Average Number Of Outpatient Visits Research Articles

Not all Medicaid for pregnancy care is delivered equally.

Pregnant beneficiaries in the two primary Medicaid eligibility categories, traditional Medicaid and pregnancy Medicaid, have differing access to care especially in the preconception and postpartum periods. Pregnancy Medicaid has higher income limits for eligibility than traditional Medicaid but only provides coverage during and for a limited time period after pregnancy. Our objective was to determine the association between type of Medicaid (traditional Medicaid and pregnancy Medicaid) on receipt of outpatient care during the perinatal period. This retrospective cohort study compared outpatient visits using linked birth certificate and Medicaid claims from all Medicaid births in Oregon and South Carolina from 2014 through 2019. Pregnancy Medicaid ended 60 days postpartum during the study. Our primary outcome was average number of outpatient visits per 100 beneficiaries each month during three perinatal time points: preconceputally (three months prior to conception), prenatally (9 months prior to birthdate) and postpartum (from birth to 12 months). Among 105,808 Medicaid-covered births in Oregon and 141,385 births in South Carolina, pregnancy Medicaid was the most prevelant categorical eligibility. Traditional Medicaid recipients had a higher average number of preconception, prenatal and postpartum visits as compared to those in pregnancy Medicaid. In South Carolina, those using traditional Medicaid had 450% more preconception visits and 70% more postpartum visits compared with pregnancy Medicaid. In Oregon, those using traditional Medicaid had 200% more preconception visits and 29% more postpartum visits than individuals using pregnancy Medicaid. Lack of coverage in both the preconception and postpartum period deprive women of adequate opportunities to access health care or contraception. Changes to pregnancy Medicaid, including extended postpartum coverage through the American Rescue Plan Act of 2021, may facilitate better continuity of care.

Long-term effects of adenotonsillectomy in children with attention deficit hyperactivity disorder.

Adenotonsillectomy (AT) improves short-term symptoms of attention deficit hyperactivity disorder (ADHD) in children; however, its long-term effects remain unclear. We aimed to verify the therapeutic long-term effects of AT in children with ADHD. This retrospective control study included children ages < 18 years who were diagnosed with ADHD and receiving ADHD medications. Participants were divided into groups depending on whether AT was performed (AT [+] or AT [-] groups) and matched 1:1 for age, sex, and year and month of diagnosis using randomized nonreplacement selection. Among patients with ADHD (n = 171,112), 3,615 underwent AT. In both groups, the number of drugs taken gradually increased before and decreased after the AT date (ATD). There was no difference in the number of drugs used before (P = .88) and after ATD (P = .06). Before ATD, the average number of outpatient visits (nOV) did not change in both groups (AT [+]: P = .12; AT [-]: P = .71). After ATD, the average number of outpatient visits decreased only in the AT (+) group (P = .001). However, there was no difference in the average number of outpatient visits between the two groups before (P = .47) and after ATD (P = .17). Before ATD, methylphenidate doses between the groups were not different (P = .06); however, a significant increase was noted after ATD in the AT (+) group (P < .001). AT does not result in significant long-term therapeutic effects in terms of medication use and health care utilization in children with ADHD. Lee J, Choi A, Kim S, Kim K. Long-term effects of adenotonsillectomy in children with attention deficit hyperactivity disorder. J Clin Sleep Med. 2024;20(5):727-733.

Healthcare utilization of lung cancer patients associated with exposure to fine particulate matter: A Korean cohort study.

Higher concentrations of particulate matter (PM) have been shown to cause deterioration of the symptoms of respiratory and cardiovascular disease in several regional studies. Here, we aimed to investigate the healthcare utilization of lung cancer patients associated with short-term exposure to PM at the national level in Korea. We extracted the data of 210 558 subjects over a period of 3 years (2015-2017), who were diagnosed with lung cancer before 2015 and benefited from the National Health Insurance Sharing Service. We performed the interpolation method using the geographic information system to calculate the estimated mean PM2.5 and PM10 concentrations by regions and classified three groups as high (upper 10%), intermediate (10%-90%), and low (bottom 10%) based on the mean PM mass concentrations of the month. The monthly average number of outpatient visits was significantly increased in high PM2.5 urban areas (46.296 vs. 50.646, p = 0.015). In high PM2.5 nationwide regions, the monthly average number of emergency admission was significantly increased (0.528 vs. 0.785, p = 0.001). The outpatient visits tended to change with PM2.5 concentration and correlated with PM10 /PM2.5 concentrations in urban and nationwide areas. In high PM2.5 urban regions, there was a significant increase in bronchodilator prescriptions (3.102 vs. 3.758, p = 0.008). Concerning high PM2.5 nationwide regions, there were significantly increased prescriptions of antibiotics, steroids, bronchodilators, antihistamines, and mucolytics. This study suggests that exposure to PM2.5 is significantly associated with hospital utilization and drug prescription in lung cancer patients.

