Annual Health Care Costs Research Articles

Demographic and Socioeconomic Differences in Outpatient Ophthalmology Utilization in the United States

The purpose was to assess differences in outpatient ophthalmologic usage based on patient characteristics such as race/ethnicity, income, insurance type, geographical region, and educational attainment. Retrospective cross-sectional study. The Medical Expenditure Panel Survey (MEPS) is a nationally representative data set for the noninstitutionalized population cosponsored by the Agency for Healthcare Research. This study involved 183,054 MEPS respondents from 2007 to 2015. Primary outcome measure was patient utilization of outpatient ophthalmologic care. Secondary outcome measure was annual health care use and costs by patients in outpatient, inpatient, and the emergency department settings based on race. Overall, 21,673 participants self-reported an ophthalmologic condition, and 12,462 had at least 1 outpatient ophthalmologic visit. Hispanic (adjusted odds ratio [aOR] 0.72; P < .001) and black patients (aOR 0.74; P < .001) had fewer outpatient visits than their non-Hispanic white counterparts. Uninsured (aOR 0.41; P= .009) and Medicare/Medicaid (aOR 0.92; P < .001) patients had less outpatient care than their privately insured counterparts. Increasing income and education was associated with higher outpatient ophthalmologic care utilization. In the emergency department, non-Hispanic white patients had the least encounters (1.1 per 100 patients) and highest costs ($25,314.05) when compared to non-Hispanic black patients (3.2 encounters per 100 patients and $10,780.22 respectively) and Hispanic patients (2.2 encounters per 100 patients and $9,837.03 respectively). This study's findings demonstrate differences in outpatient ophthalmologic utilization based on demographic and socioeconomic characteristics. Concurrently, minority Americans had more ophthalmic emergency department visits but lower cost per visit. There is a need to further characterize these differences to predict future ophthalmologic care needs.

The validity of VALID act: Cost modeling cancer diagnostics regulation by the FDA.

e14124 Background: VALID Act is a bipartisan draft legislation proposing to ensure the quality and safety of diagnostic tests through direct FDA oversight. Currently, FDA exercises enforcement discretion and exempts from premarket review tests that are developed and used in the same clinical laboratory. Many stakeholders have pointed out that the lack of direct FDA oversight has led to erroneous results that have serious patient consequences. However, the maintenance cost after the implementation of the Act is unknown. Thus, we estimate the additional financial burden of genotyping all new late stage cancer patients under a fully implemented VALID Act precertification framework. Methods: Based on our laboratory with 36 high-complexity clinical assays, we modeled the cost increase by dividing the total anticipated cost for annual FDA precertification by our 2019 patient volume. To model the stringency of complying with the Act, we calculated either 3, 6, or 9 assays as representative of the laboratory’s test complexity. To make the estimated additional annual national healthcare cost relatable, we expressed the increase as a distributed cost per newly diagnosed late stage cancer patient in 2019 (NCI SEER) or per employed person in 2019 (Bureau of Labor Statistics). Results: FDA precertification for 3 assays was estimated at $638,310.13, or when divided by our annual late stage patient volume (n = 10,232), an increased cost of $62.38/patient. Precertification for 6 or 9 assays costs $684,751.60 (+$66.92/patient) or $1,253,717.25 (+$122.53/patient), respectively. If only 1 cancer center per state/DC/PR got precertified (n = 52), multiplied by the cost of precertifying 3 assays, then the annual national healthcare cost would increase by $33,192,126.50, or +$42.37/new late stage patient (n = 783,476) or +$0.21/employed (n = 158,803,000). Precertification for 52 centers for 6 or 9 assays would cost $35,607,083.20 (+$45.45/patient, +$0.22/employed) or $65,193,297.00 (+$83.21/patient, +$0.41/employed), respectively. Nationally, there are ~886 centers and the increased cost was estimated at &lt; $7/employed. Even though the VALID Act will affect more than late stage cancer patients, thus costs will vary, our data show how a specific change of the Act will impact oncology practice. Conclusions: We provided a concrete cost model for late stage cancer patients under the proposed VALID Act. Cost modeling is important in informing the balanced legislative language needed to ensure patient access to validated cancer diagnostics, while supporting continued innovation by clinical laboratories.

