Average Monthly Cost Research Articles

Intervenções farmacêuticas em utentes em uso de insulinas análogas sob demanda judicial assistidos no Centro de Especialidades Médico Odontológica, em Belém, Pará

Objetivo: Apresentar as intervenções farmacêuticas ofertadas para utentes em uso de insulinas análogas sob judicialização, por meio de serviços farmacêuticos disponibilizados no Centro de Especialidades Médico Odontológica, em Belém, Pará. Método: Trata-se de um estudo de caso, prospectivo, descritivo, analítico de natureza qualitativo e quantitativo, realizado em utentes com Diabetes Mellitus na faixa etária entre 50 e 59 anos, de ambos os sexos e gêneros, em uso de insulinas análogas sob judicialização, por meio da observação participativa, utilizando amostragem de conveniência feito no período entre agosto de 2018 e junho de 2019. Resultados: 27 utentes, sendo 15 do gênero feminino e 12 do gênero masculino, com idade entre 50 e 59 anos integralizaram as 3 Consultas Farmacêuticas. 29,6% dos utentes apresentavam alguma complicação relacionada ao diabetes; dentre as quais, a prevalência de retinopatia diabética em 50%. A glicemia capilar casual apresentou uma redução de 215,29 ± 80,56 mg/dL para 131 ± 34,74 mg/dL. A insulina glargina (Lantus®) foi encontrada em 94% das prescrições. 85,2% auto-referiram ter adesão ao tratamento. R$ 454,87 foi o custo médio mensal dos tratamentos dos utentes. 100,0% dos utentes foram classificados como tendo boa qualidade de vida. Conclusão: Infere-se que as intervenções farmacêuticas demonstraram ser efetivas quanto ao cuidado farmacêutico e a qualidade de vida do utente. Propõe-se, reflexionar, sobre a importância não só da acessibilidade as insulinas análogas via judicial; mas, imprescindivelmente da qualidade do acesso aos serviços de cuidados ofertados.

DETERMINANTS OF ADHERENCE TO ANTIHYPERTENSIVE MEDICATIONS AMONG PATIENTS ATTENDING TERTIARY CARE HOSPITALS IN ISLAMABAD

Objective: Hypertension is one of the non-communicable diseases which reduces life expectancy and decreases productive years, accounting for almost 9·4 million deaths annually and 7·0% of global DALYs. The economic burden associated with NCD deaths will rise from $152 million in the year 2010 to $296 million in 2025. Nonadherence to medications leads to poor health outcomes. The annual cost of nonadherence was estimated to be at 100 million US dollars in 2011 or 70% of healthcare expenditure on drugs worldwide. We conducted this study to have an insight into our patient's behavior towards their treatment regimes. Design and method: A hospital-based analytical cross-sectional study involving adult hypertensive patients attending the cardiology clinic of tertiary care hospital in Islamabad Capital Territory (ICT), conducted from July 2019 to October 2019. The data was collected using a semi-structured pretested questionnaire. Proportionate to target population sample was calculated and 418 subjects were enrolled through systematic random sampling technique. Data analysis was done as descriptive statistics Bivariate analysis was carried out and a p-value of less than 0.05 considered as significant. Logistic regression was done to identify independent predictors of adherence Results: The mean age of respondents was 54.4 years SD ± 10.61. Participants were predominately male (56.2%). 327 (72.7%) of the respondents had High Bp Grade I, uncontrolled blood pressure. 218 (48.44%) were not able to afford to buy monthly medication, Average monthly cost of the medication was 7.42 USD (1150 PKR) ± 1136 Pak Rupees, with 28.89% were not able to buy the medications on their own. Multivariate logistic regression analysis revealed non-affordability of treatment (OR 2.2 p-value 0.0002) and testing, uncontrolled hypertension (OR 3.1 p-value 0.0001), as statistically significant determinants for being nonadherent, whereas being educated (OR O.6 p-value 0.02))and adequate counseling by a health practitioner (OR 0.2 p-value 0.000) were protective factors. Conclusions: For improving adherence to antihypertensive therapy, we concluded the prevalent paradigm of healthcare is nonsupportive in terms of enhanced and non-affordable treatment regimes, long waiting hours, non-availability of universal health coverage. Further, education and better counseling had a positive impact on the patient's altered attitude towards medications.

Virtual grand rounds in COVID-19: A financial analysis.

