Annual Direct Healthcare Costs Research Articles

Randomized Controlled Trial Based US Commercial Payor Cost-Effectiveness Analysis of Endoscopic Sleeve Gastroplasty Versus Lifestyle Modification Alone for Adults With Class I/II Obesity.

Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT. We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was assumed. In our base-case analysis over a 5-year time horizon, ESG was cost-effective versus lifestyle modification alone with an incremental cost-effectiveness ratio of $23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons. ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients.

Cost-of-illness changes before and after the diagnosis of systemic lupus erythematosus: a nationwide, population-based observational study in Korea

Abstract Objectives To estimate the direct healthcare cost progression from before to after systemic lupus erythematosus (SLE) diagnosis and to compare healthcare costs by disease severity. Methods Patients with incident SLE diagnosed between 2008 and 2018 were identified from the Korean National Health Insurance database. Annual direct healthcare costs for 5 years before and after SLE were estimated and compared with those of age-, sex- and calendar month-matched (1:4) controls, without SLE. Direct healthcare costs were compared by disease severity of SLE using regression analysis. Results Among 11 173 patients with SLE and 45 500 subjects without SLE, annual direct healthcare costs per person increased in the year before SLE diagnosis and peaked in the first year after diagnosis. They were 7.7-fold greater in the SLE patients than in the subjects without SLE ($5871 vs $759). Severe SLE was associated with 3.284-fold (95% CI: 3.075, 3.507) higher annual costs than mild SLE during the year after diagnosis. Older age (age 60–79 years), lupus nephritis, interstitial lung diseases, and comorbidities such as avascular necrosis and chronic kidney disease were associated with higher annual direct healthcare costs (times [95% CI]) in the first year after diagnosis: age 60–69: 1.119 (1.034, 1.211); age 70–79: 1.470 (1.342, 1.611); lupus nephritis: 1.794 (1.711, 1.881); interstitial lung diseases: 1.435 (1.258, 1.638); avascular necrosis: 6.208 (4.541, 8.487); and chronic kidney disease: 1.858 (1.673, 2.064). Conclusion Patients with SLE incurred significantly higher direct healthcare costs than subjects without SLE during the first year after diagnosis. Disease severity, older age, major organ involvements and comorbidities were associated with increased healthcare costs.

Real‐world use and cost of health and social care services of 18,116 patients living with Alzheimer’s disease

AbstractBackgroundThe increasing prevalence of Alzheimer’s disease (AD) will substantially impact health and social care systems worldwide. In this study, we aimed to estimate the real‐world use and cost of health and social care services in a large cohort of AD patients in the United Kingdom.MethodWe conducted a retrospective cohort study using Discover‐NOW, a real‐world database containing linked primary and secondary care electronic health records of people living in North‐West London, England. A total of 18,116 patients diagnosed with AD were followed from first observed AD diagnosis to end of patient follow up, within the time window from 1 January 2010 to 31 December 2021. The baseline prevalence of 33 comorbidities, survival duration, health and social care resource utilisation and total direct health and social care costs (in 2019 terms) were estimated.ResultOf 18,116 patients with AD, 8,970 (50%) used social care after diagnosis. Most patients using social care were female (65% vs 62% in the general AD population) and were a similar age at diagnosis (median 82 years) compared to those who did not. Of the patients with social care utilisation, 5,248 (59%) resided in care homes and 2,636 (29%) received domiciliary care at home. Annual direct social and health care costs for each patient receiving social care were £25,664 and £6,248 respectively, constituting an annual total cost of £31,912. Median survival from time of AD diagnosis was 4.9 years in the general AD population and 1.9 years after care home admission. Patients who entered care homes, entered at a median age of 85 years and had higher baseline prevalence of stroke (11% vs 7%), chronic kidney disease (40% vs 35%), and atrial fibrillation (17% vs 13%) than the general AD population.ConclusionIn AD patients who used social care, social care costs were >4 times other healthcare costs. Slowing or delaying the requirement for social care would have a major impact on reducing the societal and economic burden of AD on patients and society.