Intelligent IoT Framework for Indoor Healthcare Monitoring of Parkinson’s Disease Patient

Parkinson's disease is associated with high treatment costs, primarily attributed to the needs of hospitalization and frequent care services. A study reveals annual per-person healthcare costs for Parkinson's patients to be $21,482, with an additional $29,695 burden to society. Due to the high stakes and rapidly rising Parkinson's patients' count, it is imperative to introduce intelligent monitoring and analysis systems. In this paper, an Internet of Things (IoT) based framework is proposed to enable remote monitoring, administration, and analysis of patient's conditions in a typical indoor environment. The proposed infrastructure offers both static and dynamic routing, along with delay analysis and priority enabled communications. The scheme also introduces machine learning techniques to detect the progression of Parkinson's over six months using auditory inputs. The proposed IoT infrastructure and machine learning algorithm are thoroughly evaluated and a detailed analysis is performed. The results show that the proposed scheme offers efficient communication scheduling, facilitating a high number of users with low latency. The proposed machine learning scheme also outperforms state-of-the-art techniques in accurately predicting the Parkinson's progression.

Real-world, retrospective study evaluating thromboembolic events, associated risk factors, and health-care resource utilization in Japanese patients with polycythemia vera.

In this retrospective, real-world study, we used medical claims data to evaluate the incidence of thromboembolic events (TEs), time to TE, associated risk factors, and health-care resource utilization (HRU) in Japanese patients with polycythemia vera (PV; N = 606) from April 1, 2008, to August 31, 2015. Baseline characteristics of interest included median age, 67.0years; previous TEs, 11.6%; cardiovascular conditions (CVCs), 45.7%; and ≥ 3 risk factors, 17.8%. Overall, 100 patients experienced TEs (118 events) at a rate of 8.15/100 person-years [TE-free survival rate, 69.3% (2008-2015)]. The annual total health-care costs [mean (per person)] were significantly impacted by the presence of TEs (yes vs. no: ¥993,000 vs ¥459,000; P < 0.001). These results confirm that the presence of CVCs increases the risk of TEs in Japanese patients with PV; occurrence of TEs was associated with a higher HRU in these patients.

PCN207 CANCER RISK AND RESOURCE UTILIZATION FOR 5 COMMON CANCERS IN A MATCHED CHINESE DIABETES POPULATION OF 331,000 PATIENTS

It is recognised that cancer usually is not a disease in isolation and comorbidities may impact significantly on clinical management and cost of cancer treatment. Previous population-based studies have investigated the relation between cancer risk and diabetes. The objective of this study was to provide rigorous estimates of cancer incidence and health care utilization in a large Chinese diabetes population. A total of 331,490 diabetes patients were matched to controls (N=331,009) based on age, sex, city and insurance type using national administrative information of China Health Insurance Association (CHIRA) data in 2015. Odds ratios were used to compare the incidence of cancers in both groups. Descriptive statistics were used to compare the annual health care use and costs of cancer patients with and without diabetes. Regression analyses were used to compare specific cancer costs. All costs were reported in US dollars (based on $US1=6.228 Chinese Yuan). The average risk of cancer was significantly higher in diabetes patients compared to control subjects for both male (OR=1.4, [95%CI 1.4-1.5]) and female (1.3, [1.3-1.4]) patients. Diabetes was most frequently associated with pancreatic cancer, male (3.78, [2.39-5.98]), female (3.50, [2.13-5.75]). Cancer patients with diabetes had more outpatient consultations (33.2 vs. 23.6 visits) and a longer hospital length of stay (41.4 vs. 30.0 days) compared to matched controls. Average cost of treatment of cancer patients with diabetes per year was about $4,530 [4,070 to 4,990] more expensive than for patients without diabetes ($10,528). In particular treatment of GI cancers was 65-103% more costly compared to matched controls. Managing cancer in patients with diabetes on average is US$4,530 (>55%) more expensive compared to cancer patients without diabetes, due to extra admissions, increased length of stay per admission, and greater treatment costs, especially for patients with GI cancers.

PRO104 HEALTHCARE UTILIZATION AND COSTS AMONG PATIENTS WITH ACUTE INTERMITTENT PORPHYRIA RECEIVING HEMIN: ANALYSES FROM A NATIONAL HEALTHCARE DATABASE

Acute hepatic porphyria (AHP) refers to a family of rare, metabolic diseases that includes four types, acute intermittent porphyria (AIP) being the most common. An economic analysis of EXPLORE, the largest prospective, multinational, study in AHP patients experiencing recurrent attacks, estimated an average total of annual healthcare costs between $400,000 to $650,000 per patient (using US cost data). This study aimed to estimate healthcare resource utilization and total healthcare costs of AIP patients in the United States, using a nationally representative health care database. This retrospective analysis utilized the IBM® MarketScan® Commercial Claims and Medicare Supplemental Databases. Patients with at least one claim for AIP (ICD-10 diagnosis code E80.21) and at least one claim for hemin use (HCPCS code J1640) between October 1, 2015 – June 30, 2018 were selected for analyses. The subset of AIP patients with continuous enrollment for at least one year following their first observed AIP diagnosis (index date) were identified for the assessment of baseline characteristics and post-diagnosis (post-index) outcomes. Means were reported as per patient per year (PPPY). A total of 19 unique patients with AIP receiving hemin were identified, 89.5% of whom were female, with a mean (SD) age of 41.1 (13.9) years. Mean observation time of identified diagnosed patients was 1.8 years. Patients had a mean (SD) of 3.0 (2.0) attacks PPPY. The majority had ≥1 hospitalization (84.2%) and emergency department (ED) visit (57.9%), with a mean (SD) of 1.9 (1.9) admissions and 3.8 (6.0) ED visits PPPY, respectively. Mean (SD) total healthcare costs were $405,035 ($422,226) PPPY. Results from this national representative healthcare claims database demonstrated a high rate of healthcare utilization associated with a high average annual expenditure per AIP patient receiving hemin in the United States.