Grand Rounds (GR) lectures are formal educational initiatives that are at the core of most academic clinical departments.1,2 GR have evolved over its commemorative beginnings, shifting away from real-time clinical skills demonstration to the now familiar, lecture-based format.2 Today, GR represent prestigious academic speaking opportunities for thought leaders to discuss topics intended to broaden the medical knowledge at an institution. Despite being considered a cornerstone of education in most training programs, GR have recently come under scrutiny for their dwindling educational efficacy, poor attendance, logistical challenges, and overhead cost.1,3 There is even concern that GR may be at risk of complete extinction altogether.4.

Implementation of pharmacist-managed early switch from intravenous to oral therapy using electronic identification at a tertiary academic hospital

Overutilization of intravenous (IV) medications can result in drug shortages, which is one of the major health care crisis, in addition to increasing costs, length of hospital stays (LOS) and the associated complications. We hypothesized that IV therapy was overused at our hospital where oral (PO) was applicable, and that the implementation of IV-PO protocol could result in a cost-effective practice. Hence, we aimed at assessing impact and outcomes of implementing such a protocol.A single center, prospective quasi-interventional study conducted at tertiary academic hospital. A protocol was implemented targeting 17 medications, with educational sessions to medical staff during a 5-month phase. IV orders of 48 h or more, among adult patients at medical or surgical wards with no contraindication to PO route were eligible. Once eligible, pharmacists send interventions using hospital’s computerized order entry system, and physicians’ responses were monitored on daily basis. Efficacy was estimated by percentage of switch recommendations that resulted in effective switch to PO medication. Cost-minimization analysis was used for course cost between the control phase and intervention phase. Length of hospital stay (LOS), readmissions within 90 days and in-hospital mortality were analyzed as secondary outcomes.During intervention phase, 781 patients had at least one IV order switched to PO. Gastric acid-reducing agents (GARAs) accounted for the most IV prescriptions (50.4%), followed by antibiotics (39.6%). Pharmacists carried out 2677 interventions to which switch recommendations were issued in 1185 (44.3%). Primary switch recommendations (N = 677) led to effective switch in 60.7% cases. These included per protocol switch (8.9%), switch to another PO (2.5%), spontaneous switch by physician (17.6%) and IV discontinuation (31.8%). The overall efficacy was estimated as 62.8%. The intervention was associated with reduced IV consumption from 4,574–18,597 vials in control phase to 3,654–15,546 vials in intervention phase, which resulted in overall cost saving of 50,960.8 SAR ($13,589.5), with an average monthly cost saving of 10,192.2 SAR ($2,717.9).Pharmacist-managed early switch from IV-PO therapy, with physicians’ education, showed significant reduction in IV medication use in our hospital. By reducing unnecessary IV use, this strategy enabled considerable cost savings, besides the potential advantages of convenience and safety.

Standardization of medication inventory in an urban family medicine clinic

BackgroundRecommendations on clinic-administered medications to stock in an urban family medicine clinic and how to manage an outpatient formulary are not well defined in the literature. Although there are numerous hypothesized incentives for a standardized medication inventory, the financial impact at the level of a single clinic is unknown. ObjectivesThe purpose of this project was to develop clinic-administered medication inventory recommendations for urban family medicine clinics and to determine the financial impact of standardization at a single clinic. MethodsThe current clinic-administered medication inventory was assessed using the following prespecified criteria: (1) clinic administration is required for successful patient outcomes, (2) use of the medication for intended indication is evidence-based, (3) appropriately trained staff and equipment are available to administer and monitor the medication, (4) most cost-effective dosage form of the medication is stocked in the clinic, and (5) quantity and location of medication stocked in the clinic match need. Changes to the medication inventory were made effective on August 1, 2018, based on physician group consensus. Monthly clinic medication cost during the study period was analyzed before and after intervention. ResultsA total of 80 medications were identified; 45 medications remained after changes according to the prespecified criteria. The monthly cost of maintaining the inventory during the study period was $1947 preintervention compared with $1048 postintervention. The estimated average monthly cost savings of a standardized inventory in a single, urban family medicine clinic is $900, or $10,800 annually. ConclusionStandardizing a clinic-administered medication inventory in an urban family medicine clinic can help reduce unnecessary cost.

The Economic Burden of Dementia: Evidence from a Survey of Households of People with Dementia and Their Caregivers.

Although a cognitive impairment such as dementia causes serious economic problems among older people, its impact on economic activities is unclear. This study investigated the actual conditions of economic activities and the current status of the financial support systems among people with dementia and caregivers. One hundred and five dyads participated in the survey. Each dyad consisted of an older person with Alzheimer’s disease and their caregiver. The Mini-Mental State Examination (MMSE) and Functional Assessment Staging (FAST) were used to evaluate the cognitive functions of people with dementia. The caregivers were asked questions concerning the financial status of the household and their utilization of the financial support systems available to people with dementia. Average monthly care costs significantly increased according to the severity of dementia, while household income and spending incurred no significant changes. People with dementia experienced financial problems (including a large amount of erroneously purchased, unnecessary shopping), even though their assets were informally managed by their caregivers. Financial support systems such as adult guardianship and civil trust systems were rarely known and used. We proposed the propagation of the adult guardianship and civil trust systems and the development of contract guidelines for elderly customers including people with dementia.

