Average Total Healthcare Costs Research Articles

AMA to Work With APA, Other Groups on Integrated Care

AMA to Work With APA, Other Groups on Integrated Care

Cost-utility analysis of chemotherapy regimens in elderly patients with stage III colon cancer.

Chemotherapy prolongs survival for stageIII colon cancer patients but community-level evidence on the effectiveness and cost effectiveness of treatment for elderly patients is limited. Comparisons were between patients receiving no chemotherapy, 5-fluorouracil (5-FU), and FOLFOX (5-FU+oxaliplatin). A retrospective cohort study was conducted using the Surveillance Epidemiology, and End Results (SEER)-Medicare linked database. Patients (≥65years) with American Joint Committee on Cancer stageIII colon cancer at diagnosis in 2004-2009 were identified. The 3-way propensity score matched sample included 3,534 patients. Effectiveness was measured in life-years and quality-adjusted life-years (QALYs). Medicare costs (2010 US dollars) were estimated from diagnosis until death or end of study. FOLFOX patients experienced 6.06 median life-years and 4.73 QALYs. Patients on 5-FU had 5.75 median life-years and 4.50 median QALYs, compared to 3.42 and 2.51, respectively, for the no chemotherapy patients. Average total healthcare costs ranged from US$85,422 for no chemotherapy to US$168,628 for FOLFOX. Incremental cost-effectiveness ratios (ICER) for 5-FU versus no chemotherapy were US$17,131 per life-year gained and US$20,058 per QALY gained. ICERs for FOLFOX versus 5-FU were US$139,646 per life-year gained and US$188,218 per QALY gained. Results appear to be sensitive to age, suggesting that FOLFOX performs better for patients 65-69 and 80+ years old while 5-FU appears most effective and cost effective for the age groups 70-74 and 75-79years. FOLFOX appears more effective and cost effective than other strategies for colon cancer treatment of older patients. Results were sensitive to age, with ICERs exhibiting a U-shaped pattern.

Clinical and economic consequences of post-operative infections following major elective surgery in U.S. hospitals.

The incidence and consequences of post-operative infections in patients undergoing major elective surgery is not well understood. Using a large U.S. healthcare claims database, we identified all patients who underwent major elective surgery between January 1, 2007, and December 31, 2009. For each such patient, date of the first-noted surgery during this period was designated as the index date. Patients who developed infections within 30 d of their index date were matched to those who did not using propensity score matching. We compared hospital readmissions, mortality, and total healthcare cost during the 30-d period following index date between patients who developed post-operative infections versus those who did not. A total of 327,618 patients met all selection criteria. At 30 d following major elective surgery, 10.9% of patients had evidence of post-operative infections, 39% of which occurred during the index admission. In propensity-matched analyses, patients with post-operative infections were about five times as likely to be readmitted to hospital (11.3% vs. 2.1%) and more than twice as likely to die (0.8% vs. 0.3%) in the 30-d period following surgery; their average total healthcare cost was $8,417 higher ($29,229 vs. $20,812) (all comparisons, p<0.01). Approximately one in 10 patients undergoing major elective surgery develop post-operative infections by day 30. Post-operative infections are associated with significantly worse clinical outcomes and higher total healthcare cost.

Clinical outcomes, quality of life, and costs associated with implantation of vagus nerve stimulation therapy in pediatric patients with drug-resistant epilepsy

BackgroundVNS (Vagus Nerve Stimulation Therapy) is approved in the USA to treat refractory epilepsy as adjunctive to antiepileptic drugs (AEDs) in patients ≥12 years with complex partial seizures. AimsTo evaluate clinical outcomes, quality-adjusted life years (QALY), and costs associated with VNS in pediatric patients with drug-resistant epilepsy in a real-world setting. MethodsA retrospective analysis was conducted using Medicaid data (USA). Patients had ≥1 neurologist visits with epilepsy diagnosis (ICD-9 345.xx, 780.3x), ≥1 procedure claims for VNS implantation, ≥1 AEDs, ≥6-months of Pre- and Post-VNS continuous enrollment. Pre-VNS period was 6-months and Post-VNS period extended from implantation until device removal, death, Medicaid disenrollment, or study end (up to 3 years). Incidence rate ratios (IRR) and costs ($2010) were estimated. QALYs were estimated using number of seizure-related events. ResultsFor patients 1–11 years old (N = 238), hospitalizations and emergency room visits were reduced Post-VNS vs. Pre-VNS (adjusted IRR = 0.73 [95% CI: 0.61–0.88] and 0.74 [95% CI: 0.65–0.83], respectively). Average total healthcare costs were lower Post-VNS vs. Pre-VNS ($18,437 vs. $18,839 quarterly [adjusted p = 0.052]). For patients 12–17 years old (N = 207), hospitalizations and status epilepticus events were reduced Post-VNS vs. Pre-VNS (adjusted IRR = 0.43 [95% CI: 0.34–0.54] and 0.25 [95% CI: 0.16–0.39], respectively). Average total healthcare costs were lower Post-VNS vs. Pre-VNS period ($14,546 vs. $19,695 quarterly [adjusted p = 0.002]). Lifetime QALY gain after VNS was 5.96 (patients 1–11 years) and 4.82 years (patients 12–17 years). ConclusionsVNS in pediatric patients is associated with decreased resource use and epilepsy-related events, cost savings, and QALY gain.