Direct incremental healthcare costs associated with mood disorders in the United States, 2007–2017

BackgroundThis study provides nationally representative estimates of the direct incremental economic burden of mood disorders in the United States between 2007–2017, and examines trends in spending on mood disorders by healthcare setting over time. MethodsThe Medical Expenditure Panel Survey (MEPS) was used to analyze nationally-representative data related to healthcare expenditures between 2007–2017. A two-part regression model was used to estimate healthcare expenditures for patients with mood disorders compared to those without, adjusting for several sociodemographic and health-related factors. ResultsTotal annual healthcare costs for patients with mood disorders were over twice as high as for those without, even after adjusting for potential confounders. A mood disorder diagnosis independently accounted for $6,591.60 in additional annual healthcare spending over this period. While healthcare spending on mood disorders increased significantly in the outpatient setting (14%), home health setting (84%), and on prescription medications (17%), it decreased in the inpatient setting and remained stable for emergency care. LimitationsStudy limitations include an inability to determine specific components of cost in each setting, analyze costs for distinct depressive and bipolar disorders by four- or five-digit diagnosis code, and the potential for recall bias during data collection. ConclusionsSpending on outpatient care, prescription medications, and home health care for mood disorder patients grew significantly between 2007 and 2017, but decreased for inpatient care and remained stable in the emergency care setting. Future research should examine drivers of spending in these settings and explore ways to improve patient outcomes and stabilize growing healthcare expenditures.

Costs and Use of Health Care in Patients With Celiac Disease: A Population-Based Longitudinal Study.

Celiac disease (CD) affects 1% of the population. Its effect on healthcare cost, however, is barely understood. We estimated healthcare use and cost in CD, including their temporal relationship to diagnosis. Through biopsy reports from Sweden's 28 pathology departments, we identified 40,951 prevalent patients with CD (villous atrophy) as of January 1, 2015, and 15,086 incident patients with CD diagnosed in 2008-2015, including 2,663 who underwent a follow-up biopsy to document mucosal healing. Each patient was compared with age- and sex-matched general population comparators (n = 187,542). Using nationwide health registers, we retrieved data on all inpatient and nonprimary outpatient care, prescribed diets, and drugs. Compared with comparators, healthcare costs in 2015 were, on average, $1,075 (95% confidence interval, $864-1,278) higher in prevalent patients with CD aged <18 years, $715 ($632-803) in ages 18-64 years, and $1,010 ($799-1,230) in ages ≥65 years. Half of all costs were attributed to 5% of the prevalent patients. Annual healthcare costs were $391 higher 5 years before diagnosis and increased until 1 year after diagnosis; costs then declined but remained 75% higher than those of comparators 5 years postdiagnosis (annual difference = $1,044). Although hospitalizations, nonprimary outpatient visits, and medication use were all more common with CD, excess costs were largely unrelated to the prescription of gluten-free staples and follow-up visits for CD. Mucosal healing in CD did not reduce the healthcare costs. The use and costs of health care are increased in CD, not only before, but for years after diagnosis. Mucosal healing does not seem to lower the healthcare costs.

Nonalcoholic fatty liver disease: impact on healthcare resource utilization, liver transplantation and mortality in a large, integrated healthcare system.