Abstract PS10-45: Budget impact of introducing neratinib for third-line treatment of HER2+ metastatic breast cancer in the United States

Abstract Background Neratinib, an oral, irreversible tyrosine kinase inhibitor of multiple HER receptors, was recently approved in combination with capecitabine (neratinib doublet regimen) in the United States (US) for adults with HER2+ metastatic breast cancer (mBC) who have received 2 or more anti-HER2 therapies. Clinical trials showed that neratinib plus capecitabine significantly improved progression-free survival versus lapatinib plus capecitabine. There are several existing and potential treatment options for this population with varying efficacies, side effect profiles, and costs. Objective This analysis estimates the budget impact for US health care payers of adding a neratinib doublet regimen to the currently available third-line HER2+ mBC treatments in the US. Methods A budget-impact model was developed to compare health care payer costs associated with third-line treatment of HER2+ mBC over 5 years between a treatment setting with neratinib and a treatment setting without neratinib for a hypothetical 1-million-person commercial plan of adults over age 18. The treatment options considered in the model include neratinib doublet regimen, oral combination therapy with lapatinib and capecitabine (lapatinib doublet regimen), tucatinib plus capecitabine plus trastuzumab (tucatinib triplet regimen), and intravenous fam-trastuzumab deruxtecan-nxki (DS-8201 single agent). The population eligible for treatment was calculated based on prevalence and incidence of HER2+ mBC and progression to third-line HER2-direct treatment; estimates were obtained from the published literature. The impact of including neratinib doublet regimen was assessed under two market share scenarios: one in which all regimens had equal market share and a second in which a clinical expert provided judgement on projected uptake of the regimens over the five-year period. In the treatment setting without the neratinib regimen, market shares for neratinib were distributed equally to the other treatments. Treatment duration, dosing, adverse event incidence, and monitoring requirements were obtained from key clinical trials and prescribing information. Drug acquisition costs, unit monitoring costs, and adverse event costs were obtained from wholesale acquisition costs, fee schedules, and the Healthcare Cost and Utilization Project, respectively. The total incremental costs and per-member-per-month (PMPM) costs were calculated by comparing total health plan costs in the treatment setting with neratinib with costs in the treatment setting without neratinib over a 5-year period. Costs were presented in 2019 US dollars. Results It was estimated that 47 patients would be eligible for third-line HER2 mBC treatment in the first year, with an additional 17 incident patients becoming eligible each subsequent year. Average monthly costs per treated patient were $15,037, $9,283, $27,759, and $14,826 for neratinib doublet regimen, lapatinib doublet regimen, tucatinib triplet regimen, and DS-8201, respectively. When market shares were assumed to be even across regimens, the treatment setting with neratinib doublet regimen reduced total annual health plan costs by $1.4 million ($0.02 PMPM) over 5 years compared with the treatment setting without neratinib doublet regimen. Cost reductions for the treatment setting with neratinib doublet regimen were $575,738 ($0.01 PMPM) over 5 years when market shares were based on clinical expert estimates. Conclusions The introduction of neratinib over the course of 5 years has the potential to reduce US health plan costs for the treatment of patients with HER2+ mBC by reducing the usage of more expensive treatment regimens. Citation Format: Seri AL Anderson, Justin Carrico, Thor-Henrik Brodtkorb, Deepa Lalla, Adam Brufsky. Budget impact of introducing neratinib for third-line treatment of HER2+ metastatic breast cancer in the United States [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS10-45.

Optimization of the average monthly cost of an EOQ inventory model for deteriorating items in machine learning using PYTHON

In many stock disintegration issues of the real world, the decay pace of certain things might be influenced by other contiguous things. Depending on the situation, the influence of weakened items can be reduced by eliminating them through examination. We specify a model that impacts the average monthly cost, and the non-linear programming Lagrangian method is solved the specified model. The fuzzify inventory model is used to determine the lowest cost by employing a trapezoidal fuzzy number, and the defuzzification process is performed using the graded mean integration representation method. To test the model, we created a CSV file, used PYTHON (version 3.8.5), we developed a program to predict the economic order quantity and total cost.

Healthcare resource utilization and cost among patients with type 1 diabetes in the United States.

