Annual Health Care Expenditures Research Articles

The determinants of caregiver use and its costs for elderly inpatients in Korea: a study applying Andersen\u2019s behavioral model of health care utilization and replacement cost method

ObjectivesThe average annual healthcare expenditure among elderly patients in Korea is increasing rapidly in indirect healthcare sectors, requiring an understanding of factors related to the use of both formal and informal caregivers. This study analyzed the characteristics of caregiver use and caregiving costs among elderly patients hospitalized due to acute illness or exacerbation of chronic diseases.Methods A total of 819 study participants were selected from the 2017 Korea Health Panel Study Data. Replacement costing methods were applied to estimate the hours of informal caregiver assistance received by elderly inpatients. Elderly inpatients’ predisposing, enabling, and need factors were studied to identify the relationship between caregiver uses, based on Andersen’s behavior model. A two-part model was applied to analyze the factors related to care receipt and to estimate the incremental costs of care.ResultsElderly inpatients who used tertiary hospitals (OR: 2.77, p-value < 0.00) and received financial support (OR: 2.68, p-value < 0.00) were more likely to receive support from a caregiver. However, elderly inpatients living alone were lesser to do so (OR: 0.49, p-value < 0.00). Elderly inpatients with Medicaid insurance (β:0.54, p-value = 0.02) or financial aid (β: 0.64, p-value < 0.00) had a statistically positive association with spending more on caregiving costs. Additionally, financial support receivers had incremental costs of $627 in caregiving costs than nonreceivers.ConclusionsThis study presented significant socioenvironmental characteristics of formal and informal caregiver use and the related expenditures. Healthcare management plans that encompass multiple social levels should be implemented to ease the caregiver burden.Trial registrationRetrospectively registered.

PDG13 Healthcare Expenditures and Resource Utilization Among a Nationally Representative Population of Narcotic Users in the United States, 2008 to 2017

To evaluate the expenditure and resources associated with narcotic users in the US, 2008-2017. We used a pooled serial cross-sectional design (2008-2017) based on a nationally representative sample from the Medical Expenditures Panel Survey. We compared annual healthcare expenditures (total, inpatient, outpatient, emergency department, prescription) and resource utilization (number of prescriptions, office-based visits, emergency department visits, and number of inpatient night stays) between narcotic and non-narcotic users. A propensity score algorithm was used to match non-narcotic respondents to narcotic respondents. Two-part generalized linear models were used to estimate the annual healthcare expenditures and resource utilization adjusting for multiple covariates. All costs were adjusted to 2019 US dollars using the gross domestic product deflator. A total of 31,696,671 weighted narcotic users were matched to 31,536,639 weighted non-narcotic users after propensity score matching. Among narcotic users, healthcare expenditures and resource utilization were significantly higher compared to non-narcotic users. After adjustments, these differences remained significantly different. The adjusted annual total expenditures for narcotic and non-narcotic users were $16,542 and $7,067, respectively (P<0.001). Similarly, adjusted prescription ($3,067 vs $2,293), outpatient ($1,804 vs $650), emergency department ($703 vs $249), and inpatient expenditures ($5,610 vs $1,640) were significantly higher for the narcotic group compared to the non-narcotic group. Average resource utilization was also significantly higher in the narcotic group compared to the non-narcotic group adjusting for confounders (number of prescriptions filled: 29.5 vs 19.0; number of office-based visits: 12.4 vs. 8,1; number of emergency department visits: 0.59 vs 0.25; and number of inpatient night stays: 1.61 vs 0.58). Narcotic users had higher healthcare expenditures and resource utilization compared to non-narcotic users from 2008-2017. Understanding the causes of these differences will be vital to optimizing treatment quality and effectiveness. These results may inform health policy initiatives that seek to reduce unnecessary wastage associated with narcotic users.