NAFLD is the most prevalent liver disease globally, affecting 20% of the world population. Healthcare resource utilization (HRU) attributable to NAFLD has been difficult to define. We performed a case control study on NAFLD patients from 2005 to 2015 in a large integrated healthcare system with an affiliated insurance company that prospectively captures HRU information. Outcomes encompassed costs, liver transplantation and mortality rates. There were 17,085 patients, of which 4512 were NAFLD cases and 12,573 were non-NAFLD controls. The cohorts were similar in age and gender distribution (p > 0.05). The NAFLD cohort had a younger mean age of death (60.9 vs. 63.3, p = 0.004) and had over twice the number of annual healthcare visits (14.6 vs. 7.1). The increased overall annual overall cost attributable to NAFLD (in 2015 $) was $449/year. Overall, NAFLD was independently associated with 17% higher annual attributable healthcare costs. More advanced NAFLD (FS 3-4) was associated with a 40% increase in median annual healthcare costs(vs. FS 0-2). The strongest predictors of HRU among patients with NAFLD were advanced fibrosis and medicalco-morbidities. The rate of liver transplantation was 18 times greater (0.054%/year) in theNAFLD compared withthe non-NAFLD cohort, while mortality rate was 1.7 times greater. Within a large, integrated healthcare system a diagnosis of NAFLD is independently associated with a 17% overall excess in HRU and a several-fold increase liver transplantation and mortality. Although the dollar amounts will change over time and between healthcare systems, the proportional need for HRU will have broad applicability and implications.

Healthcare Resource Utilization Among Patients in England with Systemic Sclerosis-Associated Interstitial Lung Disease: A Retrospective Database Analysis.

IntroductionSystemic sclerosis-associated interstitial lung disease (SSc-ILD) places a substantial burden on patients and healthcare systems. The objectives of this study were to describe clinical characteristics and assess healthcare resource utilization and costs of patients with SSc-ILD in England, compared with patients with non-pulmonary organ involvement related to SSc (SSc-OOI).MethodsThis population-based retrospective study used data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics. Data were extracted from medical records dated January 1, 2005 to March 31, 2016. Patients with SSc were identified and placed in subgroups based on organ involvement: SSc-ILD, SSc-OOI, and both (SSc-ILD-OOI). Patients with SSc-ILD-OOI were included in both the SSc-ILD and SSc-OOI subgroups. All-cause healthcare costs, excluding medication costs, were calculated to 2016 British pounds sterling (£).ResultsThis study included 675 patients with SSc: 174 (26%) had neither ILD nor other organ involvement (OOI); 127 (19%) had SSc-ILD; 477 (71%) had SSc-OOI; 103 (15%) had SSc-ILD-OOI. Age-weighted median [interquartile range (IQR)] annual healthcare costs per patient were: £1496 (£664–£2817) in SSc only; £6375 (£3451–£15,041) in SSc-ILD; £4084 (£1454–£10,105) in SSc-OOI; £6632 (£4023–£17,009) in SSc-ILD-OOI. In multivariate analysis, older age at diagnosis, diagnosis of anemia, and number of comorbid diseases were associated with higher yearly healthcare costs.ConclusionThe annual healthcare cost for patients with SSc-ILD is substantial, and higher than that of patients with SSc-OOI or SSc only. These results quantify the economic burden of SSc-ILD in a real-world setting, and highlight the need for treatment of this disease.Electronic supplementary materialThe online version of this article (10.1007/s12325-020-01330-0) contains supplementary material, which is available to authorized users.

Direct Health Care Costs, Health Services Utilization, and Outcomes of Biliary Atresia: A Population-based Cohort Study.

Biliary atresia (BA) is the most common reason for liver transplant in childhood, and outcomes worsen with older age at hepatoportoenterostomy (HPE). We determined direct health care costs in children with BA, compared to controls in a population-based cohort of children in Ontario, Canada. We used health administrative data to identify all children diagnosed with BA between 2002 and 2016 (n = 121) and matched controls (n = 602). We determined annual direct healthcare costs, and rates of health services utilization, liver transplantation, death, portal hypertension, cirrhosis, esophageal varices, and major upper gastrointestinal bleeding requiring hospitalization. Multivariable regression models determined the association between age at HPE, risk of liver transplant, and direct costs. Incidence of BA was 6.07 (4.99-7.15) per 100,000 live births. The annual median (interquartile range) direct health care costs were higher in BA cases ($4210; interquartile range $1091-$16,765) compared to controls ($283; $112-$634). Compared to age at HPE <45 days, there was no significant association between direct costs and HPE ≥90 days (rate ratio 1.24, 95% confidence interval [CI] 0.78-1.97) or 45 to 90 days (rate ratio 1.05, 95% CI 0.73-1.50). Age at HPE ≥90 days was significantly associated with risk of undergoing liver transplant compared to age <45 days (hazard ratio 5.27, 95% CI 2.45-11.34). Direct costs were higher in patients with BA who underwent liver transplantation compared to those who did not ($39,476±$84,367 vs $22,579 ± $67,913). Direct ealth care costs were high in patients with BA, especially in those who underwent liver transplantation. Age at HPE was associated with risk of liver transplantation, but not direct health care costs, utilization, or other risk outcomes.

The Humanistic and Economic Burden of Pediatric Focal Seizures in the United States.