BACKGROUND: Approximately 5%-10% of patients with diabetes are diagnosed with type 1 diabetes mellitus (T1DM), the incidence and prevalence of which is projected to increase through 2050. Despite this, T1DM-related health care resource utilization (HCRU) and economic burden in the United States have not been adequately assessed, since previous studies used various cost definitions and underlying methods to examine these outcomes. OBJECTIVE: To assess HCRU and costs incurred by patients with T1DM in the United States. METHODS: This retrospective cohort study used IBM Watson MarketScan data from 2011 to 2015 and Optum's electronic medical record (EMR) and integrated data (i.e., linked EMR and administrative claims data) from 2011 to 2016. Included patients had ≥ 1 T1DM diagnosis (the earliest diagnosis date was designated as the index date), were continuously enrolled for ≥ 6 months during their pre-index baseline periods, and had ≥ 1 pharmacy claim for insulin or an insulin pump within ± 90 days of the index date. Baseline demographic and clinical characteristics were summarized descriptively. Average monthly HCRU and costs per patient per month (PPPM) paid by the health plan and patient were assessed. Costs were adjusted for inflation to 2018 U.S. dollars. RESULTS: We identified 181,423 patients with T1DM who met the selection criteria in MarketScan, 84,759 in the Optum EMR, and 8,948 in the Optum integrated databases. Most patients were male (range across databases: 52.6%-53.1%), relatively young (medians: 33-35 years, overall range: 0-100 years), and had a Charlson Comorbidity Index score of 1 (69.2%-73.0%) across all databases. Total all-cause and diabetes-related costs ranged from $1,482 to $1,522 and $733 to $780 PPPM, respectively, during the follow-up period. Pharmacy costs contributed most to the total cost of care, accounting for 55.3% ($431) to 61.1% ($448) of total diabetes-related costs. On an annualized basis, patients had an average of 0.2-0.9 all-cause hospitalizations and 0.1-0.3 diabetes-related hospitalizations during follow-up. The median costs per diabetes-related hospitalization ranged from $6,548 to $8,439, accounting for 4%-7% of total monthly diabetes-related costs. Patients had an average of 0.4-0.5 all-cause and 0.1-0.2 diabetes-related emergency department (ED) visits annually; the median costs of ED visits were $972-$1,499, contributing about 2% of monthly diabetes-related costs during follow-up. CONCLUSIONS: In this large, retrospective, observational study of pediatric and adult patients with T1DM, diabetes-related costs totaled nearly $800 per month. Pharmacy costs contributed to over half of diabetes-related costs, indicating the substantial economic burden associated with the treatment of T1DM. Additional research is needed to determine risk factors associated with costly events (e.g., hospitalizations and ED visits) and indirect costs associated with T1DM. DISCLOSURES: JDRF International provided funding for this project and manuscript. JDRF International also contracted with Evidera, a research and consulting firm for the biopharma industry, for its participation in the project and in the development of this manuscript. The Leona M. and Harry B. Helmsley Charitable Trust provided JDRF International with funding. Simeone, Shah, and Ganz are employed by Evidera and do not receive any payment or honoraria directly from Evidera's clients. LeGrand is an employee of JDRF International. Bushman was employed by JDRF International during the conduct of the study and development of this manuscript. Sullivan and Koralova are employees of The Leona M. and Harry B. Helmsley Charitable Trust.

The economic impact of disease progression and death in hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2-) advanced breast cancer patients: using Korean nationwide health insurance claims data

Objectives Recognizing the value of anticancer treatments based on progression-free survival and overall survival may help decision making in healthcare policy. We aimed to measure and compare the impact of disease progression and terminal state prior to death on healthcare costs in HR+, HER2- ABC patients. Methods We conducted a retrospective study using Korean nationwide health insurance claims database between 1 September 2012 and 31 August 2017. The impact of disease progression was estimated by measuring the average incremental monthly cost per patient during 1 year after progression compared to 1 year before progression. Death-related costs per patient per month (PPPM) were measured for those who died within 1 year after progression. Generalized estimating equation (GEE) was used to estimate the variations in PPPM costs by progression and death with adjustment for clinical factors. Results After progression, 1,636 patients expensed $2,892 per month more on average than before progression ($3762 vs. $870). The GEE analysis with adjustment for baseline characteristics showed that PPPM costs increased by 3.46 folds (95% CI = 3.06–3.93) after progression. Also, PPPM costs were 1.74 (95%CI = 1.43–2.12) times higher in patients who died within 1 year after progression relative to survived patients. When considering the interaction between progression and death, deceased patients showed higher increased ratio of PPPM costs after progression (4.91; p=value<.0001) than survived patients (2.95; 95% CI = 2.61–3.34). Conclusions From the payer’s perspective, more healthcare costs incurred during the progression state than terminal state in HR+, HER2- ABC patients. The impact of disease progression emphasizes the importance of effectively treating HR+, HER2- ABC patients.