PP140 Burden of Illness And Health Care Costs In People with Alzheimer’s Disease

IntroductionAlzheimer’s disease (AD), the most common cause of dementia, is becoming increasingly prevalent worldwide. Understanding the current burden of AD is important in health economic evaluations of new therapies. We aimed to estimate the burden of illness, and healthcare costs of people living with AD using a large, comprehensive real-world database in England.MethodsA retrospective cohort study was undertaken in the Discover-NOW dataset, a real-world database containing the linked primary and secondary care electronic health records of ˜3 million people living in North West London, England. Patients diagnosed with AD were followed from the later of 1 January 2010 or AD diagnosis date, to the earlier of 31 December 2021 or end of follow up (maximum 10 years). Baseline prevalence of 33 comorbidities, incidence of 7 outcomes (survival, cardiovascular, care home admission, hepatic and renal outcomes), healthcare resource utilisation and total direct healthcare costs (using National Health Service tariffs and unit cost approaches) were calculated.ResultsOf 18,116 patients diagnosed with AD, at baseline the mean age was 81 years, 62 percent were female, 65 percent were White, 16.5 percent Asian and 8.9 percent Black. At baseline, hypertension prevalence was 60.2 percent, chronic kidney disease 35.5 percent and Type 2 diabetes 22.4 percent. The highest incidence rates across these outcomes were 13.4 (95% confidence interval [CI]:12.2,14.7) per 1,000 person years for stroke, 7.5 (95% CI: 6.6, 8.5) for myocardial infarction, and 83.6 (95% CI: 80.1, 87.0) for care home admission. Median survival was 4.9 years from diagnosis. Their annual total direct healthcare cost was GBP4,547 per patient, of which 58 percent were from hospital admissions. The majority (75%) of healthcare contacts were from primary care. AD patients had an average length of stay of 11.5 days per inpatient admission, and spent on average one week per year as inpatients.ConclusionsAD is associated with high direct healthcare costs, with patients’ annual costs ˜1.7 times that of the UK population. The majority of these costs are associated with inpatient hospital admissions.

Socio-economic burden of cystic fibrosis in Europe: a systematic review of cost of illness evidence

Abstract Background Cystic Fibrosis (CF) is one of the most prevalent severe genetic diseases, with a high economic impact on healthcare systems due to its complexity. The life expectancy of CF patients has substantially lengthened due to early diagnosis and improvements in therapeutic regimens with Cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Therefore, strategies to ensure equitable access to these treatments should be optimized. Our study aimed to summarize existing literature regarding the costs of CF in Europe. Methods A systematic literature review was performed querying three online database (PubMed, Scopus, Web of Science) from January 2013 to March 2023. Studies carried out in European countries, written in English language, and focused on the socio-economic burden of CF were selected. Results Overall, 11 studies were considered. Across countries, the average total annual cost for a CF patient amounted to €14.174,00-53.256,00, higher for children (€15.771-60.412,00) compared to adults (€15.714-€47.217,00). The largest expenditures were recorded for annual direct healthcare costs, which amounted, per patient, to €9861,00-28.827,00, followed by direct non-healthcare costs (€4512,00-18.329,00). For adults, drugs, tests, and hospitalizations represented the primary cost drivers of direct healthcare costs, while for children, direct non-healthcare costs, especially for caregivers, were predominant. Moreover, indirect costs, whose main expenses were related to productivity loss and early retirement, ranged between €1,094-12,443 per patient per year. Conclusions The CF management is associated with relevant costs. CFTR modulators represent an important therapeutic opportunity of reducing the clinical and economic burden of CF. Therefore, new evidence and value-based economic evaluations, that also take into account a social perspective, are needed to support the decision-making process. Key messages • The use of new health economic models is needed to guide the policy-makers in a value-based evaluation of Cystic Fibrosis treatments that take into account their whole value. • The assessment of the socio-economic burden of Cystic Fibrosis could guide the identification of the main actions to be implemented to respond adequately to the real health needs of patients.

Predicting direct healthcare costs of general practitioner-guided care in patients with musculoskeletal complaints.

Information on healthcare utilization and costs of general practitioner (GP)-guided care in patients with musculoskeletal complaints is important for keeping healthcare affordable and accessible. A registry-based study was performed to describe healthcare utilization and costs of GP-guided care in patients with musculoskeletal complaints and to predict having higher direct healthcare costs. Healthcare costs of GP-guided care included all healthcare resources used by patients due to a musculoskeletal condition in 2018. Data were extracted from the database with a 1-year follow-up and descriptively analyzed. A general linear model was developed to predict having higher direct healthcare costs. In total, 403,719 patients were included, of whom 92% only received a single consultation. The number of referrals varied across the different types of complaints. Total annual direct healthcare costs amounted to €39,180,531, of which a key cost driver was referrals. Primary care consultations accounted for the largest part of referral-related costs. For all musculoskeletal conditions combined, the mean annual direct healthcare cost per patient was €97 (SEM = €0.18). Older age, being a woman, low socioeconomic status, spine complaints, high number of musculoskeletal diagnoses, and a high comorbidity score were predictive of having higher direct healthcare costs and explained 0.7% of the variance. This study showed that mean annual direct healthcare costs of GP-guided care in patients with musculoskeletal conditions were relatively low and did not differ considerably across conditions. The predictive model explained a negligible part of the variance in costs. Thus, it is unclear which factors do predict high direct healthcare costs in this population.

