post-index CLI-related healthcare utilization included inpatient services (14.6%) and ≥ 1 outpatient visits (32.1%). Median annual all-cause and CLI-related costs per patient were $30,514 and $2196, respectively. REFS™ identified diagnosis of skin and subcutaneous tissue infections, cellulitis and abscess, use of nonselective beta-blockers, other aftercare, and osteoarthritis as high confidence predictors of all-cause hospitalizations. The leading predictors for total all-cause costs included region of residence and comorbid health conditions including other diseases of kidney and ureters, blindness of vision defects, chronic ulcer of skin, and chronic ulcer of leg or foot. REFS™ identified baseline predictors of subsequent healthcare resource utilization and costs in CLI patients. Machine learning and model-based, data-driven medicine may complement physicians' evidence-based medical services. These findings also support the PPPM framework that a paradigm shift from post-diagnosis disease care to early management of comorbidities and targeted prevention is warranted to deliver a cost-effective medical services and desirable healthcare economy.

Vaso-Occlusive Crises and Costs of Sickle Cell Disease from a Commercial Payer's Perspective

Background: Episodes of acute pain caused by vaso-occlusive crises (VOCs) are a frequent and debilitating complication associated with sickle cell disease (SCD) and represent the most common cause for emergency room (ER) visits and inpatient (IP) stays. VOCs are due to a complex pathophysiology including multicellular adhesion. The purpose of this study was to characterize VOCs and assess the costs of SCD for patients with commercial insurance using an Excel-based model. Methods: Patients with SCD aged ≥16 years were identified in the IBM Truven MarketScan commercial databases (01/01/2000-06/30/2018). The index date was randomly selected among potential calendar dates to have ≥12 months of continuous health plan enrollment before (pre-index period) and after (follow-up period) that date. Patients with Medicare Supplemental coverage or stem cell transplant (SCT) were excluded. Data were analyzed at the state level for 23 key states with the highest concentration of patients with SCD and at the national level to be incorporated into an Excel-based model. The key variables in the model were age, gender, state of residence, and SCD clinical characteristics measured during the 12-month pre-index period. The following model inputs were assessed during the subsequent 12-month follow-up period: number, type, and setting (i.e., IP, ER, or outpatient [OP]) of VOC episodes; and total all-cause and SCD-related healthcare costs. Costs were reported in 2018 USD from a payer's perspective. We defined a VOC episode requiring medical services in claims data as follows: medical service claims with a VOC-related diagnosis occurring within 3 days of each other, IP re-admission within 14 days of a previous IP stay (both with VOC-related diagnoses), or any follow-up medical services with VOC-related diagnoses in the 7 days following an initial VOC diagnosis. A complicated VOC type was defined as a VOC episode with a diagnosis of priapism, splenic sequestration, acute hepatic sequestration, or acute chest syndrome. Variables were stratified by annual number of VOCs (i.e., 0, 1, ≥2 VOCs) and medical service setting (i.e., IP, ER, or OP). Results: A total of 16,092 commercially-insured patients with SCD from all US states were included in this study: mean age was 36.7 years, and 61.4% were females. In total, 27.7% had Hb-SS, 23.4% Hb-SC, 25.8% Hb-thalassemia, and 23.1% had an unspecified SCD type. The five states that contributed the highest number of patients with SCD were New York (n=1,711; 10.6%), Texas (n=1,593; 9.9%), Florida (n=1,397; 8.7%), Georgia (n=1,382; 8.6%), and California (n=966; 6.0%). In a given year, 64.7% of patients did not have any VOC episodes, 14.0% had only 1 VOC, and 21.2% had ≥2 VOCs (10.1% had ≥4 VOCs). Among patients with ≥1 VOC, the mean number of VOC episode was 3.3 (7.3% were complicated VOCs); among those with ≥2 VOCs, this figure was 4.8 (6.9% were complicated VOCs). The model showed that VOC episodes were distributed as follows: 37.4% in an IP setting, 26.4% in an ER, and 36.2% in an OP setting (Figure 1). The mean duration of a VOC episode was 11.7 days in an IP setting, 2.3 days in an ER setting, and 1.9 days in an OP setting (Figure 2). Total annual all-cause healthcare costs for patients with 0, 1, and ≥2 VOCs were $15,747, $27,194, and $64,555, respectively (Figure 3). Total annual SCD-related healthcare costs for patients with 0, 1, and ≥2 VOCs were $8,885, $21,323, and $60,624, respectively, representing 56.4%, 78.4%, and 93.9% of total annual all-cause healthcare costs, respectively (Figure 3). Conclusions: Among commercially-insured patients with SCD in the US, over one-third of patients experienced VOCs. The model showed that the contribution of SCD-related costs to annual total healthcare costs increases with the number of VOCs per year. Disclosures Joseph: Amgen: Equity Ownership; Novartis: Employment, Equity Ownership; Pfizer: Equity Ownership; Cigna: Equity Ownership. Latremouille-Viau:Novartis: Other: I am an employee of Analysis Group, Inc., which provided paid consulting services to Novartis for the conduct of this study. Sharma:NOVARTIS HEALTHCARE PVT. LTD.: Employment. Gagnon-Sanschagrin:Novartis: Other: I am an employee of Analysis Group, Inc., which provided paid consulting services to Novartis for the conduct of this study. Bhor:Novartis: Employment, Equity Ownership. Khare:HEALTHCARE PVT. LTD.: Employment. Singh:NOVARTIS HEALTHCARE PVT. LTD.: Employment. Serra:Novartis: Other: I am an employee of Analysis Group, Inc., which provided paid consulting services to Novartis for the conduct of this study. Davidson:Novartis: Other: I am an employee of Analysis Group, Inc., which provided paid consulting services to Novartis for the conduct of this study. Guerin:Novartis: Other: I am an employee of Analysis Group, Inc., which provided paid consulting services to Novartis for the conduct of this study. Shah:GBT: Research Funding; Alexion: Speakers Bureau; Novartis: Consultancy, Research Funding, Speakers Bureau.