Assessment of costs related to cancer treatment.

Cancer patients and their caregivers incur costs not covered by the Sistema Único de Saúde - SUS(Unified Health System) during their treatment, with expenses related to transportation, symptomatic medications, food, loss of working days, and others. To evaluate the costs incurred and not covered for cancer patients and their caregivers during cancer treatment at SUS. This is a cross-sectional study of 110 cancer patients undergoing chemotherapy, radiotherapy, and 88 caregivers in the last month prior to their inclusion in the study. We correlated costs with clinical and sociodemographic variables such as gender, race, age, marital status, education, occupation, place of birth, origin, monthly income, family income, housing, comorbidities, types of cancer, and staging. We observed that the average cost for study patients was R$ 747.92, which corresponds to 78.4% of the minimum wage, and the average cost for caregivers was R$ 118.86, which is 12.46% of the minimum wage. Among all variables analyzed, the average overall monthly cost for patients was positively correlated with the occupation (p = 0.021) and origin (p = 0.038) variables. For the other variables, no significant associations were detected. The positive correlation found between occupation and origin variables with costs incurred and not covered for patients suggests that the creation of programs that enable the payment of costs not covered by SUS and the decentralization of access to cancer treatment could potentially facilitate patients' adherence to cancer treatment.

1604P Aggregated analysis of treatment and survival outcome of all metastatic renal cell carcinoma patients treated from 2014 to 2018 in the Veneto region, Italy

Monitoring the use of high cost drugs at a population level is becoming increasingly relevant for regional Healthcare systems in order to appropriately program the allocation of resources and conduct budget impact analyses whenever a novel drug is approved. We planned a retrospective analysis of all prescriptions of high cost drugs to mRCC pts in the Veneto Region of Italy, years 2014-2018. Aggregated data of type of drug, line of treatment, treatment duration-TD, OS and costs were extracted from Veneto Healthcare database covering 4.9 million people. Average monthly cost of therapy was calculated dividing the cost of all drug resupplies dispensed to each patient by TD in mo of the same treatment. Managed entry agreements and clinical trials were not considered. We identified 1135 pts who started at least one line of systemic treatment for mRCC, and a total of 1665 treatments: 58% in first line, 26% second, 12% third, 4% fourth or further line. First-line pazopanib and sunitinib had a median DT of 10.5 and 9.7 mo (32.3% censored, p=0.51), and median OS of 28.6 and 26.2 mo (54.6% censored, p=0.61), respectively. Average monthly cost was estimated to be 3,583 and 2,679 euros for sunitinib and pazopanib, respectively (p<0.0001) (Table). Nivolumab and cabozantinib had a longer DT both in second line (compared to axitinib, everolimus and sorafenib (p<0.0001)) and third line (compared to everolimus or sorafenib, (p<0.0001)), although medians were not reached with all drugs (Table). Cost of second or third line treatment per patient was significantly higher for Nivolumab compared to all other drugs, p<0.0001 (Table). Our pupulation-based analysis confirms that first line pazopanib and sunitinib have comparable DT and OS, although cost of sunitinib without managed entry agreements is higher. Nivolumab and cabozantinib have superior DT both in second and third line setting, with nivolumab being the most expensive drug.Table 1604PDT, OS and average monthly cost of drugs per patient (NR=not reached)LineNDT (mo)pOS (mo)Pcost (euros)pFIRSTPazopanibSunitinib34461510.5 (8.7-12.9)9.7 (8.4-12.0)0.512.9.0 (21.7-35.3)26.8 (21.4-33.4)0.6126793583<0.0001SECONDAxitinibCabozantinibEverolimusNivolumabSorafenib11734123118285.9 (3.9-7.2)NR4.5 (3.1-5.0)8.7 (5.2-13.7)2.8 (1.6-3.7)<0.000113.8 (10.8-24.6)NR12.2 (9.0-15.6)NR12.5 (5.4-19.4)<0.00013.0442860335755593261<0.0001THIRDCabozantinibEverolimusNivolumabSorafenib30585261NR3.8 (2.9-4.5)4.8 (2.8-10.0)3.0 (2.2-5.6)<0.0001NR8.3 (6.9-14.3)NR8.9 (5.7-12.2)<0.00012939360253482920<0.0001 Open table in a new tab

State Variations in Regulatory Stringency for Assisted Living Communities: Potential Implications for Service Supply, Cost, and Quality