To better understand the humanistic and economic burden of focal seizures in children 2-12 years old. We conducted a targeted literature review by searching MEDLINE for English-language publications reporting on children 2-12 years old with focal seizures published in the United States since 2008. Thirty-five publications were included. Incidence of focal seizures was 23.2 to 47.1 per 100,000 children per year; prevalence was 2.0 per 1,000 children, and ranged from 1.6 - 2.6 per 1,000 in patients of any age. Life expectancy was 47.3-61.8 years among children 3-12 years old. Patients took several antiepileptic drugs and experienced frequent seizures, sleep disorders, mood disorders, migraine, and seizure-related injuries (eg, bone fractures, sprains, open wounds). Children with focal seizures scored below average on cognitive assessments and up to 42%, 16%, and 19% had depression, anxiety, and attention-deficit disorder, respectively. Patients of any age had about 10 outpatient visits (2 epilepsy-related), 2 inpatient visits (less than 1 epilepsy-related), and 24 procedures (1 epilepsy-related) per year. Medication adherence was low: only half of pediatric patients maintained ≥90% adherence over 6 months. Annual total health care costs among patients of any age ranged from $18,369 - 38,549; first-year total health care costs for children were $19,883. Incidence and prevalence of focal seizures is high and the humanistic and economic burdens are significant. Future studies focused exclusively on children with focal seizures are needed to more precisely describe the burden. We also suggest further research and implementation of methods to improve medication adherence as an approach to lessen burden on these young patients.

The impact of chronic kidney disease on developed countries from a health economics perspective: A systematic scoping review.

Chronic kidney disease (CKD) affects over 10% of the global population and poses significant challenges for societies and health care systems worldwide. To illustrate these challenges and inform cost-effectiveness analyses, we undertook a comprehensive systematic scoping review that explored costs, health-related quality of life (HRQoL) and life expectancy (LE) amongst individuals with CKD. Costs were examined from a health system and societal perspective, and HRQoL was assessed from a societal and patient perspective. Papers published in English from 2015 onward found through a systematic search strategy formed the basis of the review. All costs were adjusted for inflation and expressed in US$ after correcting for purchasing power parity. From the health system perspective, progression from CKD stages 1–2 to CKD stages 3a-3b was associated with a 1.1–1.7 fold increase in per patient mean annual health care cost. The progression from CKD stage 3 to CKD stages 4–5 was associated with a 1.3–4.2 fold increase in costs, with the highest costs associated with end-stage renal disease at $20,110 to $100,593 per patient. Mean EuroQol-5D index scores ranged from 0.80 to 0.86 for CKD stages 1–3, and decreased to 0.73–0.79 for CKD stages 4–5. For treatment with renal replacement therapy, transplant recipients incurred lower costs and demonstrated higher HRQoL scores with longer LE compared to dialysis patients. The study has provided a comprehensive updated overview of the burden associated with different CKD stages and renal replacement therapy modalities across developed countries. These data will be useful for the assessment of new renal services/therapies in terms of cost-effectiveness.

Impact of atherosclerotic cardiovascular disease on healthcare resource utilization and costs in patients with type 2 diabetes mellitus in a real-world setting

BackgroundThis study evaluated the impact of atherosclerotic cardiovascular disease (ASCVD) on healthcare resource utilization and costs in patients with type 2 diabetes mellitus (T2DM).MethodsThis study was a retrospective, cross-sectional study using US claims data. Adult patients with T2DM were stratified by presence or absence of ASCVD and compared regarding annual (2015) healthcare resource utilization and associated costs. Subgroup analyses were conducted for three age groups (18–44, 45–64, and ≥ 65 years).ResultsAmong 1,202,596 eligible patients with T2DM, 45.2% had documented ASCVD. The proportions of patients with inpatient and ER-based resource utilization during 2015 were three-to-four times greater in the ASCVD cohort as compared to the non-ASCVD cohort for the categories of inpatient visits (15.6% vs 4.4% of patients), outpatient ER visits (18.4% vs 5.2% of patients), and inpatient ER visits (4.3% vs 0.9% of patients). Outpatient utilization also was higher among patients with ASCVD as compared to those without ASCVD (mean number of annual office visits per patient, 9.1 vs 5.6), and more than twice as many patients with ASCVD had ≥ 9 office visits (43.5% vs 19.8%). Average per-patient total healthcare cost was $22,977 for ASCVD vs $9735 for non-ASCVD, with medical costs primarily driving the difference ($17,849 vs $6079); the difference in pharmacy costs was smaller ($5128 vs $3656). In the 18–44, 45–64, and ≥ 65 age subgroups respectively, total annual healthcare costs were 143, 127, and 114% higher in ASCVD vs non-ASCVD patients.ConclusionsThese findings indicate significantly higher healthcare resource utilization and associated costs in patients having T2DM with ASCVD compared to T2DM without ASCVD.