Cost-minimization analysis of oral versus intravenous antibiotic treatment for Klebsiella pneumoniae liver abscess

A cost-minimization analysis was conducted for Klebsiella pneumoniae liver abscess (KLA) patients enrolled in a randomized controlled trial which found oral ciprofloxacin to be non-inferior to intravenous (IV) ceftriaxone in terms of clinical outcomes. Healthcare service utilization and cost data were obtained from medical records and estimated from self-reported patient surveys in a non-inferiority trial of oral ciprofloxacin versus IV ceftriaxone administered to 152 hospitalized adults with KLA in Singapore between November 2013 and October 2017. Total costs were evaluated by category and payer, and compared between oral and IV antibiotic groups over the trial period of 12 weeks. Among the subset of 139 patients for whom cost data were collected, average total cost over 12 weeks was $16,378 (95% CI, $14,620–$18,136) for the oral ciprofloxacin group and $20,569 (95% CI, $18,296–$22,842) for the IV ceftriaxone group, largely driven by lower average outpatient costs, as the average number of outpatient visits was halved for the oral ciprofloxacin group. There were no other statistically significant differences, either in inpatient costs or in other informal healthcare costs. Oral ciprofloxacin is less costly than IV ceftriaxone in the treatment of Klebsiella liver abscess, largely driven by reduced outpatient service costs.Trial registration: ClinicalTrials.gov Identifier NCT01723150 (7/11/2012).

#2705 MEDICAL COST AND HEALTHCARE UTILIZATION IN ADULTS WITH CHRONIC KIDNEY DISEASE AND TYPE 2 DIABETES MELLITUS IN A CHINESE REGIONAL DATABASE

Abstract Background and Aims The presence of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM) leads to elevated medical and economic burden, and with CKD progression, the medical expenditure increases substantially. Information about healthcare utilization and medical expenditures of this patient population is limited in China. This study aims to describe the medical cost and healthcare utilization of patients with CKD and T2DM in a regional database in China. Method A retrospective, regional EHR-based serial cross-sectional study was conducted in Yinzhou Regional Healthcare Database (YRHCD), Ningbo, China. All adult patients (age &amp;gt; = 18 years) with CKD and T2DM were collected between 1st Jan 2017 and 31st Dec 2020, patients were excluded if they did not have serum creatinine (SCr) values or initiated renal replacement therapy. Eligible patients were identified at each calendar year and categorified by CKD stages (G1-G5). Data on demographics, comorbidities and drug prescription were presented for all included patients at baseline and from 2017 to 2020. Annual medical costs and healthcare utilization were described among different CKD stages. Two-part models were built to estimate the medical costs and healthcare utilization in each CKD stage. Results A total of 16,521 patients with CKD and T2DM were included with a substantial increase between 2017 and 2020. Among all patients, the majority of them were classified in CKD stage 1 and 2. Over 70% of patients aged 65 years or older and approximately 55% were female. &amp;gt;90% of patients had hypertension, followed by peripheral vascular diseases, which increased from 69.2% in 2017 to 82.2% in 2020. Renin–angiotensin system inhibitors (RASI) were the most prescribed medication and metformin ranked the second. In general, the age, proportion of having comorbidities and proportion of drug prescription presented an increasing trend from 2017 to 2020. The proportion of eGFR value &amp;gt; = 25 and &amp;lt; = 75 mL/min/1.73m2 in G1 to G4 was 64.4% for baseline and decreased from 58.2% in 2017 to 48.7% in 2020. The general trend of medical costs in all CKD stages increased from 2017 to 2020; for healthcare utilization, the average number of outpatient visits per person per year was over 10.0 times per each CKD stage. The medical cost and healthcare utilization increased substantially in patients with more advanced CKD stages. Mean annual medical costs per patients were 6,084, 8,675, 14,291, 24,971 and 42,580 CNY (908, 1,294, 2,132, 3,726 and 6,353 USD) and the mean length of stay were 2.2, 3.3, 6.2, 12.6 and 16.1 days for G1-5 patients respectively in 2020. Patients in G1 and G2 had more outpatient visits compared with hospitalization, the cost of hospitalization raised dramatically in patients with G4-G5 and became a main contributor of total medical cost. Conclusion Our contemporary study revealed the medical cost and use of healthcare resources increased moderately over time in earlier CKD stages but grew remarkably from G4 stage onwards. The estimates suggested significant correlation between CKD stages and medical costs and healthcare utilization. Our findings further suggest earlier CKD identification and timely treatment may reduce the overall medical and economic burden in this population.