Research ObjectiveOver 30 000 Assisted Living (AL) communities in the US now serve 1 million older Americans. AL growth has occurred largely without federal oversight and with variable state regulatory efforts. Research on AL regulations has been scant, largely descriptive, and mostly focused on dementia‐care. This study aimed to (a) assess/compare states’ approaches to regulating AL communities across multiple policy domains and (b) identify state‐level factors associated with regulation stringency.Study DesignPrimary data source was each state’s AL regulations published on state websites. Additional data, for example, the 2019 National Center for Assisted Living (NCAL) Regulatory Review, were used to augmented/check the accuracy of our coding of policies. Several secondary sources were employed to derive state covariates.We focused on 4 policy domains, which regulate residents’ admission and retention (9 items), medication management (4 items), staffing/training (8 items), and dementia care (9 items). We used codes developed in prior research and developed new codes inductively. Each domain was coded independently by two researchers, and differences were reconciled. For each domain, we summed all items and created a standardized state‐level stringency measure as: (X‐mean)/SD. For each state, the standardized values were added to create an overall stringency score. Psychometric properties of the individual and overall stringency measures were tested using factor analysis and Cronbach α.Descriptive statistics, mapping, and OLS regression analyses were employed to examine 5 measures of stringency (overall and 4 domains). Based on literature reviews, we identified 5 state‐level independent variables: AL average monthly cost; number of AL beds/1000 people age 75+; % aged Medicaid beneficiaries using AL; Medicaid spending on AL services; and % nursing homes (NH) with 4‐5 star quality on deficiencies.Population StudiedDescriptive analyses included data on 50 states and DC, while 47 states were included in OLS regressions.Principal FindingsOverall, 10 states had high (&gt;1SD) and 5 states had low (&lt;1SD) stringency. While only 1/3 of states with high overall stringency exhibited similar levels of stringency across all domains, 2/3 of states with low stringency remained consistently low. State variations were highest in regulations for medication management (18 states scored high and 13 low), and lowest for staffing/training (8 high and 7 low). Regression results showed statistically significant (P &lt; 0.05) negative associations between AL cost and AL beds/1000 for all domains except staffing/training. NH quality on deficiencies and Medicaid AL spending were positively associated with staffing/training regulation stringency.ConclusionsWhile many states have implemented some AL regulatory measures, substantial variations across states exist. For example, in states with higher Medicaid AL spending, regulation on AL staffing/training is stronger. AL investors may react to overall state regulatory environment as lower AL bed supplies are found in states with stronger regulations. High stringency may influence AL providers to maintain lower case‐mix acuity among residents, which may be more congruent with the ALs’ ability to provide services, and in turn results in lower monthly costs.Implications for Policy or PracticeState variations in AL regulations may influence service supply and cost as well as resident case‐mix and care quality. A more in‐depth understanding of these relationships is needed.Primary Funding SourceAgency for Healthcare Research and Quality.

Integrated palliative homecare in advanced dementia: reduced healthcare utilisation and costs

ObjectivesTo determine the economic benefit of an integrated home-based palliative care programme for advanced dementia (Programme Dignity), evaluation is required. This study aimed to estimate Programme Dignity’s average monthly cost...

Atenção domiciliar no Sistema Único de Saúde: perfil de pacientes assistidos

Objetivo: delinear o perfil dos pacientes assistidos em um Serviço de Atendimento Domiciliar da cidade de Curitiba. Métodos: desenho transversal, retrospectivo, abordagem quantitativa; coleta de dados dos pacientes assistidos no serviço em 2017; contendo as variáveis sociodemográficas e clínicas. Realizou-se análise estatística descritiva e modelos de regressão. Resultados: em 2017 houve 1798 atendimentos de 1436 pacientes. O perfil apontou maioria dos pacientes do sexo feminino, média de idade acima de 71 anos e raça branca; a procedência predominante dos assistidos foram as Unidades Básicas de Saúde ou Estratégia de Saúde da Família com tempo médio de atendimento superior a 38 dias; prevalência de distúrbios neurológicos; desfecho de atendimento foi alta. O custo médio mensal foi de R$ 1.403,56 por paciente. Conclusão: o perfil dos pacientes indicou maioria de mulheres, brancas, com até oito anos de estudo, idade acima de 71 anos e assistidos por distúrbios neurológicos.