PSS6 Identification of Healthcare Expenditures Associated with Frequent Exercise Status Among United States Older Adults with Self-Reported PAIN

Frequent exercise is often recommended for older adults with pain, however the association between frequent exercise and healthcare expenditures in this population is unknown. This study sought to identify if differences exist in the healthcare expenditures of older United States (US) adults with pain who reported frequent exercise versus those who did not. This cross-sectional study included a nationally-representative sample of US adults from the 2018 Medical Expenditure Panel Survey who were aged ≥50 years, alive during the calendar year, with self-reported pain in the past four weeks, and positive total healthcare expenditures. The independent variable was frequent exercise status, defined as doing ≥30 minutes of moderate-vigorous intensity physical activity ≥5 times per week. Adjusted linear regression models assessed differences in total annual healthcare expenditures between individuals who reported frequent exercise and those who did not. Secondary analyses assessed differences between the groups for: emergency room; inpatient; office-based; outpatient; other; and prescription medication expenditures. Cost data were logarithmically transformed for analysis. Analyses accounted for the complex survey design. The a priori alpha level was 0.05. An estimated 23,940,144 of 56,979,267 older US adults with pain reported frequent exercise. Frequent exercise status was associated with all personal characteristics except ethnicity, census region, and smoking status (p>0.05). In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared to those who did not report frequent exercise (β=-0.16, p=0.007). There were no statistical differences between frequent exercise status for the other categories of healthcare expenditures (p>0.05). Adjusted annual prescription medication expenditures were 15% lower among older US adults with pain who reported frequent exercise versus those who did not, while there was no difference between frequent exercise status for all other healthcare expenditures. Future research should investigate clinical and humanistic outcomes between frequent exercise status in this population.

PIH13 Effect of Multimorbidity on Healthcare Expenditures Among Older Adults with Self-Reported PAIN in the United States

Older adults with pain commonly have multimorbidity. However, up-to-date estimates of healthcare expenditures among this population are unavailable. This study compared the healthcare expenditures associated with multimorbidity versus no multimorbidity among a nationally representative sample of older United States (US) adults with pain. This retrospective, cross-sectional study involved a sample of US adults aged ≥50 years, alive during the calendar year, with self-reported pain in the past four weeks from the 2018 Medical Expenditure Panel Survey dataset. Adjusted linear regression models were constructed to evaluate differences in 2018 total annual healthcare expenditures between those with multimorbidity (≥2 chronic conditions) and those with no multimorbidity. Secondary analyses were conducted for: inpatient; outpatient; office-based; emergency room; prescription medications; home health; vision; and other expenditures. Expenditure data were logarithmically transformed for analysis. Analyses accounted for the complex survey design and were weighted to produce nationally-representative estimates. The a priori alpha level was 0.05. The weighted population included 57,134,711 older US adults with self-reported pain in the last four weeks, of which 46,996,409 had multimorbidity and 10,138,302 had no multimorbidity. Descriptive statistics indicated multimorbidity was associated with all personal characteristics except gender and smoking status (p>0.05). Compared to no multimorbidity in adjusted analyses, those with a multimorbidity had 75.8% greater annual total health expenditures (β=0.564, p=0.0083), 40.6% greater office-based expenditures (β=340, p=0.0224), 100.6% greater prescription medication costs (β=0.696, p=0.0268), but 47.3% lower inpatient expenditures (β=-0.640, p=0.0158), and 56.6% lower home health expenditures (β=-0.835, p<0.0001). No differences were identified between groups for the remaining expenditures. Adjusted total healthcare expenditures were 76% greater among older US adults with pain and multimorbidity compared to those with no multimorbidity, capturing the financial burden of comorbidity in this population. Specific healthcare expenditures that were greater among those with multimorbidity may be targets for future interventions to reduce healthcare costs.

Ischemic Heart Disease: Noninvasive Imaging Techniques and Findings.