Determinants of province-based health service utilization according to Andersen’ s Behavioral Model: a population-based spatial panel modeling study

ObjectiveThe Andersen’ s Behavioral Model was used to explore the impact of various factors on the utilization of health services. The purpose of this study is to establish a provincial-level proxy framework for the utilization of health services from a spatial perspective, based on the influencing factors of the Andersen’ s Behavioral Model.MethodProvincial-level health service utilization was estimated by the annual hospitalization rate of residents and the average number of outpatient visits per year from China Statistical Yearbook 2010–2021. Exploring the relevant influencing factors of health service utilization using the spatial panel Durbin model. Spatial spillover effects were introduced to interpret the direct and indirect effects influenced by the proxy framework for predisposing, enabling, and need factors on health services utilization.ResultsFrom 2010 − 2020, the resident hospitalization rate increased from 6.39% ± 1.23% to 15.57% ± 2.61%, and the average number of outpatient visits per year increased from 1.53 ± 0.86 to 5.30 ± 1.54 in China. For different provinces, the utilization of health services is uneven. The results of the Durbin model show that locally influencing factors were statistically significantly related to an increase in the resident hospitalization rate, including the proportion of 65-year-olds, GDP per capita, percentage of medical insurance participants, and health resources index, while statistically related to the average number of outpatient visits per year, including the illiteracy rate and GDP per capita. Direct and indirect effects decomposition of resident hospitalization rate associated influencing factors demonstrated that proportion of 65-year-olds, GDP per capita, percentage of medical insurance participants, and health resources index not only affected local resident hospitalization rate but also exerted spatial spillover effects toward geographical neighbors. The illiteracy rate and GDP per capita have significant local and neighbor impacts on the average number of outpatient visits.ConclusionHealth services utilization was a variable varied by region and should be considered in a geographic context with spatial attributes. From the spatial perspective, this study identified the local and neighbor impacts of predisposing factors, enabling factors, and need factors that contributed to disparities in local health services utilization.

Medical costs of brucellosis patients in Datong of Shanxi province, 2017-2019

Objective: To explore the medical costs and influencing factors of patients diagnosed with Brucellosis in Datong of Shanxi province. Methods: Information on demographics, medical visits, and costs of patients diagnosed with Brucellosis between January 1, 2017, and December 31, 2019, were collected. Health care utilization and medical costs were analyzed from different genders, age groups, underlying diseases, clinical stages, and comorbidities. Results: A total of 2 289 patients (1 715 outpatient and 574 inpatient cases) were included in the analysis. 72.0% (1 649/2 289) were male, with an average age of (49.6±15.5) years; age between 45-59 years was the dominant group (36.2%,829/2 289). The mean age of inpatients (51.4±16.0) was higher than that of outpatients (49.0±15.2)(Z=-4.01, P<0.001). The average number of outpatient visits per outpatient was (1.6±1.5) times. The duration of hospitalization was (14.6±9.9) and (20.8±11.4) days for patients with central nervous system complications and (16.6±9.5) days for vascular system complications. Of the inpatients, 51.0% (293/574) had underlying diseases, and 30.3% (174/574) had endocrine and metabolic diseases. 54.0% (310/574) of inpatients were diagnosed with acute Brucellosis, and 46.0% (264/574) were diagnosed with chronic Brucellosis. A total of 64.3% (369/574) of inpatients had complications, 30.3% (174/574) of digestive system complications, followed by skeletal system complications (29.1%, 167/574). Among outpatients, age significantly affected medical costs (P<0.001). For inpatients, age and complications and treatment effect were influential factors (P<0.05). Patients with the combined skeletal system and central nervous system complications had significantly higher medical costs (P<0.001). Conclusions: The medical costs for outpatient cases of Brucellosis were moderate. However, the economic burden was higher for inpatients, especially those with skeletal and neurological complications. Early detection, diagnosis, and treatment of cases were essential to avoid chronic Brucellosis and its complications and reduce medical costs.

Trends in outpatient visits and deaths due to congenital heart defects in Peru

IntroductionCongenital heart defects (CHD) are the most frequent congenital birth defects, affecting approximately 1% of newborns and constituting the main cause of death among all congenital malformations. The prevalence of CHD in Andean America is heterogeneous and in Peru the burden of CHD is unknown. ObjectiveTo describe the trends of CHD outpatient visits and mortality and their variation according to sex, age and altitude levels. MethodsWe performed a secondary data analysis of CHD outpatient visits and mortality using publicly available information from the Peruvian Ministry of Health national registries from 2000 to 2020. ResultsThere was a statistically significant increase in CHD outpatient visits of 20.4 over time. Pediatric patients, those who lived at low altitude (≤2500 ​m above sea level) and those who lived in the capital of Peru had a higher average number of outpatient visits per 100 ​000 population. CHD-related mortality increased by 0.31 per million population per year. Although this trend was not statistically significant overall, pediatric patients experienced higher mortality than adults. ConclusionIn Peru, the outpatient CHD volume has increased significantly over the last two decades, however CHD-related mortality has remained constant. Children in the first decade of life are the predominant group in both, outpatient CHD volume and mortality.