PCN277 CATCH THE WIND EARLY: PRICE FORECASTING OF EARLY STAGE ONCOLOGY ASSETS IN US

Price and value forecasting is challenging for developmental products where only early efficacy data is available, with products often reaching pivotal clinical development stages without an estimate of likely price potential and, effectively, returns. This may result in missing the opportunity to optimise the asset’s evidence generation plan, price and launch sequence. To define the value and forecast the price potential of assets in development, we have selected a variety of different value attributes that drive decision-making within oncology to arrive at a value framework. A Multiple Criteria Decision Analysis (MCDA) framework was developed using 21 weighted criteria validated by previously published research on MCDA and value framework methodologies from ICER (Institute for Clinical and Economic Review) and ASCO for the evaluation of medicines. The MCDA was based on a scoring system on a scale of 0 to 5 depending on each criterion. The MCDA framework included two groups: the first (core) group includes attributes that measure clinical benefit, economic value and disease characteristics; the second (extended) group covers additional broader considerations such as public health interests and non-health benefits. A linear regression analysis was performed using monthly cost of treatment as the dependent variable and aggregate MCDA score as the independent variable for immune-oncology products launched in US. For 6 immuno-oncology products, a strong correlation between the MCDA scores and the average monthly cost of treatment was observed [R of 0.89 for core group and 0.93 for the extended group]. The correlation that statistically measures how close the data are to the fitted regression line (R2) was over 0.8 for both groups suggesting a high explanatory power of the developed value framework. The study provides a robust framework for estimating the value and price of assets within immuno-oncology indications to inform Pricing and Market Access strategy.

Economic burden of seizure disorders on medication adherence and treatment outcomes of people with epilepsy in a Tertiary Hospital in Ibadan, Nigeria

Introduction: The burden of seizure disorder in relation to adherence and outcome has not then explored in many developing countries.Objective: The study aimed at estimating the economic burden of seizure disorder on the patient and their caregivers.Methods: A Structured and pretested self-administered questionnaire was used to obtain information from the participants. Information was also retrieved from patients’ case notes using a structured data form. Participants’ self-report on medication adherence was assessed using Morisky’s Medication Adherence Scale (MMAS-4). Cost of management (direct cost only) of the disorder was based on patients and families perspective. Data were analyzed with SPSS version 23. Relationship between duration of use of AntiEpileptic Drugs (AEDs) and adherence level was tested using Pearson moment product correlation and p <0.05 considered significant.Results: One third (19, 37.8%) of the patients were diagnosed with mixed seizure. Carbamazepine was the most commonly prescribed medication (60.8%). Only 18 (35.3%) had high adherence to prescribed medication(s) of which 3 (5.9%) had seizure remission for the past one year. Forgetfulness (31; 60.8%) and cost of medication(s) (24, 47.1%) were the most common reason(s) for non-adherence. Medical bill of 34 (66.7%) of the participants were paid by parents and relatives. Average monthly income of employed participants was ₦56,781.2 ($177.4). Average monthly cost of management per patient obtained was ₦11,723.9 ($36.6). The mean cost of AEDs (₦99,061.1±59,569.7) among adherent group was less than and non-adherent group (₦113,546.9±63,301.6). There is a significant negative correlation between years of use of AEDs and medication adherence score (r = - 0.3, p = 0.04).Conclusion: Economy burden of seizure is huge among the participants. Medical bills of more than two-third of them was borne by caregivers while those employed spent one-fifth of their monthly income on the disorder. Treatment outcome was poor due to high level of non-adherence to medication(s) associated with financial constrain. Measure to improve adherence and ease of financial burden among seizure disorder patients is highly essential.Keywords: Seizure disorders, Adherence, Cost, AED, Outcome

Ending the pain of children with severe epilepsy? An audit of the impact of medical cannabis in 10 patients

Background Scientific and anecdotal evidence suggest that whole plant cannabis extracts are effective in reducing seizure frequency in individuals with a range of epileptic etiologies. We report a case series of 10 individuals using CBMPs in the UK to treat their conditions. Methods In this retrospective study, we report on patients (aged 2-48) with severe, intractable, childhood onset epilepsies using combined cannabinoid therapy. Carers of patients provided details through the charity ‘End our Pain’ and these data were subsequently analysed. Our primary objective was to assess changes in monthly seizure frequency pre and post initiation of CBMPs. We also report on previous and current AED, CBD:THC daily dose, quality of life and financial costs associated with CBMP private prescription. Change in monthly seizure frequency were assessed using a Wilcoxon Signed-ranks test. Results Of the 10 patients enrolled in the study there was an 97% mean reduction in monthly seizure frequency post initiation of CBMPs which was statistically significant (Z = 0, p &lt; 0·01). We showed a reduction in AED use following initiation of CBMPs from a mean of 8 (±5·98) to 1 (±1·05). All patients were using either Bedrolite or Bedica (Bedrocan International) as their CBMP. Individual daily doses of THC ranged from 6·6mg – 26·5mg and for CBD, 200 mg – 550 mg. Average monthly cost of CBMP was £1816·20. Interpretation Our findings suggest a combination of CBD and THC based products are effective in reducing seizure frequency in a range of epileptic conditions. We highlight the inefficacy of the healthcare system in supporting these patients who bare great personal and financial burdens. We encourage specialist physicians and relevant bodies to permit greater ease of access of these medications to those patients where efficacy has been shown.