Healthcare resource utilization and costs in patients with multiple myeloma with and without skeletal-related events.

To compare healthcare resource use and costs between newly diagnosed multiple myeloma (NDMM) patients with and without skeletal-related events (SREs). Adults newly diagnosed with MM (1 January 2006 and 30 June 2017) with at least 12 months continuous health coverage prior to diagnosis were identified using the IBM MarketScan administrative claims. To control for baseline differences, NDMM patients with SREs were propensity score matched to NDMM patients without SREs. Outcomes included annual HRU and costs during follow-up along with number and type of SREs (SRE cohort only). Patients with SREs were stratified by number of SREs, and annual SRE-related costs were reported. Student's t test and Chi-squared test were used to compare outcomes. Before matching, the 6648 patients in the SRE cohort had more comorbidities, were more likely to have MM treatment, and had higher pre-index healthcare costs than the 7458 patients in the non-SRE cohort. After matching, cohorts of 3432 patients were well balanced on baseline characteristics. Patients with SREs (vs. without SREs) had significantly higher inpatient, outpatient, and pharmacy HRU. Patients with SREs had significantly higher mean annual all-cause healthcare costs ($213,361 vs. $94,896, p < 0.001) with hospitalization being the leading driver of increased costs (38.7% of total). Among 6648 patients with SREs, the mean annual SRE-related healthcare costs were $39,603, $45,463, and $50,111 for patients with one, two, and three or more events, respectively. NDMM patients with SREs have more than twice the all-cause healthcare costs than matched patients without SREs. Costs increase with the number of SRE events.

Abstract 112: 12-Month Healthcare Utilization and Expenditures in Medicare Advantage Patients With Mitral Regurgitation From the Medical Outcomes Research for Effectiveness and Economics Registry