Ischemic heart disease is a leading cause of death worldwide and comprises a large proportion of annual health care expenditure. Management of ischemic heart disease is now best guided by the physiologic significance of coronary artery stenosis. Invasive coronary angiography is the standard for diagnosing coronary artery stenosis. However, it is expensive and has risks including vascular access site complications and contrast material–induced nephropathy. Invasive coronary angiography requires fractional flow reserve (FFR) measurement to determine the physiologic significance of a coronary artery stenosis. Multiple noninvasive cardiac imaging modalities can also anatomically delineate or functionally assess for significant coronary artery stenosis, as well as detect the presence of myocardial infarction (MI). While coronary CT angiography can help assess the degree of anatomic stenosis, its inability to assess the physiologic significance of lesions limits its specificity. Physiologic significance of coronary artery stenosis can be determined by cardiac MR vasodilator or dobutamine stress imaging, CT stress perfusion imaging, FFR CT, PET myocardial perfusion imaging (MPI), SPECT MPI, and stress echocardiography. Clinically unrecognized MI, another clear indicator of physiologically significant coronary artery disease, is relatively common and is best evaluated with cardiac MRI. The authors illustrate the spectrum of imaging findings of ischemic heart disease (coronary artery disease, myocardial ischemia, and MI); highlight the advantages and disadvantages of the various noninvasive imaging methods used to assess ischemic heart disease, as illustrated by recent clinical trials; and summarize current indications and contraindications for noninvasive imaging techniques for detection of ischemic heart disease.Online supplemental material is available for this article.Published under a CC BY 4.0 license.

Costs associated with depression and obesity among cardiovascular patients: medical expenditure panel survey analysis

BackgroundThere is a lack of information on the cost of depression associated with metabolic syndrome and cardiovascular diseases in the literature.MethodsWe evaluated the synergistic effects of depression and obesity on total expenditures for cardiovascular conditions using data from the Medical Expenditure Panel Survey (MEPS) database. We analyzed MEPS data from 1996 to 2017 comprising adult cardiovascular subjects. We categorized individuals following a combination of International Classification of Diseases ICD-9-CM and ICD-10 codes, and depression symptoms as evaluated using the Patient Health Questionnaire-2 (PHQ-2) depression screening tool. Our sample comprised cardiovascular patients aged 18 years and older, with a body mass index (BMI) between 18.5 and 60. Our study comprised unweighted sample of 96,697 (weighted sample of 938,835,031) adults, a US-nationwide representative sample of cardiovascular disease patients. The four response categories were: no depression; unrecognized depression; asymptomatic depression; and symptomatic depression. Our evaluated outcomes were total annual healthcare expenditures, including dental, emergency room, hospital outpatient, hospital inpatient, office-based, prescription, and home health care expenses.ResultsAsymptomatic and symptomatic depression was more frequent among obese individuals than in individuals with a normal BMI (p < 0.001). Total expenditure was highest among symptomatic depression individuals (17,536) and obese (9871) with cardiovascular disease. All the expenditure outcomes were significantly higher among symptomatic depression individuals than those without depression (p < 0.001), except for dental costs. All healthcare expenditures associated with obesity were higher compared to individuals with normal BMI with p < 0.001, except for emergency and home healthcare costs. Most importantly, among obese individuals, all healthcare expenditures were significantly higher (p < 0.001) in those with symptomatic depression than those without depression, except for dental costs, where the difference was not significant (0.899). Therefore, obesity and depression entail increased expenses in patients with cardiovascular disease.ConclusionsWe found incremental expenditures among unrecognized, asymptomatic, and symptomatic depressed individuals with obesity compared to non-depressed, non-obese subjects. However, these are preliminary results that should be further validated using different methodologies.

Estimated Health Care Utilization and Expenditures in Individuals With Heart Failure From the Medical Expenditure Panel Survey.