Recent transition of medical cost and relapse rate of multiple sclerosis in Japan based on analysis of a health insurance claims database

BackgroundIn this study, we aimed to understand the trends in total and itemized medical expenses, especially of disease-modifying therapy (DMT), for multiple sclerosis (MS) in Japan through an analysis of health insurance claims data.MethodsWe analyzed a database containing health insurance claims data from hospitals that have adopted the Diagnosis Procedure Combination/Per-Diem Payment System in Japan. According to an algorithm based on diagnosis codes, data for all patients diagnosed with MS from April 2008 to July 2016 were extracted. Medical costs, rate of each medical treatment, and rate of relapses were analyzed by calendar-year. Medical costs in the month of relapse were compared with average medical costs per month of all MS patients by a cross-sectional analysis.ResultsFour thousand three hundred seventy-four MS patients were identified in the database. Total medical cost per patient per month (PPPM) increased from ¥87,640 (US$787.7 or €723.0 as of May 2017) to ¥102,846 (US$924.4 or €848.4) during the study period. This increment was mainly attributed to the growth in cost of outpatient DMT prescriptions, which increased from ¥23,039 (US$207.1 or €190.1) to ¥51,351 (US$461.5 or €423.6). In contrast, the rate of hospitalizations and relapses PPPM decreased during the study period (from 0.053 to 0.030, and 0.032 to 0.019, respectively). Medical costs in the month of relapse (¥424,661, US$3816.8 or €3503.1) were 3.57 times higher than the average monthly costs for all MS patients (¥119,021, US$1069.8 or €981.8), with the majority comprising hospitalization cost.ConclusionConcomitant with the increased usage of DMT, the total medical cost for treating MS is increasing in Japan. However, rates of relapse and hospitalization have shown a decreasing trend. Although this study does not show the direct causality between DMT and reduction of relapse rates/fewer hospitalizations among MS patients, a reduction in hospital costs has been revealed concomitantly with the increasing prevalence of DMT.

Evaluating uptake and patient satisfaction with an out-of-pocket cost tracker for gynecologic cancer patients undergoing treatment.

101 Background: Tracking expenses may be useful to minimize financial distress in cancer patients. Our objective was to evaluate uptake and satisfaction with an out of pocket (OOP) cost tracker for gynecologic cancer patients on treatment. Methods: Within a longitudinal survey to assess financial burden among gynecologic cancer patients starting a new line of systemic therapy at a tertiary-care cancer center, we provided worksheets for participants to track their OOP expenses voluntarily. We assessed patient usage and satisfaction at 3 and 6 months. Financial distress was measured using Comprehensive Score for Financial Toxicity &lt; 26. Results: Among 121 participants with an average age of 59 years, 34 (28%) were African-American and 33 (27%) had a high school diploma or less. Half (55/110, 50%) of participants reported annual income &lt; $40,000. Most participants had health insurance (113/121, 93%) and were unemployed (77/118, 65%). Forty-nine of 121 (40%) participants reported ever using the OOP cost tracker at 3 or 6 months. Those who used the cost tracker stated it was helpful to track costs (86%, 73%), easy to use (97%, 100%), and useful for budgeting (42%, 24%) at 3 and 6 months. Participants reported using the cost tracker at least weekly (33%, 19%), every 2 weeks (36%, 27%), or monthly (31%, 54%) at 3 and 6 months. Twelve participants returned their OOP cost trackers for review with a median use of 5.5 months (range 3-10). Average monthly patient-reported OOP costs (range) were: $41 ($0-$584) for direct non-medical costs (i.e., transportation, lodging), $15 ($0-$120) for outpatient services, $13 ($0-$150) for medications/supplies, and $9 ($0-$100) for hospital services. Use of the OOP cost tracker at 3 months was not associated with financial distress at baseline (p = 0.30) or at 3 months (p = 0.89). Qualitative analysis showed the OOP cost tracker reminded patients to save receipts and to track categories of cost they would not have otherwise considered. Conclusions: 40% of gynecologic cancer patients undergoing treatment used an OOP cost tracker worksheet and found it helpful and easy to use. Direct non-medical costs accounted for the highest average monthly patient-reported OOP cost.