Background: Mitral Regurgitation (MR) is associated with significant health care costs. This study aims to quantify the financial healthcare burden of Medicare Advantage (MA) patients across all MR patients from the Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry. Methods: MA patients with a minimum of 1 inpatient or 2 outpatient claims for MR from 2008-2014 were reviewed. The index date was defined as a first inpatient claim or second outpatient claim. A 6-month pre-period (baseline) and 6-month post (washout) after index was used to define baseline etiology and severity. Three MR cohorts were defined: (1) Functional MR (FMR) was defined by the presence of heart failure during washout; (2) Degenerative MR (DMR) was defined by presence of chordal rupture or the absence of both heart failure and ischemia; and (3) Uncharacterized MR (UMR) was defined by patients otherwise not meeting the criteria for FMR or DMR. sMR was defined by a history of MR surgery, a diagnosis of atrial fibrillation or pulmonary hypertension, chordal rupture (DMR only), or record of two or more echocardiograms (per clinical guidelines) during washout. Demographics, comorbidities, healthcare utilization, and all-cause expenditures were summarized. Results: Of the 164,682 MA patients with MR who met inclusion criteria, 70,452 (43%) had FMR, 51,399 (31%) had DMR, and 42,831 (26%) had UMR. Average age (SD) was similar across cohorts: 74 (7.95), 72 (8.46), and 74 (7.45) years for FMR, DMR, and UMR, respectively. Proportion of severe patients and Charlson Comorbidity Index (CCI) indicates that the FMR cohort was “sicker” as compared to the others: FMR (41,325 [59% of 70,452]; CCI 4.56), DMR (16,169 [32% of 51,399]; CCI 1.67), and UMR (16,131 [38% of 42,831]; CCI 2.80). 2,079 patients (1.26% of total 164,682) received mitral valve surgery at index or washout with the highest occurrence in FMR patients (1,663), followed by UMR (327) and DMR (89). When comparing across the MR cohorts, the FMR cohort had higher rates of hospital admission, but length of stay was similar between cohorts (FMR [19.9%, 4-days], DMR [9.4%, 4-days], and UMR [13.6%, 3-days]). FMR had the highest annual all-cause healthcare costs (SD) ($22,569, [$59,876]), followed by UMR ($14,735 [$32,070]) and DMR ($10,485 [$23,934]). Conclusions: MR in the Medicare Advantage population is associated with a substantial health care burden, with FMR patients having the highest cost and utilization patterns. This population should, therefore, have access to innovative treatment options that relieve symptoms and reduce economic burden.

Economic Burden of Irritable Bowel Syndrome with Diarrhea: Retrospective Analysis of a U.S. Commercially Insured Population.

The economic burden associated with irritable bowel syndrome with diarrhea (IBS-D) is not well understood. To (a) evaluate total annual all-cause, gastrointestinal (GI)-related, and symptom-related (i.e.,IBS, diarrhea, abdominal pain) health care resource use and costs among IBS-D patients in a U.S. commercially insured population and (b) estimate incremental all-cause health care costs of IBS-D patients versus matched controls. Patients aged ≥ 18 years with 12 months of continuous medical and pharmacy benefit eligibility in 2013 were identified from the Truven Health MarketScan research database. The study sample included patients with ≥ 1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code in any position for IBS (ICD-9-CM 564.1x) and either (a) ≥ 2 claims for diarrhea (ICD-9-CM 787.91, 564.5x) on different service dates in 2013, or (b) ≥ 1 claim for diarrhea plus ≥ 1 claim for abdominal pain (ICD-9-CM 789.0x) on different service dates in 2013, or (c) ≥ 1 claim for diarrhea plus ≥ 1 pharmacy claim for a symptom-related prescription on different service dates in 2013. Controls included patients with no claims for IBS, diarrhea, abdominal pain, or symptom-related prescriptions in 2013. Controls were randomly selected and matched with IBS-D patients in a 1:1 ratio based on age (± 4 years), gender, geographic location, and health plan type. All-cause health care resource utilization included medical and pharmacy claims for health care services associated with any condition. Total health care costs were defined as the sum of health plan-paid and patient-paid direct health care costs from prescriptions and medical services, including inpatient, emergency department (ED), and physician office visits, and other outpatient services. A total cost approach was used to assess all-cause, GI-related, and symptom-related health care costs for IBS-D patients. An incremental cost approach via generalized linear models was used to assess the excess all-cause costs attributable to IBS-D after adjusting for demographics and general and GI comorbidities. Of 39,306 patients (n = 19,653 each for IBS-D and matched controls) included, mean (± SD) age was 47 (± 17) years and 76.5% were female. Compared with controls, IBS-D patients had a significantly higher mean annual number of hospitalizations, ED visits, office visits, and monthly (30-day) prescription fills. Mean annual all-cause health care costs for IBS-D patients were $13,038, with over half (58.4%) attributable to office visits and other outpatient services (e.g.,diagnostic tests and laboratory or radiology services), and remaining costs attributable to prescriptions (19.5%), inpatient admissions (13.6%), and ED visits (8.5%). GI-related ($3,817) and symptom-related ($1,693) costs were also primarily driven by other outpatient service costs. After adjusting for demographics and comorbidities, incremental annual all-cause costs associated with IBS-D were $2,268 ($9,436 for IBS-D patients vs. $7,169 for matched controls; P < 0.001) per patient/year, of which 78% were from medical costs and 22% were from prescription costs. IBS-D was associated with a substantial burden in direct costs in this population. Compared with matched controls, IBS-D patients had greater medical service use and incurred significantly more annual all-cause health care costs, even after controlling for demographics and comorbidities. Incremental costs associated with IBS-D were primarily attributable to increased use of medical services rather than pharmacy costs. This study was funded by Allergan. The authors received no compensation related to the development of the manuscript. Buono and Andrae are employees of Allergan. Mathur is an employee of Axtria. Averitt was an employee of Axtria at the time this study was conducted. Data from this manuscript have previously been presented in poster format by Buono at the American College of Gastroenterology Annual Scientific Meeting; Honolulu, Hawaii; October 16-21, 2015. Mathur and Averitt were involved in conducting the study analyses. All authors were involved in the study design, interpretation of the data, and preparation of the manuscript. The authors take full responsibility for the scope, direction, and content of the manuscript and have approved the submitted manuscript.