PS-C36-6: REAL-WORLD ANALYSIS OF ADHERENCE, OUTCOMES AND HEALTHCARE COSTS OF THE QUADRUPLE COMBINATION PERINDOPRIL, INDAPAMIDE, AMLODIPINE AND BISOPROLOL IN ITALY

Objective: this real-world analysis aimed to evaluate drug utilization, outcomes and direct healthcare costs in hypertensive patients treated with the combination of perindopril, indapamide, amlodipine and bisoprolol (PER/IND/AML/BIS) in Italy. Design and method: a retrospective analysis was performed using administrative databases covering approximately 7 million health-assisted Italian subjects. Adults prescribed with PER/IND/AML/BIS in free combination during 2018 were included. Index date corresponded to first prescription date of the four drugs (prescribed within 30 days). Follow-up was 1 year after index date; patients who died during this period were excluded. Drug utilization was evaluated as adherence (proportion of days covered (PDC): PDC < 40% non-adherence; PDC = 40–79% partial adherence; PDC> = 80% adherence); persistence/interruption (presence/absence of PER/IND/AML/BIS in last trimester of follow-up); add-on (new antihypertensive agent added to PER/IND/AML/BIS), switch (change of at least 1 among PER/IND/AML/BIS). Outcomes [i.e. incidence rate per 1,000-person/year of death and cardiovascular (CV) events] and mean annual direct healthcare costs (related to all-cause drugs, hospitalizations and outpatient services) covered by National Health Service, were evaluated. Results: A total of 5,677 patients (50.6% male, mean age 70 years) had a prescription of the antihypertensive drugs PER/IND/AML/BIS. 98.5% had a history of cardiovascular diseases and 35.2% had diabetes. During first year of follow-up, 44% of patients were adherent to PER/IND/AML/BIS, 24% partially adherent, 32% non-adherent. A higher proportion of adherent patients was found among those receiving PER/IND/AML/BIS in 2 pills compared to 3 pills (45.4% and 30.2%, p < 0.001). Among all patients, 682 (12%) received additional antihypertensive treatment to PER/IND/AML/BIS, while 761 (13%) had at least one switch. Switch of therapy was around 5-times more frequent among non-adherent patients (25.3% vs 5.1%, p < 0.001). 53% of patients were persistent to PER/IND/AML/BIS while 47% had an interruption. In adherent patients, a significant reduction of the incidence rate of death and CV events was found (62.7/1,000-person/year) compared to non-adherent and partially-adherent (88.1 and 76.8/1,000-person/year, respectively, p < 0.001). Mean total individual annual direct cost was higher for non-adherent (euro 2,456) compared to adherent (euro 2,071), with hospitalization costs almost 2-fold higher in non-adherent patients (euro 918 vs euro 456, p < 0.001). Conclusions: This analysis provides real-world evidence on sub-optimal adherence and persistence in patients treated concomitantly with four antihypertensive drugs in Italy. In non-adherent patients, higher incidence of CV events and higher healthcare costs were reported. Better adherence was observed when fewer pills were taken. Further strategies to improve treatment adherence, especially in poly-medicated patients, are needed.

A Comprehensive Report of German Nationwide Inpatient Data on the Post-COVID-19 Syndrome Including Annual Direct Healthcare Costs.

The aim of this study was to provide a comprehensive overview of German nationwide data including (i) the number of hospitalized Post-COVID Syndrome (PCS) cases including in-hospital mortality rates and intensive care unit treatments, (ii) the main common concomitant diagnoses associated with PCS, (iii) the most frequently performed treatment procedures, and (iv) the annual direct healthcare costs. The incidence was calculated based on annual ICD-10 diagnosis codes "U09.9!, Post-COVID-19 condition". Data on concomitant diagnoses, treatment procedures, treatment in an intensive care unit (ICU), in-hospital mortality, the proportion of G-DRGs, and cumulative costs were assessed based on the Institute for the Hospital Remuneration System (InEK) data for 2019. A total of 29,808 PCS inpatients could be identified yielding a prevalence of 5.5%. In total, 1330 (4.5%) in-hospital deaths were recorded, and 5140 (17.2%) patients required ICU treatment. The majority of patients (18.6%) were aged 65-74 years. The most common concomitant diagnoses included pneumonia, critical illness polyneuropathy, dyspnea, chronic fatigue syndrome, and pulmonary embolisms. The most frequently performed procedures were computed tomography of the thorax with contrast medium, whole-body plethysmography, and the monitoring of respiration, heart, and circulation. The cost per case of the G-DRG codes that were analyzed ranged from € 620 ± 377 (E64D, Respiratory insufficiency, one day of occupancy) to € 113,801 ± 27,939 (A06B, Ventilation > 1799 h with complex OR procedure). Total cumulative direct healthcare costs of € 136,608,719 were calculated, resulting in mean costs of € 4583 per case. Post-COVID Syndrome is of major public health importance with substantial financial implications. The present article can support stakeholders in health care systems to foresee future needs and adapt their resource management. Consensus diagnostic criteria and rehabilitation guidelines are highly warranted.