Heart failure (HF) constitutes a growing burden for public health and the US health care system. While the prevalence of HF is increasing, differences in health care utilization and expenditures within various sociodemographic groups remain poorly defined. We used the Medical Expenditure Panel Survey to assess annual health care utilization and expenditures from 2012 to 2017. Health care utilization was based on the annual frequency of various health care encounters. Annual total and out-of-pocket expenditures were evaluated for hospital inpatient stays, emergency room visits, outpatient visits, office-based medical provider visits, prescribed medicines, dental visits, home health aid visits, and other medical expenses. We performed univariable and multivariable regression analysis based on patient characteristics including sociodemographic and comorbidity variables. Our results showed that total health care expenditures among patients with HF were $21 177 (95% CI, $18 819-$24 736) per year as compared with $5652 (95% CI, $5469-$5837) in those without HF (P<0.001). Total expenditures within the population with HF were primarily being driven by expenditures associated with inpatient hospitalizations. Increasing number of comorbid conditions was associated with significant increases in total health care expenditures. Older age, female sex, earlier study years, number of comorbidities, higher level of education, and increasing family income brackets independently raised out-of-pocket expenditures. Our findings of increased health care utilization and expenditures based on sex, age, increasing number of comorbidities, wealthier income status, and increased education attainment level may be used for efforts aimed at better distributing health care resources to improve health outcomes in HF.

Association of Multimorbidity on Healthcare Expenditures Among Older United States Adults With Pain.

Objectives: This cross-sectional study compared the healthcare expenditures associated with multimorbidity (having ≥2 chronic conditions) versus no multimorbidity among older United States (US) adults (aged ≥ 50years) with self-reported pain in the past 4weeks. Methods: This research used data from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression models evaluated group differences in various annual healthcare expenditures. Results: Descriptive statistics indicated multimorbidity was associated with all personal characteristics (p < 0.05) except gender and smoking status (p > 0.05). Multimorbidity had 75.8% greater annual total health expenditures (p = 0.0083), 40.6% greater office-based expenditures (p = 0.0224), 100.6% greater prescription medication costs, (p = 0.0268), yet 47.3% lower inpatient expenditures (p = 0.0158), and 56.6% lower home healthcare expenditures (p < 0.0001) than no multimorbidity. Discussion: This study found greater healthcare expenditures among older US adults with pain and multimorbidity, which captures the financial burden of comorbidity in this population.

Parking Meters to Touch Screens: The Unforeseen Barriers That Expansion of Telemedicine Presents to the Disability Community.

Greater than 25% of annual healthcare expenditures in the United States are associated with the medical needs of people with disabilities. People with disabilities often experience inequalities with access to healthcare services, resulting in increased costs of living with disability. The economic burden of living with a disability results in nearly US $400 billion spent annually from combined public and private payor sources. Historically, disparities in health care are associated with intersections between race, culture, and environmental factors. Minority status also plays a significant role in health outcomes, and studies have highlighted the additional burdens faced at the junction of race and disability status. COVID-19 changed the landscape of healthcare delivery in the United States, resulting in a drastic increase in telehealth utilization. Traditional nonmedical barriers to persons with disability, such as unforeseen parking fees, are documented in the literature. However, conditions surrounding access to the necessary technology required to participate in a telehealth-driven medical landscape are less clear. This article addresses the nonmedical barriers and costs associated with living with a disability and discusses potential solutions in the evolving healthcare system.

Estimating Long-Term Health Utility Scores and Expenditures for Cardiovascular Disease From the Medical Expenditure Panel Survey.