Systematic analysis of therapeutic patterns and healthcare use during 12 months before inflammatory bowel disease-related hospitalization in Switzerland.

Given the lack of data, we aimed to systematically analyze therapeutic patterns and health resource utilization in the year before inflammatory bowel disease (IBD)-related hospitalization. Based on claims data of the Helsana health insurance group, therapy patterns and health resource utilization were assessed, and costs reimbursed by mandatory basic health insurance were calculated during a one-year period before an index hospitalization between 1 January 2013 to 31 December 2015. We analyzed 344 IBD patients (140 ulcerative colitis [40.7%], 204 Crohn's disease [59.3%]). Drug regimens applied in the year before index hospitalization were as follows: no IBD drugs (43.6% ulcerative colitis, 43.1% Crohn's disease); 5-ASA (45.7% ulcerative colitis, 19.1% Crohn's disease); local steroids (17.9% ulcerative colitis, 17.6% Crohn's disease); systemic steroids (38.6% ulcerative colitis, 29.4% Crohn's disease); immunomodulators (10.7% ulcerative colitis, 18.1% Crohn's disease); biologics (10% ulcerative colitis, 24% Crohn's disease); and calcineurin inhibitors (2.1% ulcerative colitis, 1.5% Crohn's disease). Forty-five percent of ulcerative colitis patients and 31.4% of Crohn's disease patients had no diagnostic procedures [computed tomography (CT), MRI, radiograph, sonography, colonoscopy, and calprotectin] in the year before hospitalization. Total annual health care costs before index hospitalization was EUR 4060 (interquartile range (IQR) 2360-7390) for ulcerative colitis and EUR 4900 (IQR 1520-14 880) for Crohn's disease patients, respectively. Over 40% of ulcerative colitis and Crohn's disease patients did not receive any treatment in the year before index hospitalization. Efforts should be launched to timely diagnose and adequately treat IBD outpatients.

Estimation of Annual Health Care Costs for Adults with Type 1 Diabetes in the United States.

Diabetes health care resource utilization (HCRU) studies tend to focus on patients with type 2 diabetes (T2D) or pool patients with T2D and type 1 diabetes (T1D). There is a paucity of recent data on the cost of treating patients with T1D in the United States. To (a) estimate the per-patient per-year (PPPY) HCRU and costs, from a payer perspective, associated with treating U.S. adults with T1D and (b) compare these with the HCRU and costs for patients with T2D. This retrospective cohort study used claims data from the Optum Clinformatics database between January 2015 and December 2017. Adults (aged ≥ 18 years) with a diagnosis of T1D were propensity score-matched to adults with T2D. Overall and nondiabetes-related HCRU and costs were assessed for T1D and T2D and compared between the 2 groups. Propensity scores were used to match 10,103 patient pairs from T1D and T2D cohorts (mean ages 54.4 and 56.9 years, respectively). In the T1D cohort, inpatient, emergency department (ED), outpatient, and prescription claims occurred in 14.0%, 17.3%, 85.5%, and 100% of patients, respectively, resulting in a mean total cost of U.S. $18,817 PPPY (diabetes-related = $11,002; nondiabetes-related = $7,816). The T1D cohort had significantly higher mean total costs than the T2D cohort ($18,817 vs. $14,148 PPPY; P < 0.001). When extrapolating these findings to a commercial health plan with 1 million covered lives, the estimated total direct medical costs of T1D would be $103.4 million. This study showed that the total annual cost of managing an adult with T1D is significantly higher than that of an adult with T2D. Nondiabetes costs accounted for 40% of the total per-patient cost, similar to patients with T2D, confirming that as patients with T1D live longer lives, they may also be at greater risk for cardiometabolic complications. This study was funded by Sanofi U.S. and Lexicon Pharmaceuticals as part of a business partnership in a diabetes program at the time this study was conducted. Joish and Davies are employees and stockholders of Lexicon Pharmaceuticals. Zhou, Preblick, and Paranjape are employees and stockholders of Sanofi. Lin was a postdoctoral fellow at Sanofi through Rutgers University during this project. Deshpande provided consulting services through Communication Symmetry. Verma is an employee of Evidera, which was contracted by Sanofi for work on this study. Pettus is a consultant for Diasome, Insulet, Lexicon, Lilly, Mannkind, Novo Nordisk, Sanofi, and Senseonics.

Schizophrenia: opportunities to improve outcomes and reduce economic burden through managed care.