Asthma and Chronic Obstructive Pulmonary Disease Overlap Syndrome: Doubled Costs Compared with Patients with Asthma Alone

BackgroundPatients with asthma and chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) have more rapid disease progression and more exacerbations than do those with either condition alone. Little research has been performed, however, in these patients. ObjectiveThe objective was to summarize the health care utilization, costs, and comorbidities of patients with uncontrolled asthma and patients with ACOS. MethodsThis retrospective analysis used medical and pharmacy claims from large commercial health plans. The study included patients 6 years or older with a diagnosis of asthma and one or more asthma exacerbation (index event). Patients were classified as having asthma alone or ACOS, and the two groups were matched for age, sex, region, index year, index month, and health plan type. Outcomes included rates of comorbid disease, health care utilization, and costs during the 12 months before and after the index exacerbation. ResultsAmong the matched patients with asthma (6,505 ACOS; 26,060 without COPD), mean annual all-cause health care costs were twice as high as for patients with ACOS ($22,393 vs. $11,716; P < 0.0001). Asthma-related costs, representing 29% of total costs, were nearly twice as high among patients with ACOS ($6,319 vs. 3,356; P < 0.0001). Cost differences were driven by large differences in the proportions of patients with an inpatient hospitalization (34.0% vs. 14.6%; P < 0.0001) or emergency department visit (29.6% vs. 19.9%; P < 0.0001). Nearly all prespecified comorbid conditions were more prevalent in the ACOS group. ConclusionsPatients with asthma and COPD had nearly double the health care costs as did patients with asthma without COPD. The overall disease profile of patients with asthma should be considered when managing patients, rather than treating asthma as a solitary condition.

Impact of non-remission of depression on costs and resource utilization: from the COmorbidities and symptoms of DEpression (CODE) study

Objective:To determine the economic impact of sustained non-remission of depression on the total annual all-cause healthcare costs of patients with a history of depression.Methods:Adults with ≥2 claims with depression diagnosis codes from the HealthCore Integrated Research Database were invited to participate in this retrospective/prospective fixed-cohort repeated-measures study. Patients with scores >5 at initial survey and 6 month assessment on the Quick Inventory of Depressive Symptomatology (QIDS-SR) were considered to be in ‘sustained non-remission’, while those with scores ≤5 at both assessments were considered to be in ‘sustained remission’. Patients also completed self-report instruments to assess pain, fatigue, anxiety, sleep difficulty, and other health and wellness domains. Survey data were linked to patient claims (12 month pre- and post-initial-survey periods). After adjusting for demographic and clinical characteristics using propensity scores, post-survey costs and resource utilization were compared between remission and non-remission groups using non-parametric bootstrapping methods.Results:Of the 640 patients who met inclusion criteria, 140 (21.9%) were in sustained remission and 348 (54.5%) never achieved remission. Using propensity-score adjusted costs, sustained non-remission of depression was associated with higher annual healthcare expenditures of >$2300 per patient ($14,627 vs. $12,313, p = 0.0010) compared to remitted patients. Higher costs were associated with greater resource utilization and increased medication use. Non-remitters were prescribed more medications than remitters, including antidepressants and second-generation antipsychotics. Although length of antidepressant exposure over 12 months was similar, remitters were more likely to be adherent to antidepressants. Non-remission was associated with anxiety, pain, fatigue, sleep disruption, diabetes, anemia, obesity, and heavy drinking.Conclusion:Failing to achieve remission of depression was associated with increased costs and greater resource utilization. Clinicians should strive to achieve sustained remission in patients with depression. Study limitations included reliance on claims data for initial identification of cohort and high rate of attrition in the analytic sample.