POSA152 Characterising Patients with Major Depressive Disorder with Moderate-to-High Suicide Intent and Their Healthcare Resource Utilisation in England

To characterise patients with major depressive disorder (MDD) with moderate-to-high-suicide-intent in England, compare their healthcare resource utilisation (HCRU) to MDD patients without moderate-to-high-suicide-intent, and better understand their patient pathways. This retrospective cohort study used primary care electronic health records from the Clinical Practice Research Datalink (CPRD), linked to Hospital Episode Statistics (HES) and the Mental Health Dataset in England. Adults with ≥1 MDD diagnosis between 4/2007-11/2015 were included and categorised by suicide intent. MDD patients with moderate-to-high-suicide-intent were followed from their initial suicide intent diagnosis, whereas MDD patients without moderate-to-high-suicide-intent were followed from their first MDD diagnosis. Patients with psychosis, schizophrenia, mania, bipolar disorder, or dementia were excluded. 307,476 patients were included (294,259 MDD patients without moderate-to-high-suicide-intent and 13,217 MDD patients with moderate-to-high-suicide-intent). MDD patients with moderate-to-high-suicide-intent were younger on average and had a lower proportion of females than patients without moderate-to-high-suicide-intent (age: 39.0 versus 44.8 years; female: 58% versus 65%). The average number of outpatient visits was greater among MDD patients with moderate-to-high-suicide-intent than patients without moderate-to-high-suicide-intent during the first follow-up year for the following: general practitioner consultations (38.5 versus 29.4), psychiatric outpatient visits (1.5 versus 0.1), psychiatrist visits (3.6 versus 0.3), and accident and emergency visits (1.5 versus 0.3). Approximately 86% of MDD patients with moderate-to-high-suicide-intent were hospitalised during the first follow-up year compared with 26% of patients without moderate-to-high-suicide-intent (average duration: 3.2 and 2.8 days, respectively). A total of 56% of MDD patients with moderate-to-high-suicide-intent had an antidepressant prescription within 30 days of the index date, with citalopram being the most frequently prescribed. This study provides novel results on the patient characteristics, healthcare resource utilisation, and patient pathways among MDD patients with moderate-to-high-suicide-intent in England. These results indicate the need for new treatments that can achieve a rapid therapeutic response and reduce HCRU.

The Impact of Pharmaceutical Home Care on Medical Utilization for Frequent Users of Outpatient Services in Taiwan.

Due to the high-accessibility and low-copayment of healthcare system in Taiwan, the clinical visit frequency of people is relatively high, which often leads to an excessively high healthcare expenditure. The aim of this research was to explore the effectiveness of pharmaceutical home care for frequent users of outpatient service and to analyze the impact of pharmaceutical home care on medical utilization. The study was based on the Taiwan National Health Insurance Research Database. Patients with over 100 clinical visits during 2010 to 2012 were selected as subjects. Whether these patients participate the experimental plan of pharmaceutical home care in the following year and the medical utilization of the research subjects were analyzed to compare the difference between participating group and non-participating group in this plan. The generalized estimating equation was employed to examine the difference of medical utilization. A total of 3943 subjects were included in this study, including 591 patients (14.99%) participating in the experimental plan. The average number of physician visits during the following year of the participating group was higher than that of the non-participating group by 0.12 visits, and the outpatient medical expense was lower than the non-participating group by 18,302 points (1 point = 0.03 US dollars). After participating in the plan, the average number of clinical visits of frequent users of outpatient services was significantly reduced by 6.63 visits, and the outpatient expense was significantly decreased by 9871 points. After joining the experimental plan of pharmaceutical home care, the average number of outpatient visits decreased significantly and the medical expense was lower when compared with those who did not participate in the plan.

Association of preconception paternal health and adverse maternal outcomes among healthy mothers

Maternal morbidity continues to be an issue of national and global concern. Paternal preconception health may play a significant role in pregnancy outcomes and has received less attention than maternal health. This study aimed to examine the association between preconception paternal health and the risk for adverse maternal outcomes among healthy mothers. This was a retrospective analysis of live births from 2009 through 2016 to healthy women aged 20 to 45 years recorded in the IBM Marketscan research database. Infants were linked to paired mothers and fathers using family ID. Preconception paternal health was assessed using the number of metabolic syndrome component diagnoses and the most common individual chronic disease diagnoses (hypertension, diabetes mellitus, obesity, hyperlipidemia, chronic obstructive pulmonary disease, cancer, and depression). Women with metabolic syndrome components were excluded to avoid potential confounding of maternal and paternal factors. Adverse maternal outcomes that were assessed included (1) abnormal placentation including placenta accreta spectrum, placenta previa, and placental abruption; (2) preeclampsia with and without severe features including eclampsia; and (3) severe maternal morbidity, identified as any indicator from the Centers for Disease Control and Prevention Index of life-threatening complications at the time of delivery to 6 weeks postpartum. The trend between preconception paternal health and each maternal outcome was determined using the Cochran-Armitage Trend test. The independent association of paternal health with maternal outcomes was also determined using generalized estimating equations models, accounting for some mothers who contributed multiple births during the study period, and by adjusting for maternal age, paternal age, region of birth, year of birth, maternal smoking, and average number of outpatient visits per year. Among 669,256 births to healthy mothers, there was a significant trend between all adverse maternal outcomes and worsening preconception paternal health defined either as the number of metabolic syndrome diagnoses or number of chronic disease diagnoses (P<.001; Cochran-Armitage Trend test). In the generalized estimating equations model, the odds for preeclampsia without severe features increased in a dose-dependent fashion and were 21% higher (95% confidence interval, 1.17-1.26) among women whose partners had ≥2 metabolic syndrome diagnoses than among women whose partners had no metabolic syndrome diagnosis. The odds for preeclampsia with severe features and eclampsia increased in a dose-dependent fashion and were 19% higher (95% confidence interval, 1.09-1.30) among women whose partners had ≥2 metabolic syndrome diagnoses than among women whose partners had no metabolic syndrome diagnosis. The odds for severe maternal morbidity were 9% higher (95% confidence interval, 1.002-1.19) among women whose partners had ≥2 metabolic syndrome diagnoses than among women whose partners had no metabolic syndrome diagnosis. The odds for abnormal placentation were similar between the groups (adjusted odds ratio, 0.96; 95% confidence interval, 0.89-1.03). Among healthy mothers, we report that preconception paternal health is significantly associated with increased odds of preeclampsia with and without severe features and weakly associated with increased odds of severe maternal morbidity. These findings suggest that paternally derived factors may play significant roles in the development of adverse maternal outcomes in healthy women with a low a priori risk of obstetrical complications.