Direct and indirect costs, early retirement, cardiovascular events and mortality in more than 50,000 adults with chronic heart failure in Sweden: a matched case-control study

Abstract Introduction Chronic heart failure (CHF) is a progressive condition that requires long-term treatment for symptom management; it is associated with reduced physical functioning and quality of life, and increased mortality. Real-world data from population-based registries can be used to quantify CHF impact on both individuals and healthcare systems. Purpose To examine the progression of direct and indirect healthcare costs, cardiovascular (CV) outcomes and mortality over 5 years in people with CHF and matched controls in Sweden. Methods In this closed cohort study, adults (aged ≥18 years) living in Sweden on 1/1/2012 were identified in an existing database,1,2 and those with CHF (≥1 inpatient admission/outpatient visit with a main or sub-diagnosis of heart failure in the National Patient Register [1997–2011]) were propensity score matched to controls without CHF by birth year, sex and educational status. Study variables included costs of selected hospital-based care and prescription drugs, and mortality from the National Board of Health and Welfare; demographic and socioeconomic information from Statistics Sweden; and work absences from Försäkringskassan (Swedish Social Insurance Agency). We compared annual and cumulative direct healthcare costs (inpatient, outpatient and drug costs) and indirect costs from lost productivity, and analysed risks of stroke, myocardial infarction (MI), early retirement, and mortality. Results After matching, there were 53,520 individuals in each cohort. Demographic characteristics were well matched (Table). Over 5 years (2012–2016), cumulative direct costs for people with CHF were four- to fivefold higher than those for controls (2012: €5477/€971; 2013: €10 074/€1986; 2014: €14,009/€2976; 2015: €17 622/€3950; 2016: €20,723/€4942); cumulative indirect costs were at least 2.5 times higher (2012: €5419/€2144; 2013: €10,524/€4047; 2014: €15,215/€5735; 2015: €19,595/€7285; 2016: €23,732/€8646). In people with CHF, inpatient costs comprised 78% of total annual mean direct costs over follow-up (€3995/€5144). Outpatient costs contributed 15% (€763) and drug costs contributed 8% (€386) of total annual direct costs. In controls, these were 71% (€808), 18% (€209) and 11% (€124), respectively, of total annual mean direct costs (€1141). People with CHF were significantly more likely than controls to experience stroke (hazard ratio [HR]: 1.61 [95% confidence interval (CI): 1.51–1.71]) or MI (1.75 [1.65–1.87]). All-cause mortality was nearly threefold higher (2.89 [2.80–2.98]) and the risk of early retirement was nearly fourfold higher (3.79 [3.16–4.53]). During follow-up, 31.3% (n=16,766) of people in the CHF cohort died, compared with 10.1% (n=5426) of controls (Figure). Conclusions This analysis demonstrates the considerable impact of CHF, in terms of risk of CV events and death, early retirement and healthcare costs. Inpatient admissions and lost productivity were major contributors to economic costs. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This study was supported by a grant from Novo Nordisk A/S to the Swedish Institute for Health Economics. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK, with funding from Novo Nordisk A/S.

Economic burden of atherosclerotic cardiovascular disease: costs related to healthcare and loss of productivity; a matched case-control study in more than 450,000 Swedish individuals