Economic burden of irritable bowel syndrome with constipation: a retrospective analysis of health care costs in a commercially insured population.

The prevalence of irritable bowel syndrome with constipation (IBS-C) is estimated to be between 4.3% and 5.2% among adults in the United States. Little is known about the health care resource utilization and costs associated with IBS-C. To (a) evaluate the annual total all-cause, gastrointestinal (GI)-related, and IBS-C-related health care costs among IBS-C patients seeking medical care in a commercially insured population and (b) estimate the incremental all-cause health care costs among IBS-C patients relative to matched controls. Patients aged ≥ 18 years with continuous medical and pharmacy benefit eligibility in 2010 were identified from the HealthCore Integrated Research Database, which consists of administrative claims from 14 geographically dispersed U.S. health plans representing 45 million lives. IBS-C patients were defined as those with ≥ 1 medical claim with an ICD-9-CM diagnosis code in any position for IBS (ICD-9-CM 564.1x) and either ≥ 2 medical claims for constipation (ICD-9-CM 564.0x) on different service dates or ≥ 1 medical claim for constipation plus ≥ 1 pharmacy claim for a constipation-related prescription on different dates of service during the study period. Controls were defined as patients without any medical claims for IBS, constipation, abdominal pain, or bloating or pharmacy claims for constipation-related prescriptions. Controls were randomly selected and matched with IBS-C patients in a 1:1 ratio based on age (± 4 years), gender, health plan region, and health plan type. Patients with diagnoses or prescriptions suggesting mixed IBS, IBS with diarrhea, chronic diarrhea, or drug-induced constipation were excluded. Total health care costs in 2010 U.S. dollars were defined as the sum of health plan and patient paid costs for prescriptions and medical services, including inpatient visits, emergency room (ER) visits, physician office visits, and other outpatient services. The total cost approach was used to assess total all-cause or disease-specific health care costs for patients with IBS-C, while the incremental cost approach was used to examine the excess all-cause costs of IBS-C by comparing IBS-C patients with matched controls. Generalized linear models with bootstrapping were used to assess the incremental all-cause costs attributable solely to IBS-C after adjusting for demographics, Elixhauser Comorbidity Index (ECI) score, and other general and GI-related comorbidities not included in the ECI score. A total of 7,652 patients (n = 3,826 each in the IBS-C and control cohorts) were included in the analysis. The mean (± SD) age was 48 (± 17) years, and 83.6% were female. The mean annual all-cause health care costs for IBS-C patients were $11,182, with over half (53.7%) of the costs attributable to outpatient services, including physician office visits and other outpatient services (13.1% and 40.6%, respectively). Remaining total all-cause costs were attributable to hospitalizations (21.8%), prescriptions (19.1%), and ER visits (5.4%). GI-related costs ($4,456) comprised 39.8% of total all-cause costs, while IBS-C-related costs ($1,335) accounted for 11.9% and were primarily driven by costs of other outpatient services (50.3%). After adjusting for demographics and comorbidities, the incremental annual all-cause health care costs associated with IBS-C were $3,856 ($8,621 for IBS-C patients vs. $4,765 for controls, P less than 0.01) per patient per year, of which 78.1% of the incremental costs were due to medical services, and 21.9% were due to prescription fills. IBS-C imposes a substantial economic burden in terms of direct health care costs in a commercially insured population. Compared with matched controls, IBS-C patients incurred significantly higher total annual all-cause health care costs even after controlling for general and GI-related comorbidities. Incremental all-cause costs associated with IBS-C were mainly driven by costs related to more frequent use of medical services as opposed to prescriptions.