The impact of the pandemic on neurosurgical services: A study from a coronavirus disease 2019 referral hospital in Surakarta.

Background: A decrease in hospital visits including neurosurgery cases during the coronavirus disease 2019 (COVID-19) pandemic has been reported by many countries. This study aims to reveal important data regarding the effect that the COVID-19 pandemic has on services, neurosurgical surgery, and inpatients before and during the COVID-19 pandemic.Methods: This comparative study compares neurosurgical services, neurosurgical patients, outpatient visits, and monthly inpatients assessed from January to December 2020 (onset of the pandemic) with those of the same period in 2019.Results: The average number of outpatient visits per month during the pandemic (January to December 2020) was 369 visits per month, compared to 397 visits in the same period in the previous year. The lowest outpatient visits occurred in May 2020 with 227 outpatient visits. There was a decrease in the number of neurosurgical patients in January-December during the pandemic period compared to the same period in 2019. A significant decrease in outpatients during and before the pandemic was noted with P = 0.046 (P < 0.05).Conclusion: There are differences in the number of visits by outpatients, neurosurgical patients, and inpatients during the pandemic compared to the period before the onset of the pandemic.

174 Association between paternal health and severe maternal morbidity: analysis of US claims data

A critical paternal role in placental dysfunction and pre-eclampsia has been reported and attributed to immunologic and genetic factors. Our objective was to examine the hypothesis that paternal health is associated with abnormal placentation, pre-eclampsia and severe maternal morbidity (SMM). Retrospective analysis of live births from 2007-2016 among women 20-45 years of age in the IBM Marketscan® research database. Infants were linked to paired mothers and fathers using family ID. Preconception paternal health was assessed using the number of metabolic syndrome (MetS) diagnostic criteria and the most common individual chronic disease diagnoses (hypertension, diabetes mellitus, obesity, hyperlipidemia, COPD, cancer, and depression). Adverse pregnancy outcomes assessed included: 1) abnormal placentation including placenta accreta spectrum, placenta previa and placental abruption, 2) pre-eclampsia with severe features and eclampsia, and 3) SMM, identified as any indicator from the CDC Index except blood transfusion alone, which has been found to overestimate true cases. The association between paternal health and maternal pregnancy outcomes was determined using logistic regression models estimated with generalized estimating equations adjusted for maternal age, region, birth year, maternal obesity, smoking, parity and average number of outpatient visits per year. Among 785,809 births, preconception paternal health was significantly associated with all adverse pregnancy outcomes (Table 1). The odds of SMM were 57% higher (95% CI 1.16-2.13) for women whose partners had 5 or more chronic diseases than for women whose partners did not have a chronic disease. Furthermore, the magnitude of risk of SMM increased with preconception paternal comorbidities in a dose-dependent fashion. Preconception paternal health is associated with abnormal placentation, pre-eclampsia and SMM, suggesting that paternally derived factors may play significant roles in placentation and the subsequent development of adverse pregnancy outcomes.