Abstract Introduction Atherosclerotic cardiovascular disease (ASCVD) is associated with significant morbidity and mortality. We aimed to quantify the impact of ASCVD on healthcare costs, risk of cardiovascular (CV) events and mortality. Purpose To examine the progression of direct healthcare costs, indirect costs and other outcomes over 5 years in people with ASCVD and matched controls in Sweden. Methods In this 5-year retrospective closed cohort study, adults (aged ≥18 years) living in Sweden on 1/1/2012 were identified in an existing database,1,2 and those with ASCVD (≥1 inpatient admission/outpatient visit with a main or sub-diagnosis relating to stroke, ischaemic heart disease or peripheral artery disease, or procedure codes related to revascularization or amputation, in the National Patient Register [1997–2011]) were propensity score matched to controls without ASCVD by birth year, sex and educational status. Study variables included costs of selected hospital-based care and prescription drugs, and mortality from the National Board of Health and Welfare; demographic and socioeconomic information from Statistics Sweden; and work absences from Försäkringskassan (Swedish Social Insurance Agency). We compared annual direct healthcare costs (inpatient, outpatient and drug costs) and indirect costs from lost productivity, and analysed risks of early retirement, stroke, myocardial infarction and mortality. Hazard ratios (HRs) were estimated using Cox proportional regression adjusted for baseline age, sex, comorbidities, education and marital status. Results Individuals with ASCVD (N=231,417) had similar ages, sex distribution and education to matched controls, but were more likely to have T2D or renal disease (Table). Over the 5-year study period, average annual total direct and indirect costs for people with ASCVD were 2.5 times higher than in controls; direct healthcare costs in the ASCVD group were three times those for controls (Figure). In both groups, indirect costs accounted for nearly two-thirds of total costs. In the ASCVD group, inpatient costs comprised 74% of total direct costs, whereas outpatient costs and drug costs contributed 15% and 11%. In controls, total direct costs were made up of 70% inpatient costs, 18% outpatient costs and 12% drug costs. All-cause mortality was 72% higher in people with ASCVD than in controls (HR: 1.72 [95% confidence interval: 1.69–1.75]). Individuals with ASCVD were also more likely than controls to experience stroke (HR: 1.89 [1.83–1.95]), myocardial infarction (HR: 2.33 [2.26–2.41]) and early retirement (HR: 3.04 [2.78–3.33]). Conclusions Individuals with ASCVD incurred more than 2.5 times the total costs of matched controls, and had a greater risk of death, CV events and early retirement. Effective measures to prevent ASCVD and to slow its progression could limit these substantial burdens for individuals, healthcare systems and society. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): This study was supported by a grant from Novo Nordisk A/S to the Swedish Institute for Health Economics. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK, with funding from Novo Nordisk A/S.

Direct healthcare costs of Rome IV or Rome III‐defined irritable bowel syndrome in the United Kingdom

SummaryBackgroundPrevious studies have demonstrated a substantial economic impact of irritable bowel syndrome (IBS).AimsTo provide contemporaneous estimates of direct healthcare costs of IBS in the United Kingdom.MethodsWe collected demographic, gastrointestinal and psychological symptoms, quality of life and healthcare usage data from adults with Rome IV or Rome III IBS in the United Kingdom. We calculated the mean annual direct healthcare costs of IBS per person and used contemporaneous IBS prevalence data, together with census data, to estimate annual direct costs of IBS. We also examined predictors of higher costs.ResultsThe mean annual direct cost of IBS per person among 752 individuals with Rome IV IBS was £556.65 (SD £1023.92) and £474.16 (SD £897.86) for 995 individuals with Rome III IBS. We estimate the annual direct healthcare cost of IBS in the United Kingdom is £1.27 billion if the Rome IV criteria are used to define IBS, and £2.07 billion using Rome III. Among individuals with Rome IV IBS, mean annual costs were higher in those with opiate use (£907.90 vs £470.58, p < 0.001), more severe symptoms (p < 0.001 for trend), a shorter duration of IBS (1 year, £1227.14 vs >5 years £501.60, p = 0.002), lower quality of life (p < 0.001 for trend), and higher depression, somatisation and gastrointestinal symptom‐specific anxiety scores (P < 0.001 for trend for all).ConclusionWe estimate annual direct healthcare costs of IBS of between £1.3 and £2 billion in the United Kingdom.

Rising Healthcare Costs and Utilization among Young Adults with Cirrhosis in Ontario: A Population-Based Study.

Objectives Chronic diseases account for the majority of healthcare spending. Cirrhosis is a chronic disease whose burden is rising, especially in young adults. This study aimed at describing the direct healthcare costs and utilization in young adults with cirrhosis compared to other chronic diseases common to this age group. Methods Retrospective population-based study of routinely collected healthcare data from Ontario for the fiscal years 2007–2016 and housed at ICES. Young adults (aged 18–40 years) with cirrhosis, inflammatory bowel disease (IBD), and asthma were identified based on validated case definitions. Total and annual direct healthcare costs and utilization were calculated per individual across multiple healthcare settings and compared based on the type of chronic disease. For cirrhosis, the results were further stratified by etiology and decompensation status. Results Total direct healthcare spending from 2007 to 2016 increased by 84% for cirrhosis, 50% for IBD, and 41% for asthma. On a per-patient basis, annual costs were the highest for cirrhosis ($6,581/year) compared to IBD ($5,260/year), and asthma ($2,934/year) driven by acute care in cirrhosis and asthma, and drug costs in IBD. Annual costs were four-fold higher in patients with decompensated versus compensated cirrhosis ($20,651/year vs. $5,280/year). Patients with cirrhosis had greater use of both ICU and mental health services. Conclusion Healthcare costs in young adults with cirrhosis are rising and driven by the use of acute care. Strategies to prevent the development of cirrhosis and to coordinate healthcare in this population through the development of chronic disease prevention and management strategies are urgently needed.

Health care costs higher for people with unrecognized depression

Annual direct health care costs for people who did not recognize their symptoms of depression average 149% higher than the average of people with no symptoms of depression, according to a recent analysis conducted by Happify Health, a clinical‐grade technology company.