Schizophrenia is a complicated chronic disease affecting approximately 3.5 million people in the United States, and its annual healthcare costs exceed $155 billion. People living with schizophrenia often experience a reduced quality of life (QOL) and are more likely to be homeless, unemployed, or living in poverty compared with the general population. Life expectancy for patients with schizophrenia is 15 to 20 years below the average and is complicated by numerous comorbidities, such as weight gain, increased cardiovascular risk, and changes in mood and cognition. Treatment nonadherence can increase the risk of relapse, rehospitalization, and self-harm, leading to a reduced QOL and increased economic burden. Managed care professionals are positioned to improve adherence and outcomes through various drug utilization strategies. Clinicians may also empower patients with schizophrenia through shared decision making and the creation of a therapeutic alliance. Careful monitoring of medication-related adverse effects and offering potential medication alternatives and routes of administration when indicated may also improve adherence to treatment regimens, resulting in improved outcomes and reduced healthcare costs.

Medical Malpractice in Nerve Injury of the Upper Extremity.

Background: Medical malpractice accounts for more than $55 billion of annual health care costs. Updated malpractice risk to surgeons and physicians related to upper extremity peripheral nerve injury has not been published. Methods: A comprehensive database analysis of upper extremity nerve injury claims between 1995 and 2014 in the United States was conducted using the Medical Professional Liability Association Data Sharing Project, representing 24 major insurance companies. Results: Nerve injury in the upper extremity accounted for 614 (0.3%) malpractice claims (total of 188 323). Common presenting diagnoses included carpal tunnel syndrome (41%), upper extremity fractures (19%), and traumatic nerve injuries to the shoulder or upper limb (8%). Improper performance (49% of total claims) and claims without evidence of medical error (19%) were the most common malpractice suits. Orthopedic surgeons were the most frequently targeted specialists (42%). In all, 65% of nerve injury claims originated from operative procedures in a hospital, 59% of claims were dismissed or withdrawn prior to trial, and 30% resulted in settlements. Thirty-three percent of claims resulted in an indemnity payment to an injured party, with an average payout of $203 592 per successful suit. Only 8% of claims resulted in a completed trial and verdict, and verdicts were overwhelmingly in favor of the defendant (83%). Conclusions: Most malpractice claims from peripheral nerve injuries in the United States arise from the management of common diagnoses, occur in the operating room, and allege improper performance. Strategies to reduce malpractice risk should emphasize the management of common conditions and patient-physician communication.

Abstract P2-08-08: A population-based study examining the epidemiology, treatment patterns and resource utilization by stage in Ontario patients with triple negative breast cancer

Abstract Background: There is limited current data on the incidence, clinical characteristics, treatment patterns, and resource utilization in breast cancer patients with a triple negative (TNBC) clinical phenotype (ER-/PR-/HER2-). Moreover, no prior publications have detailed the differences in resource use according to TNBC stage in a publicly funded healthcare setting. Methods: We retrospectively collected data for women aged 18-105 years, residing in Ontario, utilizing the public healthcare system, and diagnosed with invasive BC from Apr 1, 2012 to Mar 31, 2016. Data were extracted from datasets housed by the Institute for Clinical Evaluative Sciences. Women with triple negative pathology were identified and baseline clinical characteristics, treatment patterns, and healthcare resource utilization were descriptively compared between stage I-III and stage IV sub-cohorts. Outcomes assessed included 5-year overall survival (OS) rate by stage. Patients alive/lost to follow-up at the end of the study period (Mar 31, 2017) were censored. Unit costs (2017 CAD $) for publicly funded healthcare services were multiplied by resources used in order to calculate the total and annual health system-related costs. Results: In total, 3,271 women were identified as having TNBC; 3,081 with stage I-III and 190 with stage IV disease at diagnosis. Patients with metastatic TNBC tended to be older (63.9 ± 15.7 years) compared to those with stage I-III disease (58.8 ± 14.4 years). With a median follow-up of 34.5, 32.7, 26.2 and 8.9 mos, 5-year OS rates were 93.3%, 78.9%, 47.2% and 7.4% for stage I, II, III, and IV, respectively. Surgery was the most common treatment modality among patients with stage I-III (n=2,979, 96.7%) and least common in those with stage IV (n=16, 8.4%) disease. Among patients treated with upfront surgery for early stage disease (n=2,419, 81.2%), 1,890 (78.1%) received adjuvant systemic therapy (AT) with a median time from surgery to treatment of 45 days (IQR: 35,62). The remaining 560 patients (18.8%) with stage I-III disease received neo-AT starting a median of 28 days (IQR: 21,39) after diagnosis, with 221 (39.5%) also receiving AT. In total, 2,341 (76.0%) of patients with stage I-III BC received radiation. Among patients with metastatic TNBC, 138 (72.6%) received systemic therapy and 109 (57.4%) were treated with radiotherapy. Annual mean healthcare cost per person was $35,063.96 for stage I-III and $140,160.23 for stage IV TNBC. In both early and metastatic TNBC, cancer clinic visits, in-patient hospitalization, and professional fees were the main contributors to healthcare costs whereas pharmaceutical, home care, day surgery and continuing care contributed &amp;lt;10% each to the total annual expenses. Conclusions: Characteristics and clinical outcomes were as expected for our Ontario-based population of women with TNBC. Our data highlights room for improvement related to wait times for surgery and initiation of systemic therapy in patients with early stage TNBC; an important endeavour considering the aggressiveness of this disease. Despite receiving fewer treatment interventions (surgery, pharmacologic and/or radiation), patients with stage IV TNBC incurred more healthcare costs per person than those with earlier stage disease. These data illustrate the treatment patterns and resource utilization for women with TNBC in Ontario and highlight opportunities to improve their outcomes. Citation Format: Christine Brezden-Masley, Kelly Elizabeth Fathers, Megan Coombes, Cloris Xue, Behin Pourmirza, Katarzyna J. Jerzak. A population-based study examining the epidemiology, treatment patterns and resource utilization by stage in Ontario patients with triple negative breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-08.