PCN332 Healthcare Resource Utilization and Survival in Patients with Advanced Breast Cancer in Finland

In Finland, approximately 850 women annually die of advanced breast cancer (aBC). The subtype of aBC guide treatment decisions and is an essential prognostic factor. This study evaluated the subtype-related healthcare resource utilization (HCRU) and survival among patients with aBC in Finland. The study was a retrospective cohort study utilizing real world secondary (specialist) care data during 2004−2016 from the Finnish Auria Biobank covering approximately 20% of the population in Finland. Adult female patients diagnosed with aBC between 2004−2013 were identified with ICD-10 code C50 (breast cancer) and through text mining algorithms, and the data were extracted until the end of 2016. Auria Biobank data were complemented with the patients’ electronic healthcare records of Turku University Central Hospital. Overall survival (OS) was estimated using the Kaplan-Meier method. The results are presented by subtype: HR+/HER2-, HER2+, and triple negative breast cancer (TNBC). A total of 444 patients with aBC were identified, with the mean age at diagnosis of 66.0 years (range 20.6−102.5). Overall, HR+/HER2-, HER2+, and TNBC were identified for 65%, 19%, and 6% of the patients, respectively. The average number of inpatient days per patient-year was 10.6 for HR+/HER2-, 9.1 for HER2+, and 27.3 for TNBC, respectively. The average number of outpatient visits per patient-year was 34.0 for HR+/HER2-, 48.6 for HER2+, and 55.6 for TNBC, respectively. Median OS was 22.6 months (95% CI: 19.4-25.6) for HR+/HER2-, 23.1 months (95% CI: 12.7-37.7) for HER2+, and 5.5 months (95% CI: 3.6-15.2) for TNBC. TNBC patients had the highest resource use per patient-year and the shortest OS. The inpatient days per patient-year and the median OS did not differ markedly between HR+/HER2- and HER2+ patients. The generalizability of the results might be limited because the study describes only the patient population in Southwest Finland.

PCN59 Best Supportive Care Costs and Healthcare Use during END-of-Life Care in Terminal Cancer Patients in South Korea: A Retrospective Observational Study from Nationwide Claims Cohort DATA

Because of symptoms that affect the quality of life, terminal cancer patients who cannot be treated require the best supportive care(BSC). This study aims to analyze the healthcare use and costs of terminal cancer patients receiving BSC to present the economic burden. This study is a retrospective observational study using the National Sample Cohort data from the Korean Health Insurance Service(NHIS-NSC) between 1 January 2002 and 31 December 2015. We selected patients treated with one of the six cancers with the highest mortality rates as reported by the National Cancer Information Center. We defined the index date as the date of using the last anticancer drug based on the ATC code, and we followed up the patients from the index date to death. The follow-up period was limited to a maximum of 6 months. The average time to death after using the last anticancer drug was 72.26 days and the longest in the gallbladder and biliary cancer patients (87.90 days). The average total medical cost per patient was 6494.55 USD and was the highest in pancreatic cancer patients (7709.60 USD). The proportion of hospital admission was 86.36% which was the highest in the gallbladder and biliary cancer patients (92.68%) and was the lowest in the colon cancer patients (80.11%). The average length of hospital stay per patient was 33.66 days, and the average number of outpatient visits per patient was 6.26 times, which was the longest and the highest in pancreatic cancer patients (39.48 days and 7.74 times). Patients receiving BSC show differences in healthcare use and costs according to cancer. Therefore, customized supportive care should be performed to improve the quality of life of terminal cancer patients.

Effects, costs and implementation of monitoring kidney transplant patients' tacrolimus levels with dried blood spot sampling: A randomized controlled hybrid implementation trial.

AimsDried blood spot (DBS) home sampling allows monitoring creatinine levels and tacrolimus trough levels as an alternative for blood sampling in the hospital, which is important in kidney transplant patient follow‐up. This study aims to assess whether DBS home sampling results in decreased patient travel burden and lower societal costs.MethodsIn this single‐centre randomized controlled hybrid implementation trial, adult kidney transplant patients were enrolled. The intervention group (n = 25) used DBS home sampling on top of usual care in the first 6 months after transplantation. The control group (n = 23) received usual care only. The primary endpoint was the number of outpatient visits. Other endpoints were costs per patient, patient satisfaction and implementation.ResultsThere was no statistically significant difference in the average number of outpatient visits between the DBS group (11.2, standard deviation: 1.7) and the control group (10.9, standard deviation: 1.4; P = .48). Average costs per visit in the DBS group were not significantly different (€542, 95% confidence interval €316–990) compared to the control group (€533, 95% confidence interval €278–1093; P = .66). Most patients (n = 19/23, 82.6%) were willing to perform DBS home‐sampling if this would reduce the number of hospital visits. Only 55.9% (n = 143/256) of the expected DBS samples were received and 1/5 analysed on time (n = 52/256).ConclusionAdult kidney transplant patients are willing to perform DBS home sampling. However, to decrease patient travel burden and costs in post‐transplant care, optimization of the logistical process concerning mailing and analysis of DBS samples is crucial.