US health care utilization and costs in adult patients with atopic dermatitis by disease severity.

BACKGROUND: Although previous studies have reported the economic burden of atopic dermatitis (AD) in adults, updates are needed using more current data and measure of disease severity. OBJECTIVE: To describe the health care resource utilization (HCRU) and associated costs in US adults diagnosed with AD overall and by disease severity. METHODS: This real-world retrospective study identified adults aged at least 18 years who received a clinical diagnosis of AD in a dermatology electronic medical record (EMR) database between 2016 and 2018 (first record = index date), which was linked to an administrative claims database. Patients were required to have an AD diagnostic code and at least 6 months of continuous enrollment in medical and pharmacy benefits before and after the index date. Baseline severity was assessed using the Physician Global Assessment score closest to the index date. Inpatient and outpatient services, visits to specialists and its seasonality, treatment use, and associated annual direct health care costs were reported using descriptive statistics. RESULTS: Annual all-cause direct health care costs were $10,474 per patient per year and primarily driven by outpatient visits and pharmacy use. Compared with patients with clear to mild disease, more AD patients with severe disease had at least 1 dermatology (73.0% vs 58.5%) and allergy/immunology office visit (16.0% vs 5.5%) and AD-related medications (90.0% vs 64.3%). All-cause total annual costs in patients with severe disease ($23,242) were significantly higher than in patients with clear to mild disease ($8,936; P = 0.0002). Little seasonal variation in dermatology office visits was observed. CONCLUSIONS: Significant economic burden primarily driven by outpatient and pharmacy utilization was observed in AD patients, which increased with disease severity. DISCLOSURES: This work was sponsored by Eli Lilly and Company. Gorritz and Wade are employees of IQVIA, which was contracted by Eli Lilly and Company to conduct this study and develop the manuscript. Wang was employed by IQVIA at the time of this study. Malatestinic and Goldblum are employees and stockholders of Eli Lilly and Company. Boytsov was an employee of Eli Lilly at the time of this research.

Pain-related health care costs for long-term care residents

BackgroundWe tested for differences in direct health care costs among long-term care (LTC) residents age 65 and older with clinically significant pain (CSP) and with no pain or non-daily mild pain (NP/NDMP). We are not aware of any other large scale investigation that examined the cost of pain in LTC environments.MethodsPopulation-based administrative health data from Saskatchewan, Canada for 2004 to 2015 were used to compare direct health care costs for CSP and NP/NDMP groups up to one year after admission to LTC. Total accumulated costs for hospitalization, physician services, LTC, and prescription drugs were calculated in 2015 Canadian dollars. Group differences were tested using generalized linear models with generalized estimating equations.ResultsAmongst 24,870 LTC residents, 8289 (33.3%) were censored due to death or discharge in the 365-day study observation period. Of the 16,581 (66.7%) observed residents, 5683 (34.3%) had CSP at admission. Residents (66.3% female) had a mean age of 85 years (SD = 7.4). The mean annual total direct health care cost per resident was higher among the CSP group (CAD $8063) than the NP/NDMP group (CAD $6455). This difference was found even after including LTC costs, and for each cost component (i.e., CSP residents had higher hospitalization, physician, and prescription drug costs). Similar results were obtained after controlling for demographics, comorbidities, physical and cognitive impairment, prior health care costs, and facility characteristics.ConclusionThe higher costs incurred by CSP residents compared to NP/NDMP residents are likely underestimated because pain problems are often missed in residents with dementia, who comprise a large portion of the LTC population. Improved pain care can reduce such costs and improve quality of life.

MO545INSIDE ANEMIA OF CKD: ESTIMATING THE IMPACT OF POLICY INTERVENTIONS ON ANAEMIA OF CKD IN THE USA BY MICROSIMULATION MODELLING