Annual All-Cause Healthcare Costs Among Influenza Patients With and Without Influenza-Related Complications

Several studies have reported that patients with influenza have a high risk of developing complications such as secondary infections, exacerbation of cardiovascular conditions and asthma. However, limited data exists on the healthcare cost burden for influenza patients with and without influenza-related complications. We compared healthcare utilization and costs among influenza patients with related complications versus patients without complications. In this retrospective database analysis (LifeLink database: 1998-2009) of a US managed care database, we selected patients diagnosed with influenza during influenza seasons and categorized them as complicated or uncomplicated based on the presence or absence of a diagnosis for a related complication in the year following their influenza diagnosis. Multivariable regression analyses were conducted to compare all-cause utilization and costs (adjusted to 2009 US dollars) between the two groups. We identified 54,469 patients of which ~65% had evidence for at least one complication. Patients with complicated influenza had a 1.5-fold higher rate of inpatient utilization compared with uncomplicated cases (p<0.001). Significantly higher covariate-adjusted predicted mean annual costs were also observed among complicated influenza patients across all care (p-values <0.001 for all comparisons). Healthcare costs were twice as high among influenza patients with complications versus those without, with inpatient and outpatient services being the primary cost drivers. Now with the universal recommendation for seasonal influenza vaccination for all individuals ≥6months of age, improvement in coverage rates may help reduce the healthcare utilization and costs associated with influenza and associated complications.

A retrospective cohort study of economic outcomes and adherence to monotherapy with metformin, pioglitazone, or a sulfonylurea among patients with type 2 diabetes mellitus in the united states from 2003 to 2005

Objectives: The aims of this study were to compare all-cause total health care costs and diabetes mellitus (DM)-specific health care costs between patients who were adherent or nonadherent to monotherapy with metformin, pioglitazone, or a sulfonylurea and to examine whether cost differences varied among patients using these oral antidiabetic drugs. Methods: This was a retrospective cohort study using data from the MEDSTAT MarketScan Research Databases. Patients aged 18 to 90 years who were continuously insured between 2003 and 2005 and had ≥2 outpatient claims or ≥1 inpatient claim with a diagnosis of DM ( International Classification of Diseases, Ninth Revision, Clinical Modification code 250.xx) in 2003 were eligible for the study. To be part of the final sample, patients had to fill ≥2 prescriptions for metformin, pioglitazone, or a sulfonylurea during 2003, including ≥1 prescription during the last 3 months of the year. Patients were not eligible if they were taking polytherapy or a combination drug. All eligible patients were followed in 2004 and 2005. Adherence was calculated for each year using a medication possession ratio, and was dichotomized at ≥80% as either adherent or nonadherent. Annual all-cause health care costs and diabetes-specific costs were estimated using generalized linear models, adjusting for demographic characteristics, insurance, and comorbid conditions. Results: A total of 108,592 patients who met the inclusion criteria were identified. Their mean age was 63 years; 49.8% (54,037/108,592) were women. More pioglitazone users resided in the north-central or south regions (81.3% [9364/11,520]) compared with metformin (62.4% [32,550/52,156]) or sulfonylurea (62.6% [28,105/44,916]) users ( P < 0.001). Mean comorbidity scores were higher in the sulfonylurea (1.78) and pioglitazone (1.69) group than in the metformin group (1.45) ( P < 0.001). Mean adherence ranged from 61.3% to 73.8% during the 2 years of follow-up. After adjustment, all-cause health care costs were $12,412 annually among adherent patients and $13,258 among nonadherent patients (difference, $846 [95% CI, $747 to $945]). Diabetes-related health care costs were $2230 annually among adherent patients and $2284 among nonadherent patients (difference, $55 [95% CI, $33 to $77]). In specific monotherapy groups, adjusted annual all-cause health care costs were $336 higher (95% CI, $216 to $456) for nonadherent metformin users, $1140 higher (95% CI, $793 to $1486) for nonadherent pioglitazone users, and $1509 higher (95% CI, $1339 to $1679) for nonadherent sulfonylurea users compared with adherent users. Compared with metformin users, sulfonylurea and pioglitazone users had greater adherence-related differences in all-cause health care costs ( P < 0.05). There was no significant difference in diabetes-specific total costs between nonadherent and adherent patients taking metformin (difference, $6; 95% CI, −$31 to $20). Patients who were nonadherent to sulfonylureas had $271 higher (95% CI, $235 to $307) diabetes-specific costs per year than patients who were adherent to sulfonylureas. Patients who were nonadherent to pioglitazone had $433 lower (95% CI, −$516 to −$350) diabetes-specific costs per year than patients who were adherent to pioglitazone. Conclusions: Adherence with metformin, pioglitazone, or a sulfonylurea was associated with overall cost reductions in the patients studied, but these cost reductions varied by monotherapy. Adherence to sulfonylureas or pioglitazone was associated with greater total cost reductions than was adherence to metformin. Health systems that commit resources to improving interventions may be able to achieve a return on investment if adherence to oral antidiabetic agents can be improved.