Identification of a pulmonary arterial hypertension (PAH) patient cohort and study of its burden of illness in Programme de Médicalisation des Systèmes d'information (PMSI)

ObjectivesDefine a French PAH cohort using an evidence-based algorithm and describe its burden of disease in terms of healthcare resource use and costs. MethodsA retrospective database analysis was performed using the French national hospital discharge database (PMSI-MCO, 2012–2016). The main criteria used to define the PAH patient cohort were the PH ICD-10 codes (I27.0 or I27.2), a visit to an expert referral centre, a right heart catheterisation procedure and/or a prescription of a PAH specific drug. Hospital visits were split based on the length of stay. 0-day length of stay visits were labelled outpatient visits while all others were labelled inpatient visits. ResultsA cohort of 2173 patients diagnosed with PAH was defined. These patients had 26,944 hospital visits over the study period. Approximately 63% of patients were female and mean age at index date was 58 years old. Inpatient visits represented 52% of total hospital events with an average between 2.2 and 2.3 inpatient visits per year per patient. The average number of outpatient visits per year increased from 1.4 to 2.5 (2012 to 2016). The average cost per patient in 2016 for inpatient visits was equal to €10,256 while outpatient visits cost was equal to €1899. The 20% of patients associated with the highest costs accounted for approximately 60% of total costs in each year. ConclusionsThere is a high hospital economic burden of PAH in France. The high level of resource use and costs is mainly attributable to inpatient visits and has remained stable throughout the time period studied.

Clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the department of cardiology in general hospitals

Objective: To explore the clinical characteristics and related factors of somatization symptoms in outpatients with psychiatric disorders of the cardiology department in general hospital. Methods: Cross-sectional survey method was used in this study. From August 2017 to September 2018, 508 outpatients of our department with suspected mental disorders, who complained of physical discomfort and screened by the "Three Questions" method recommended by the Chinese Expert Consensus on Psychological Prescriptions of Cardiovascular Patients in 2014, were consecutively included. General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire (PHQ-9), Patient Health Questionnaire-15 (PHQ-15) and self-made general demographic questionnaire (including age, sex, marital status, educational level, occupation, duration of disease, clinical diagnosis and the process of medical treatment for the main somatic symptoms in recent one year) were used to investigate these patients, under the assistance of unified training psychological consultants. The detection rate of anxiety and depression, the degree and distribution of somatization symptoms in outpatients with mental disorders were analyzed, and the related factors affecting the occurrence of somatization symptoms were screened by multivariate logistic regression. Results: The selected patients were (51.3±10.1) years old, of which 37.8% (192/508) were males and 62.2% (316/508) were females. The total detection rate of anxiety/depression was 86.8% (441/508), and the detection rate of somatization symptoms was 93.1% (473/508). The number of positive symptom items in PHQ-15 was 8.0±2.7, and the detection rate of anxiety/depression was 78.6% (372/473) in patients with somatization symptoms. There were significant differences in the proportion of women, the average number of outpatient visits and hospitalizations in the past one year, GAD-7 score and PHQ-9 score among the patients with mild, moderate and severe somatization symptoms (all P<0.05). PHQ-15 score was positively correlated with GAD-7 score (r=0.524 5, P<0.001) and PHQ-9 score (r=0.574 9, P<0.001) in patients with somatization symptoms. Stepwise logistic regression analysis showed that total scores of PHQ-9 (OR=8.020, 95%CI 3.470-18.930, P<0.001) and GAD-7 (OR=6.526, 95%CI 2.903-13.045, P<0.001) and female (OR=4.440, 95%CI 1.059-9.073, P=0.011) were related factors of somatizations. Conclusions: The incidence of somatization symptoms is high in patients with psychological disorders in outpatients of cardiology department in general hospital. Anxiety, depression and gender are the main related risk factors of somatization symptoms in this patient cohort. Degree of anxiety and depression increased in proportion to the severity of somatization symptoms. Anxiety, depression and female is related to somatization symptoms.

Health Economic Burden and Treatment-Based Survival for Current Follicular Lymphoma Treatment Practice in Japan Using a Nationwide Retrospective Claims Database