Long-term health utility scores and costs used in cost-effectiveness analyses of cardiovascular disease prevention and management can be inconsistent, outdated, or invalid for the diverse population of the United States. Our aim was to develop a user friendly, standardized, publicly available code and catalog to derive more valid long-term values for health utility and expenditures following cardiovascular disease events. Individual-level Short Form-12 version 2 health-related quality of life and expenditure data were obtained from the pooled 2011 to 2016 Medical Expenditure Panel Surveys. We developed code using the R programming language to estimate preference-weighted Short Form-6D utility scores from the Short Form-12 for quality-adjusted life year calculations and predict annual health care expenditures. Result predictors included cardiovascular disease diagnosis (myocardial infarction, ischemic stroke, heart failure, cardiac dysrhythmias, angina pectoris, and peripheral artery disease), sociodemographic factors, and comorbidity variables. The cardiovascular disease diagnoses with the lowest utility scores were heart failure (0.635 [95% CI, 0.615-0.655]), angina pectoris (0.649 [95% CI, 0.630-0.667]), and ischemic stroke (0.649 [95% CI, 0.635-0.663]). The highest annual expenditures were for heart failure ($20 764 [95% CI, $17 500-$24 027]), angina pectoris ($18 428 [95% CI, $16 102-$20 754]), and ischemic stroke ($16 925 [95% CI, $15 672-$20 616]). The developed code and catalog may improve the quality and comparability of cost-effectiveness analyses by providing standardized methods for extracting long-term health utility scores and expenditures from Medical Expenditure Panel Survey data, which are more current and representative of the US population than previous sources.

Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure, hospitalization and worsening of diabetes: an observational study using medical, dental and pharmacy claims data in Japan

To investigate the effects of regular periodontal management for people with type 2 diabetes on total healthcare expenditure, hospitalization and the introduction of insulin. We collected data of individuals who were prescribed diabetes medications during the fiscal year 2015 from the claims database of a prefecture in Japan. We fitted generalized linear models that had sex, age, comorbidities and the status of periodontal management during the previous two years as predictors. A total of 16,583 individuals were enrolled. The annual healthcare expenditure in the third year was 4% less (adjusted multiplier 0.96, 95% confidence interval [CI] 0.92-1.00) in the group receiving periodontal management every year. The adjusted odds ratio (aOR) for all-cause hospitalization was 0.90 (95% CI: 0.82-0.98). The aOR of introducing insulin in the third year for those who had not been prescribed insulin during the previous two years (n=13,222) was 0.77 (95% CI: 0.64-0.92) in the group receiving periodontal management every year. Regular periodontal management for diabetic people was associated with reduced healthcare expenditure, all-cause hospitalization and the introduction of insulin therapy.

The economic burden of vertigo and dizziness in the United States.

Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.

Lifetime Risks, Life Expectancy, and Health Care Expenditures for Rheumatoid Arthritis: A Nationwide Cohort Followed Up From 2003 to 2016.

ObjectiveThis study was undertaken to estimate the cumulative incidence rate of rheumatoid arthritis (RA) in the Taiwanese population ages 16–84 years, and life expectancy, loss of life expectancy, and lifetime health care expenditures for incident RA in Taiwan after 2003, when biologics began to be prescribed.MethodsWe obtained all claims data for the period 1999 to 2016 from the National Health Insurance program of Taiwan, and validated the data against the Catastrophic Illness Registry to establish the study cohort. We estimated the survival function for RA and extrapolated to lifetime using a rolling‐over algorithm. For every RA case, we simulated sex‐, age‐, and calendar year–matched referents from vital statistics and estimated their life expectancy. The difference between the life expectancy of the referent and the life expectancy of the RA patient was the loss of life expectancy for the RA patient. Average monthly health care expenditures were multiplied by the corresponding survival rates and summed up throughout the lifetime to calculate the lifetime health care expenditures.ResultsA total of 29,352 new RA cases were identified during 2003–2016. There was a decreasing trend in cumulative incidence rate in those ages 16–84 for both sexes. Mean life expectancy after diagnosis of RA was 26.3 years, and mean lifetime cost was $72,953. RA patients had a mean loss of life expectancy of 4.97 years. Women with RA survived 1–2 years longer than men with RA of the same age, which resulted in higher lifetime expenditures for the former. Since the life expectancy for women in Taiwan was 6–7 years higher than that for men, the loss of life expectancy for women with RA was higher than that for men with RA. Annual health care expenditures were similar for both sexes.ConclusionOur findings indicate that since biologics became available, RA patients have lived longer and had higher lifetime expenditures, which should be monitored and evaluated for cost‐effectiveness.