Abstract Background and Aims Anaemia is a common complication in patients with chronic kidney disease (CKD) and is associated with increased mortality, cardiovascular complications, reduced quality of life and increased use of healthcare resources. Mathematical modelling based on robust epidemiological and clinical data is a useful approach for predicting the future burden of disease and the impact of different intervention scenarios; this is important for health service planning. This analysis uses a microsimulation model, Inside ANEMIA of CKD, to predict the effects of a hypothetical intervention scenario that reduces the prevalence of anaemia of CKD on related healthcare costs in the USA from 2020 to 2025. Method A virtual cohort representing the US population was created within the Inside ANEMIA of CKD microsimulation model framework using demographics and epidemiological data drawn from the US Census Bureau, the Centers for Disease Control and Prevention, and the National Health and Nutrition Examination Survey. In the cohort, virtual individuals were ascribed an age–sex-stratified CKD status (defined by estimated glomerular filtration rate and albuminuria levels, as per international guidelines) and anaemia status (defined by haemoglobin level as mild, moderate or severe, as per WHO criteria) based on US prevalence data. Key comorbidities (type 2 diabetes, heart failure and hypertension) were also assigned, reflecting US-specific population statistics. Healthcare costs related to CKD and anaemia of CKD were taken from the published literature. The study modelled the effects on healthcare costs of a hypothetical intervention scenario in which the prevalence of moderate and severe anaemia is reduced by 20% per year from 2020 to 2025 compared with no intervention (baseline). In each scenario (i.e. intervention or baseline), the modelling analysis estimated healthcare costs related to CKD and anaemia (including inpatient, outpatient, pharmacy costs) for patients with moderate or severe anaemia of CKD. The model did not adjust for the potential costs of the intervention. Results Preliminary results predict that, with the hypothetical intervention, there could be 1.40 million fewer patients with moderate or severe anaemia of CKD in the USA in 2025 compared with no intervention (1.45 million versus 2.85 million). This represents a 49% reduction in cases of moderate or severe anaemia of CKD in 2025 with the intervention versus no intervention. The intervention is projected to lead to a reduction of approximately US$18 billion in annual direct healthcare costs in 2025 for patients with moderate or severe anaemia of CKD compared with no intervention (US$26 billion versus US$44 billion). Conclusion The Inside ANEMIA of CKD microsimulation model predicts that a hypothetical intervention which reduces the prevalence of moderate and severe anaemia of CKD would reduce direct healthcare costs. This suggests that interventions effective at reducing the prevalence of anaemia of CKD would help to reduce the economic burden on healthcare services.

MO549INSIDE ANEMIA OF CKD: MICROSIMULATION MODELLING OF THE IMPACT OF POLICY INTERVENTIONS ON ANAEMIA OF CKD IN CANADA

Abstract Background and Aims Anaemia is common in patients with chronic kidney disease (CKD) and is associated with increased mortality, cardiovascular complications, reduced quality of life and increased use of healthcare resources. Based on robust epidemiological and clinical data, mathematical modelling is a useful approach for predicting the future burden of disease and the effects of different intervention scenarios, which is essential for health service planning. This analysis uses a microsimulation model, Inside ANEMIA of CKD, to project the impact of a hypothetical intervention scenario that reduces the prevalence of anaemia of CKD on related healthcare costs in Canada from 2020 to 2025. Method A virtual cohort representing the Canadian population was created within the Inside ANEMIA of CKD microsimulation model framework using national demographics and epidemiological data drawn from Statistics Canada and a provincial renal database. In the cohort, virtual individuals were ascribed an age- and sex-stratified CKD status (defined by estimated glomerular filtration rate and albuminuria levels, as per international guidelines) and anaemia status (defined as mild, moderate or severe based on haemoglobin level, as per WHO criteria) based on Canadian prevalence data. Key comorbidities (type 2 diabetes, heart failure and hypertension) were also assigned, reflecting Canada-specific population statistics. Costs related to the treatment of CKD were taken from the published literature, and are shown in Canadian dollars (C$). This modelling analysis evaluated the effects on healthcare costs of a hypothetical intervention scenario in which the prevalence of moderate and severe anaemia is reduced by 20% per year from 2020 to 2025 compared with no intervention (baseline). In each scenario (i.e. intervention or baseline), the modelling analysis estimated CKD-related healthcare costs for patients with moderate or severe anaemia of CKD. The modelling analysis did not adjust for the potential costs of the intervention. Results Preliminary results predict that, with the hypothetical intervention, there could be approximately 435,000 fewer patients with moderate or severe anaemia of CKD in Canada in 2025 compared with no intervention (approximately 497,000 versus 932,000). The intervention is projected to lead to a reduction of C$4.4 billion in annual direct healthcare costs in 2025 for patients with moderate or severe anaemia of CKD compared with no intervention (C$9.1 billion versus C$13.5 billion), assuming that all eligible patients are diagnosed and treated. Conclusion The Inside ANEMIA of CKD microsimulation model predicts that a hypothetical intervention which reduces the prevalence of moderate and severe anaemia of CKD would produce reductions in direct healthcare costs. This suggests that interventions effective at reducing the prevalence of anaemia of CKD would help to reduce the economic burden on healthcare services.