ABSTRACT Introduction: Follicular lymphoma (FL) is an indolent form of non-Hodgkin lymphoma (NHL), which accounts for 20-30% of all NHL cases. In most patients, FL is diagnosed in advance stages, mild disease progression and long treatment period that may incur a great burden to patients and healthcare system. However, to our knowledge there is no comprehensive analysis which have been done in the real world setting in Japan. Therefore, we conducted a retrospective claim database study to elucidate the lines of treatment patterns as well as the associated healthcare resource utilization (HCRU), and 3- and 5-year overall survival (OS) among 3,593 Japanese patients with a median age of 65.0 years. Methods: This retrospective study analyzed data from the Medical Data Vision (MDV) database for patients diagnosed with FL (ICD-10: C82). The MDV database is an electronic health records-based database comprised of anonymized inpatient and outpatient data covering over 25 million patients and over 374 Japanese hospitals, approximately 22% of acute phase hospitals, including 187 cancer therapeutic facilities. Patients who received treatment during the identification period from 1 October 2008 to 31 December 2017 were selected. Patients were required to have data for at least 6 months before the first treatment date (ie, patient index date) and at least 12 months after the index date (unless they died). Costs were converted from Japanese yen to US dollars using the exchange rate based on January of each year of service. For 3- and 5-year OS, patients who had a record of death in their hospital discharge were counted as an event, otherwise they were censored at the latest of: end of patient record, end of data availability, or end of the 3- or 5- year period. Results: A total of 3,593 patients with FL met the inclusion criteria of which 51.2% was female patients. Of these 3,593 patients who met the inclusion criteria, 3,004 patients (83.6%) received rituximab-based (R) therapy as index treatment, of which 1309 (36.4%) of patients received R-CHOP. During the subsequent lines of therapies, patients received heterogeneous treatment regimens (fig 1). Overall, the average healthcare cost during follow-up period was $67,557.40 for all FL patients, ranging from $39,340 (immunotherapy, targeted therapy, or hormone therapy without R) to $ 95,095 (other R-based chemotherapy). The average number of outpatient visits during follow-up for all FL patients was 51, ranging from 44.6 to 55.1 for each treatment group. There were 3,394 (94.5%) patients who had at least one hospitalization during follow up period. Among those who had at least one hospitalization, the average number of hospitalizations was 3.8 for all FL patients, ranging from 2.5 to 4.6 for each treatment group. The average number of days of hospitalization during follow-up was 74.5 for all FL patients, ranging from 31 to 110.4 for each treatment group. 85 (2.4%) FL patients received a stem cell transplant (SCT) during follow-up at the age under 79 years, with other R-based therapies having the highest percentage (7.6%). There were 346 (9.7%) FL patients receiving radiation therapy, ranging from 8.1% (other treatment groups) to 24.1% (immunotherapy, targeted therapy, or hormone therapy without R). There were 337 deaths (9.4%) recorded within 3 years and 400 (11.1%) within 5 years of index treatment. The median Kaplan-Meier OS was not reached for most analysis groups due to the overall high survival rates. When comparing overall survival by index regimen group, chemotherapy without R consistently had worse survival, especially compared to R-based regimens (fig. 2). Conclusions: Patients with FL in Japan received diverse treatment regimens and multiple lines of therapy with relatively high survival rates. Majority of patients have received R-based therapies and have shown longer survival rates compared to those who have received chemotherapy without R. This is the first study to clarify lines of treatment patterns using retrospective claims database and treatment group-based OS in FL patients in Japan, which will give clinical insights of the landscape of daily practices and the associated real world health economic burden for patients, clinicians and healthcare providers to support their better decision makings. Disclosures Tsutsue: Celgene: Employment. Tobinai:Solasia: Honoraria; Mundi Pharma: Consultancy, Honoraria, Research Funding; Takeda Pharmaceutical: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding; Ono Pharmaceutical: Consultancy, Honoraria, Research Funding; Yakult: Honoraria; AbbVie: Research Funding; Meiji Seika: Honoraria; Janssen Pharmaceutical: Honoraria, Research Funding; Bristol-Myers Squibb: Honoraria; HUYA Bioscience: Consultancy, Honoraria; Zenyaku Kogyo: Consultancy, Honoraria; Daiichi Sankyo: Consultancy, Honoraria; Eisai: Honoraria, Research Funding; Chugai Pharmaceutical: Honoraria, Research Funding; Verastem: Honoraria; Kyowa Kirin: Honoraria, Research Funding. Yi:Celgene: Consultancy. Crawford:Celgene: Consultancy.

Worse survival in breast cancer in elderly may not be due to underutilization of medical procedures as observed upon changing healthcare system in Poland

BackgroundEvidence is emerging that older women may tolerate breast cancer therapies equally well as the young ones, providing that they receive good supportive care. It has also been reported that these patients remain outside the current therapeutic standards. The aim of this observational study was to assess the access of breast cancer patients to medical procedures.MethodsWe retrospectively reviewed a database of breast cancer patients registered in the National Cancer Registry in Poland, searching for the numbers of new cases and deaths in the years 2010–2015. We obtained the numbers and costs of key medical procedures provided for these patients from the National Health Fund in Poland. Breast cancer survival in the years 2010–2015 was estimated based on the mortality/incidence ratio. The t-Student test and Spearman correlation coefficient were used for the analysis of data obtained from both databases.ResultsThere was no increase in survival throughout the years 2010–2015 in both analysed subpopulations of all breast cancer patients below and over 65 years of age, despite an unprecedented rise in healthcare funding in Poland. We noted 37% lower probability of 5-year survival in patients older than 65 years. The average number of outpatient visits and surgical procedures per person per year were slightly, yet significantly (p < 0.01), higher in younger vs. older patients (3.9 vs. 3.4 and 1.18 vs. 1.02, respectively). Outpatient chemotherapy was more common in older patients (6.0 vs. 5.25 cycles a year per person on average, p < 0.01). There were no significant differences in the average numbers of hospitalisations for chemotherapy, frequencies of radiotherapy and in the use of targeted therapy programmes (calculated per person per year), between younger and older patients.ConclusionsOlder women with breast cancer are treated similarly to younger patients, but have significantly worse chances to survive breast cancer in Poland. A simple increase in healthcare financing will not improve the survival in the elderly with breast cancer without developing funded individualised care and survivorship programmes.