The Hidden Costs of War: Healthcare Utilization Among Individuals Sustaining Combat-related Trauma (2007-2018).

We sought to evaluate long-term healthcare requirements of American military servicemembers with combat-related injuries. US military conflicts since 2001 have produced the most combat casualties since Vietnam. Long-term consequences on healthcare utilization and associated costs remain unknown. We identified servicemembers who were treated for combat-related injuries between 2007 and 2011. Controls consisted of active-duty servicemembers injured in the civilian sector, without any history of combat-related trauma, matched (1:1) on year of injury, biologic sex injury severity, and age at time of injury. Surveillance was performed through 2018. Total annual healthcare expenditures were evaluated overall and then as expenditures in the first year after injury and for subsequent years. Negative binomial regression was used to identify the adjusted influence of combat injury on healthcare costs. The combat-injured cohort consisted of 3981 individuals and we identified 3979 controls. Total healthcare utilization during the follow-up period resulted in median costs of $142,214 (IQR $61,428, $323,060) per combat-injured servicemember as compared to $50,741 (IQR $26,669, $104,134) among controls. Median expenditures, adjusted for duration of follow-up, for the combat-injured were $45,211 (IQR $18,698, $105,437). In adjusted analysis, overall costs were 30% higher (1.30; 95% confidence interval: 1.23, 1.37) for combat-injured personnel. This investigation represents the longest continuous observation of healthcare utilization among individuals after combat injury and the first to assess costs. Expenditures were 30% higher for individuals injured as a result of combat-related trauma when compared to those injured in the civilian sector.

Utilization of Healthcare Services &amp; Healthcare Expenditure Patterns in the Rural Households of Nepal

Background: Healthcare financing as a lever to move closer to universal health coverage. Financing health care has been identified as a barrier to access to health care and increases the likelihood of impoverishment of households. There is still limited study and information on healthcare service utilization in the rural community of Nepal. Our study aims to assess utilization of healthcare services &amp; patterns of healthcare expenditure in the rural households of Nepal. Methods: A community-based research study was conducted among 341 rural households of Tanahun District, Nepal. A Chi-square test was used for assessing the associated factors with healthcare utilization. Results: The utilization of in-patient and out-patient health services was 89.9 % and 10.1 % respectively. The majority of households (88%) had in USD less than $410 annual household healthcare expenditure. The mean annual healthcare expenditure was found to be $279. Nearly three-fourths (71.4%) of households had annual expenditure on medicine more than $40 with mostly on allopathic medicine (93.4%). The majority of participants (70%) mentioned that the healthcare expenditure was a burden to their household. Conclusion: Despite the higher knowledge of health insurance, the involvement was found to be very low &amp; poor. Educational status, knowledge about insurance, privileged ethnicity, religion, income source were the major factors associated with the utilization of healthcare services. Awareness &amp; promotion programs focusing on rural communities should be implemented with affordable health services.

Impact of Comorbid Conditions on Healthcare Expenditure and Work-related Outcomes in Patients With Rheumatoid Arthritis.