Cost comparison between the atraumatic and cutting lumbar puncture needles

The aim of this study was to determine which type of spinal needle is preferred from a cost perspective, taking into account costs of the spinal needle and treatment of postlumbar puncture headache. A decision-analytic model was created to determine the cost of diagnostic lumbar punctures using atraumatic and cutting needles. We assumed a health care system perspective and based the analysis on the treatment of a patient facing event probabilities derived from prior studies. The economic outcome measure was the difference in estimated costs between the 2 needles. One-way and probabilistic sensitivity analyses tested the robustness of the model. Lumbar puncture performed with the atraumatic needle is associated with an average cost savings of $26.07 per patient. Average total health care costs are $166.08 with the atraumatic needle, compared to $192.15 with the cutting needle. There is 94% certainty that the atraumatic needle is cost-saving compared to the cutting needle based on probabilistic sensitivity analysis. Use of the atraumatic needle over the cutting needle by neurologists alone may result in $10.4 million in cost savings to the US health care system per year. The atraumatic spinal needle is associated with an overall cost savings to the US health care system. The balance of costs and benefits favors the use of the atraumatic needle over the cutting needle for diagnostic lumbar puncture.

Clinical and economic impact of vagus nerve stimulation therapy in patients with drug-resistant epilepsy

We evaluated long-term medical and economic benefits of vagus nerve stimulation (VNS) therapy in drug-resistant epilepsy. A pre–post analysis was conducted using multistate Medicaid data (January 1997–June 2009). One thousand six hundred fifty-five patients with one or more neurologist visits with epilepsy diagnoses (ICD-9 345.xx, 780.3, or 780.39), one or more procedures for vagus nerve stimulator implantation, one or more antiepileptic drugs (AEDs), and 6 or more months of continuous Medicaid enrollment pre- and post-VNS were selected. The pre-VNS period was 6months. The post-VNS period extended from implantation to device removal, death, Medicaid disenrollment, or study end (up to 3years). Incidence rate ratios (IRRs) and cost differences ($2009) were estimated. Mean age was 29.4years. Hospitalizations decreased post-VNS compared with pre-VNS (adjusted IRR=0.59, P<0.001). Grand mal status events decreased post-VNS compared with pre-VNS (adjusted IRR=0.79, P<0.001). Average total health care costs were lower post-VNS than pre-VNS ($18,550 vs $19,945 quarterly, P<0.001). VNS is associated with decreased resource utilization and epilepsy-related clinical events and net cost savings after 1.5years.

Epidemiology and Burden of Recurrent Acute Rhinosinusitis

Objective: 1) Learn about the epidemiology of recurrent acute rhinosinusitis (RARS). 2) Understand healthcare costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis. Method: Medical claims data (2003-2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis [ARS] claims each with a filled oral antibiotic prescription in a 12-month period) were extracted. Diagnostic procedures, surgery rates, and medical costs were determined. Results: A total of 4,588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. Similarly, 0.2%, 2.0%, and 4.1% underwent endoscopic sinus surgery at these same intervals. Average total healthcare costs related to RARS averaged $1207/patient-year. Antibiotic and nasal prescription costs averaged $210 and $452, and an average of 3.8 antibiotics were filled per patient-year with RARS. Conclusion: RARS may affect approximately 1 in 3000 adults. Despite significant health care costs over $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.

Voriconazole Treatment of Invasive Aspergillosis

The objective of this study was to assess, in a real-world setting, the predictive validity (in terms of clinical outcome and treatment cost) of the voriconazole arm of a health-economic model applied in the Belgian reimbursement submission for use of voriconazole in the treatment of invasive aspergillosis. A non-interventional study was designed to prospectively collect clinical response and direct costs data related to the treatment of invasive aspergillosis with voriconazole (oral, intravenous) in real-world practice. The outcomes of this study were compared with the inputs and outputs of the health-economic model. For the analysis, unit costs of 2002 from the public payer's perspective, as used in the model, were applied. Data from 116 patients with invasive aspergillosis starting treatment with voriconazole were collected. At 12 weeks, there were similar rates of satisfactory clinical response for the observational study and the model, the latter based on the results of a clinical study (50% vs 53%, respectively). Overall mortality rates at 84 days were 42% in the observational study and 29% in the model. Average total healthcare cost associated with voriconazole treatment was lower in the observational study compared with the model for all patients. When the cost for all hospitalization days from the start until the end of the fungal infection was included in the analysis, the average total cost was euro19,674. When the cost for only those hospitalization days solely related to the fungal infection was included in the analysis, the average total cost was euro12,376. These costs are below the cost predicted by the model of euro21,298. This analysis demonstrates that the results provided in the voriconazole arm of the health-economic model were valid estimates with regard to real-world outcomes but with a slightly better survival rate and higher costs than in real life.