ECONOMIC BURDEN OF CARDIOVASCULAR DISEASES ASSOCIATED WITH TOBACCO USE IN THE RUSSIAN FEDERATION IN 2016

Abstract Objective: To estimate the economic burden of cardiovascular diseases (CVD) associated with tobacco use in the Russian Federation (RF) in 2016, including the direct costs and the economic losses caused by reduced productivity. Design and method: The prevalence of tobacco use in the Russian population was determined in a ESSE-RF epidemiological study - 23.6%. The relative risks (RRs) of morbidity and mortality from CVD associated with tobacco use were identified through meta-analyzes and large studies. Based on the data on the prevalence of tobacco use in the Russian population and relative risks (RRs), the population attributable fractions (PAFs) was calculated for CVD. Associations were presented as RRs and PAFs with 95% CIs. PAF (%) = (P_exp (RR-1))/([P_exp (RR-1)] + 1), where: P_exp - the proportion of individuals in a population who are exposed to tobacco; RR - the relative risk of a specific outcome for a given exposure to a risk factor; To assess the economic burden, the proportion of the analyzed risk factor in the morbidity and mortality from CVD was determined, and then the proportion in the economic burden of the CVD. Then we estimated attributable costs by multiplying PAFs outcomes with estimated 2016 annual direct health care and indirect costs for CVD. We used data from the Federal State Statistics Service, parameters of Annual Forms of Federal Statistical Monitoring, the results of Program of state guarantees for free medical care and the corresponding diagnosis-related groups for 2016. The calculations were performed in Microsoft Excel 10.0. (Microsoft, USA). Results: The calculated PAFs, associated with tobacco use, for CVD mortality and morbidity was 13% and 9%, respectively. Economic burden of CVD associated with tobacco use in 2016 in the RF reached 335 billion rubles (4.7 billion €). The losses in the economy due to premature mortality (313.8 billion rubles) prevail in the structure of the main burden. Estimated direct costs were responsible up to 21 billion rubles. Conclusions: The significant economic burden associated with cardiovascular diseases provides an economic rationale for action to reduce the prevalence of lifestyle-related risk factors.

Increasing Prevalence and Direct Health Care Cost of Inflammatory Bowel Disease Among Adults: A Population-Based Study From a Western Canadian Province.

ObjectivesOur study aimed to calculate the prevalence and estimate the direct health care costs of inflammatory bowel disease (IBD), and test if trends in the prevalence and direct health care costs of IBD increased over two decades in the province of Saskatchewan, Canada.MethodsWe conducted a retrospective population-based cohort study using administrative health data of Saskatchewan between 1999/2000 and 2016/2017 fiscal years. A validated case definition was used to identify prevalent IBD cases. Direct health care costs were estimated in 2013/2014 Canadian dollars. Generalized linear models with generalized estimating equations tested the trend. Annual prevalence rates and direct health care costs were estimated along with their 95% confidence intervals (95%CI).ResultsIn 2016/2017, 6468 IBD cases were observed in our cohort; Crohn’s disease: 3663 (56.6%), ulcerative colitis: 2805 (43.4%). The prevalence of IBD increased from 341/100,000 (95%CI 340 to 341) in 1999/2000 to 664/100,000 (95%CI 663 to 665) population in 2016/2017, resulting in a 3.3% (95%CI 2.4 to 4.3) average annual increase. The estimated average health care cost for each IBD patient increased from $1879 (95%CI 1686 to 2093) in 1999/2000 to $7185 (95%CI 6733 to 7668) in 2016/2017, corresponding to an average annual increase of 9.5% (95%CI 8.9 to 10.1).ConclusionsOur results provide relevant information and analysis on the burden of IBD in Saskatchewan. The evidence of the constant increasing prevalence and health care cost trends of IBD needs to be recognized by health care decision-makers to promote cost-effective health care policies at provincial and national levels and respond to the needs of patients living with IBD.

English hospital episode data analysis (1998\u20132018) reveal that the rise in dog bite hospital admissions is driven by adult cases

Dog bites are a global health issue that can lead to severe health outcomes. This study aims to describe the incidence and sociodemographics of patients admitted to English National Health Service (NHS) hospitals for dog bites (1998–2018), and to estimate their annual direct health care costs. An analysis of patient level data utilising hospital episode statistics for NHS England, including: temporal trends in annual incidence of admission, Poisson models of the sociodemographic characteristics of admitted patients, and direct health care cost estimates. The incidence of dog bite admissions rose from 6.34 (95%CI 6.12–6.56) in 1998 to 14.99 (95%CI 14.67–15.31) admissions per 100,000 population in 2018, with large geographic variation. The increase was driven by a tripling of incidence in adults. Males had the highest rates of admission in childhood. Females had two peaks in admission, childhood and 35–64 years old. Two percent (2.05%, 95%CI 0.93–3.17) of emergency department attendances resulted in admission. Direct health care costs increased and peaked in the financial year 2017/2018 (admission costs: £25.1 million, emergency attendance costs: £45.7million). Dog bite related hospital admissions have increased solely in adults. Further work exploring human–dog interactions, stratified by demographic factors, is urgently needed to enable the development of appropriate risk reduction intervention strategies.