Abstract P2-08-23: A population-based study examining the epidemiology, treatment patterns and resource utilization by stage in Ontario patients with HER2+ breast cancer

Abstract Background: Since the discovery of HER2-targeted treatments for HER2+ breast cancer (BC), women with this historically poor-prognosis subtype have benefitted from dramatic improvements in outcome. As treatment algorithms and staging become more personalized, there is increasing value in understanding real-world clinical characteristics of patients, as well as treatment patterns, resource use and outcomes. To our knowledge, no such data currently exist by BC subtype and stage in one single cohort. Methods: We retrospectively collected data for women aged 18-105 years, residing in Ontario, utilizing the public healthcare system, and diagnosed with invasive BC from Apr 1, 2012 to Mar 31, 2016. Data were extracted from datasets housed by the Institute for Clinical Evaluative Sciences. Women with HER2+ pathology were identified and baseline characteristics, treatment patterns, and healthcare resource use were descriptively compared between stage I-III and stage IV sub-cohorts. Outcomes assessed included 5-year overall survival (OS) rates by stage. Patients alive/lost to follow-up at the end of the study period (Mar 31, 2017) were censored. Unit costs (2017 CAD $) for publicly funded healthcare services were multiplied by resources used in order to calculate total and annual health-system related costs. Results: In total, 4,889 women were identified as having HER2+ BC; 4535 with stage I-III and 354 with stage IV disease at diagnosis. Patients with stage IV HER2+ BC more frequently had larger or unknown tumour size and lower hormone receptor positivity rates than those with stage I-III tumours. With a median follow-up of 34.1, 33.7, 32.2 and 21.4 mos, 5-year OS rates were 96.5, 87.5, 79.9 and 36.6% for stage I, II, III, and IV, respectively. Surgery was the most common treatment modality in stage I-III (n=4372, 96.4%) and least common in stage IV (n=82, 23.2%). Among patients treated with upfront surgery for early stage disease (n=3451, 78.9%), 3135 (90.8%) received adjuvant systemic therapy (AT) with a median time from surgery to treatment of 42 days (IQR: 26,56). The remaining 921 stage I-III patients (20.1%) received neo-AT starting a median of 28 days (IQR: 21,39) after diagnosis, with 912 (99.0%) also receiving AT. In total, 3521 (77.6%) of patients with stage I-III BC received radiation. Among patients with metastatic HER2+ BC, 314 (88.7%) received systemic therapy and 213 (60.2%) were treated with radiotherapy. Annual mean healthcare cost per person was $54,852.39 for stage I-III and $159,347.97 for stage IV HER2+ BC. In the stage I-III sub-cohort, pharmaceuticals and cancer clinic visits accounted for ~70% of measured resource costs, whereas pharmaceuticals and inpatient hospital services were the main cost contributors for patients with stage IV disease. Conclusions: Characteristics and clinical outcomes were as expected for our Ontario-based population of women with HER2+ BC. Patients appeared to be treated within reasonable timeframes and in alignment with the strategies recommended by Cancer Care Ontario at the time of the study. Improvements in survival of stage IV HER2+ BC coincide with increased resource utilization, largely driven by systemic therapy and inpatient hospitalization. While there are fewer patients with stage IV HER2+ BC, the annual mean cost per person is nearly three-fold higher than in those with early stage disease, and demonstrates a need for interventions that decrease hospitalizations and/or pharmaceutical treatment costs. Citation Format: Christine Brezden-Masley, Kelly Elizabeth Fathers, Megan Coombes, Cloris Xue, Behin Pourmirza, Katarzyna J. Jerzak. A population-based study examining the epidemiology, treatment patterns and resource utilization by stage in Ontario patients with HER2+ breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-08-23.