Positive health‐care effects of an alcohol ignition interlock programme among driving while impaired (DWI) offenders

To compare the costs of hospital care and sick leave/disability pensions between two groups of driving while impaired (DWI) offenders: participants in an alcohol ignition interlock programme (AIIP) and controls with revoked licences, but with no comparable opportunity to participate in an AIIP. As an alternative to licence revocation DWI offenders can participate in a voluntary 2-year AIIP permitting the offender to drive under strict regulations entailing regular medical check-ups. The participants are forced to alter their alcohol habits and those who cannot demonstrate sobriety are dismissed from the programme. Participants are liable for all costs themselves. Quasi-experimental, with a non-equivalent control group used for comparison; intent-to-treat design. Based on the number of occasions/days in hospital and on sick leave/disability pension, the health-care costs for public insurance have been calculated. Average total health-care costs were 25% lower among AIIP participants (1156 individuals) than among controls (815 individuals) during the 2-year treatment period. This corresponds to over 1000 euros (SEK9610) less annual costs per average participant. For those who complete the 2-year programme the cost reduction was more pronounced; 37% during the treatment and 20% during the post-treatment period. The positive health-care effects were due apparently to reduced alcohol consumption. The social benefit of being allowed to drive while in the AIIP may also have contributed. The reduction in health-care costs was significant only during the 2-year treatment period, but among those who completed the entire AIIP sustained effects were also observed in the post-treatment period. The effects were comparable to those of regular alcoholism treatment programmes.

Medical costs associated with imatinib (IM) non-compliance in chronic myeloid leukemia (CML) patients (pts)

17514 Background: Not adhering to treatment (tx) may lead to suboptimal outcomes. This study examined associations between medical costs and IM compliance in CML pts. Methods: CML pts under age 65 were identified with ICD-9 diagnosis code (205.1X) using MarketScan Commercial Claims data between 1/1/02–12/31/05. Pts were required to be continuously enrolled in the 4 months prior to (baseline) and the 6 months following (study period) IM initiation. CML severity was categorized into 3 groups by diagnosis of CML and related comorbidities. Compliance was defined by medication possession ratio (MPR=total days of IM supply in the study period divided by 180), and stratified into 3 groups (low: &lt;65%, medium: 65–95%, high: 95–100%). Tx interruption was defined as tx gap of 30 or more consecutive days in the study period. Costs for inpatient (IP), ER, outpatient (OP) services and OP drugs during the study period were adjusted to 2005 dollars. Costs, the number of IP admissions and hospital days were compared across different levels of tx compliance using Wilcoxon tests. A generalized linear model (GLM) was also used to compare costs controlling for age, sex, CML severity, Charlson comorbidity index, year of IM start, etc. Results: The study sample consisted of 404 pts. Compared to the high MPR group, pts in the low MPR group incurred 1.6 times the average total health care costs (p &lt;.001), 5.9 times the IP costs (p&lt;.001), 2.6 times the OP costs (p=.722), 2.1 times the non-IM drug costs (p&lt;.001), and 0.39 times the IM drug costs (p&lt;.001). Compared to the high MPR pts, low MPR pts had on average 3.8 times the IP admissions (p&lt;.001), and 7.3 times the IP days (p&lt;.001). Comparing costs of pts interrupting tx versus those who did not showed similar trends. GLM regression showed that 6-month total health care costs per patient in the low MPR group were 1.4 times (p&lt;.01) those of the high MPR group. Pts who had tx interruption had 1.3 times the total health care costs (p&lt;.01) compared to those who did not. Conclusions: This study shows that better IM compliance was associated with significantly lower health care costs in CML pts, especially for IP costs. Further analyses will be conducted to confirm whether lower compliance leads to more hospitalizations. No significant financial relationships to disclose.

The SECCAT survey: I. The costs and consequences of alcoholism.

The SECCAT survey assessed the Socio-Economic Costs and Consequences of Alcoholism Treatment. Basic demographic and health service resource use data (for a previous 6-month period) were obtained fro a cohort of 586 eligible patients who had had treatment at the Alcohol Problems Clinic (APC) in Edinburgh. The cohort was 75% male with a mean age of 46.0 years. Seventy-six per cent had an initial diagnosis of alcohol dependence and 21% alcohol abuse. Use of health services was highly variable. Thirty-six per cent agreed to be interviewed to provide data on their level of abstinence, on resource use, on quality of life (SF-36), on socio-economic characteristics and key adverse events. These 212 individuals had similar age and sex ratios to the full cohort, but alcohol abusers were under-represented. Nineteen patients reported no days of abstinence and 41 were abstinent over the whole 6-month period. Patients experienced a much poorer quality of life than a normal population in terms of all dimensions of the SF-36. The average total health care costs of the interviewed patients were 1134 pounds of which 38% were related to treatment at the APC. Analysis suggests that alcohol-dependent patients make substantially more costly use of resources than abusers and experience a much poorer quality of life. No clear relationship of cost to degree of abstinence has been found. There is a clear and consistent relationship of SF-36 scores and drinking behavior.