To evaluate the effect of comorbid conditions on direct healthcare expenditure and work-related outcomes in patients with rheumatoid arthritis (RA). This is a retrospective analysis of the Medical Expenditure Panel Survey from 2006 to 2015 in 4967 adults with RA in the United States. Generalized linear models were used for healthcare expenditure and income, logistic models for employment status, and zero-inflated negative binomial models for absenteeism. Thirteen comorbid conditions were included as potential predictors of direct cost- and work-related outcomes. The models were adjusted for sociodemographic factors including sex, age, region, marital status, race/ethnicity, income, education, and smoking status. Patients with RA with heart failure (HF) had the highest incremental annual healthcare expenditure (US$8205, 95% CI $3683-$12,726) compared to those without the condition. Many comorbid conditions including hypertension (HTN), diabetes, depression, chronic obstructive pulmonary disease, cancer, stroke, and HF reduced the chance of patients with RA aged between 18-64 years being employed. Absenteeism of employed patients with RA was significantly affected by HTN, depression, disorders of the eye and adnexa, or stroke. On average, RA patients with HF earned US$15,833 (95% CI $4435-$27,231) per year less than RA patients without HF. Comorbid conditions in patients with RA were associated with higher annual healthcare expenditure, lower likelihood of employment, higher rates of absenteeism, and lower income. Despite its low prevalence, HF was associated with the highest incremental healthcare expenditure and the lowest likelihood of being employed compared to other common comorbid conditions.

Comparison of Use of Health Care Services and Spending for Unauthorized Immigrants vs Authorized Immigrants or US Citizens Using a Machine Learning Model

Knowledge about use of health care services (health care utilization) and expenditures among unauthorized immigrant populations is uncertain because of limitations in ascertaining legal status in population data. To examine health care utilization and expenditures that are attributable to unauthorized and authorized immigrants vs US-born individuals. This cross-sectional study used the data on documentation status from the Los Angeles Family and Neighborhood Survey (LAFANS) to develop a random forest classifier machine learning model. K-fold cross-validation was used to test model performance. The LAFANS is a randomized, multilevel, in-person survey of households residing in Los Angeles County, California, consisting of 2 waves. Wave 1 began in April 2000 and ended in January 2002, and wave 2 began in August 2006 and ended in December 2008. The machine learning model was then applied to a nationally representative database, the 2016-2017 Medical Expenditure Panel Survey (MEPS), to predict health care expenditures and utilization among unauthorized and authorized immigrants and US-born individuals. A generalized linear model analyzed health care expenditures. Logistic regression modeling estimated dichotomous use of emergency department (ED), inpatient, outpatient, and office-based physician visits by immigrant groups with adjusting for confounding factors. Data were analyzed from May 1, 2019, to October 14, 2020. Self-reported immigration status (US-born, authorized, and unauthorized status). Annual health care expenditures per capita and use of ED, outpatient, inpatient, and office-based physician care. Of 47 199 MEPS respondents with nonmissing data, 35 079 (74.3%) were US born, 10 816 (22.9%) were authorized immigrants, and 1304 (2.8%) were unauthorized immigrants (51.7% female; mean age, 47.6 [95% CI, 47.4-47.8] years). Compared with authorized immigrants and US-born individuals, unauthorized immigrants were more likely to be aged 18 to 44 years (80.8%), Latino (96.3%), and Spanish speaking (95.2%) and to have less than 12 years of education (53.7%). Half of unauthorized immigrants (47.1%) were uninsured compared with 15.9% of authorized immigrants and 6.0% of US-born individuals. Mean annual health care expenditures per person were $1629 (95% CI, $1330-$1928) for unauthorized immigrants, $3795 (95% CI, $3555-$4035) for authorized immigrants, and $6088 (95% CI, $5935-$6242) for US-born individuals. Contrary to much political discourse in the US, this cross-sectional study found no evidence that unauthorized immigrants are a substantial economic burden on safety net facilities such as EDs. This study illustrates the value of machine learning in the study of unauthorized immigrants using large-scale, secondary databases.

Going beyond the mean: economic benefits of myocardial infarction secondary prevention

BackgroundUsing the example of secondary prophylaxis of myocardial infarction (MI), our aim was to establish a framework for assessing cost consequences of compliance with clinical guidelines; thereby taking cost trajectories and cost distributions into account.MethodsSwiss mandatory health insurance claims from 1840 persons with hospitalization for MI in 2014 were analysed. Included persons were predominantly male (74%), had a median age of 73 years, and 71% were pre-exposed to drugs for secondary prophylaxis, prior to index hospitalization. Guideline compliance was defined as being prescribed recommended 4-class drug prophylaxis including drugs from the following four classes: beta-blockers, statins, aspirin or P2Y12 inhibitors, and angiotension-converting enzyme inhibitors or angiotensin receptor blockers. Health care expenditures (HCE) accrued over 1 year after index hospitalization were compared by compliance status using two-part regression, trajectory analysis, and counterfactual decomposition analysis.ResultsOnly 32% of persons received recommended 4-class prophylaxis. Compliant persons had lower HCE (− 4865 Swiss Francs [95% confidence interval − 8027; − 1703]) and were more likely to belong to the most favorable HCE trajectory (with 6245 Swiss Francs average annual HCE and comprising 78% of all studied persons). Distributional analyses showed that compliance-associated HCE reductions were more pronounced among persons with HCE above the median.ConclusionsCompliance with recommended prophylaxis was robustly associated with lower HCE and more favorable cost trajectories, but mainly among persons with high health care expenditures. The analysis framework is easily transferrable to other diseases and provides more comprehensive information on HCE consequences of non-compliance than mean-based regressions alone.

The medical costs of low leisure-time physical activity among working-age adults: Gender and minority status matter

This study analyzes the direct medical costs of low physical activity by race/ethnicity and gender. Average health expenditures based on physical activity status for Black non-Hispanics (NH), Asian NHs, and Hispanics were compared to White NHs. Data from the National Health Interview Survey were merged with the Medical Expenditure Panel Survey for years 2000–2010 and 2001–2011, respectively, and weights were applied to ensure generalizability to the larger US population. The sample was restricted to non-pregnant adults between the ages of 25 and 64, with a final sample size of 44,953. The multivariate estimates reveal statistically significant lower annual health care expenditures among physically active men and women in five out of eight racial/ethnic groups relative to their inactive counterparts: on average, for men, $1041 less is spent among White NHs, $905 less is spent for Black NHs and $876 less is spent for Asian NHs. Among women, medical expenditures were $956 per year less among active White non-Hispanics relative to their inactive counterparts, and $815 per year among Hispanics. Essentially, the average reduction in health care expenditures is relatively consistent for five out of the eight groups. The absence of any reduction in average health care expenditures for three of the groups, however, suggests that there may be environmental factors at play for certain groups that mitigate the impact of physical activity on health expenditures.

Incremental Health Care Expenditures of the Spouses of Older Adults With Alzheimer's Diseases and Related Dementias (ADRD)

Previous research has found that having a spouse with Alzheimer's disease and related dementias (ADRD) is associated with higher health care expenditures, however it is unclear if this difference remains after accounting for the demographics and health status of the non-ADRD spouse. This paper aims to estimate the adjusted incremental health care expenditures of having a spouse with ADRD. Cross-sectional study of publicly available survey data (2003-2017 Medical Expenditure Panel Survey). Representative sample of U.S. households. Community-dwelling and married older adults (n = 28,356). Two-part models and recycled prediction techniques to estimate the incremental effects of having a spouse with ADRD on annual health care expenditures, while adjusting for demographics, socioeconomic characteristics, and health conditions. Spouses of older adults with ADRD were older, had worse perceived mental health, and had greater difficulties with activities of daily living, compared to older adults with cognitively normal spouses. Spouses of ADRD patients had significantly higher unadjusted total health care expenditures, however their adjusted incremental expenditure was not significantly greater. After controlling for demographics and health status, ADRD spouses had significantly higher home health care expenditures, but significantly lower outpatient expenditures. Results suggested that the higher health care expenditures in older adults with ADRD spouses can be attributed to the higher rate of comorbidities, rate of functional limitations, and mean age in this group. The increased use of home health and decreased use of outpatient in this population suggests the importance of tailoring preventative health care and social services to meet the needs of this group.