Resource Utilization Burden Research Articles

Healthcare resource utilization burden one year post continuous positive airway pressure initiation among adults with excessive daytime sleepiness in obstructive sleep apnea in the United Kingdom

Healthcare resource utilization burden one year post continuous positive airway pressure initiation among adults with excessive daytime sleepiness in obstructive sleep apnea in the United Kingdom

RWD153 Investigating Trends of Behavioral Healthcare Resource Utilization Burden in Children and Adolescents with Suicidal Symptoms in the United States: An Analysis of Electronic Health Record Data

The increasing rates of mental health disorders and suicide among children and adolescents have highlighted the importance of understanding the burden of healthcare resource utilization for this population. This study aims to investigate trends in the utilization of behavioral health services by minors with suicidal or self-harm symptoms in the United States.

Editorial: Optimizing the success of cold snare polypectomy in colonoscopy practice

Editorial: Optimizing the success of cold snare polypectomy in colonoscopy practice

Resource utilization and convalescent care cost in neonatal opioid withdrawal syndrome.

Neonatal opioid withdrawal syndrome (NOWS) is a growing public health problem associated with complex and prolonged medical care and a significant resource utilization burden. The objective of this study was to compare the cost of different convalescent care settings for infants with NOWS. Retrospective comparison study of infants with NOWS discharged directly from NICU, transferred to an acute care pediatric floor (PPCU) or rehabilitation hospital (PRH). Primary outcomes were length of stay (LOS) and cost of stay (COS). Infants had 1.3 (95% CI: 1.1,1.6) times and 2.5 (95% CI: 2.1,3.1) times significantly longer mean LOS for PPCU and RH discharges compared to NICU discharges. NICU discharged infants had the lowest mean COS ($25,745.00) and PRH the highest ($60,528.00), despite PRH having a lower cost per day. PRH discharged infants had higher rates of methadone and benzodiazepine and less buprenorphine exposure than NICU/PPCU discharged. Infants born to mothers on marijuana and buprenorphine had a 28% lower mean COS compared to unexposed infants. Median treatment cumulative morphine doses were six-fold higher for PRH than NICU discharge. Infants transferred to convalescence care facilities had longer and more costly admissions and received more medication. However, there may be a role for earlier transfer of a subset of infants at-risk for longer LOS as those exposed to methadone and/or benzodiazepines. Further studies exploring differences in resource utilization, convalescent care delivery and cost expenditure are recommended.

RWD128 Exploring the Burden of COVID-19 on Post-Traumatic Stress Disorder (PTSD) in Pre- and During-COVID-19 Pandemic Using Real-World Data

This study aimed to explore the impact of COVID-19 on patients with PTSD and the burden of resource utilization in the pre- and during the COVID-19 pandemic. This retrospective observational study included patients diagnosed with PTSD between 1st January 2018 to 31st December 2020 using ICD-10-CM codes from Optum’s de-identified Clinformatics® Data Mart database. In the study duration, distinct patients were identified and further classified by age, gender, and location of service. To determine the influence in pre- and during COVID-19 for each of the stratification variables, a year-wise comparison was done. Chi-square was performed as test of significance for categorical variables. Overall we observed the number of PTSD patients increased by 7% (n=206,741) during the pandemic (1st January 2020 – 31st December 2020) vs pre-pandemic (1st January 2019 – 31st December 2019). A significant increase was seen across all age groups (p<.05). In the case of teenagers, PTSD was found to have increased by 22% whereas in adults and the elderly an 8% and 3% increase was seen respectively. When broken down by gender, a significant increase was observed. Females (+9% [n=143,032]) were seen to have been affected more compared to males (+4% [n=63,625]) during the pandemic vs pre-pandemic. In healthcare resources utilization overall, there was an observed 24% increase. For both inpatients and office, PTSD decreased significantly (-3% and -4% respectively) (p<.05); while ER visits, increased only by 1% (p<.05). A significant increase in outpatient and telehealth services was observed (122% and 454% respectively) (p<.05). An increased exacerbation in PTSD was observed during the pandemic with respect to burden across various stratification and resource utilization; especially in outpatient and telehealth services. Better treatment, psychotherapy and alternative care programs may be required to curb this impact and decrease the overall burden across various care setting.

RWD60 Exploring the Burden of COVID-19 on Eating Disorders Spectrum (Types of Eating Disorders) in Pre- and During-COVID-19 Pandemic Using Real-World Data

This study aimed to explore the impact of COVID-19 on patients with eating spectrum disorders and the burden of resource utilization in the pre- and during COVID-19 pandemic. This retrospective observational study included patients diagnosed with anorexia, bulimia, and other eating disorders (OED) between 1st January 2018 to 31st December 2021 using ICD-10-CM codes from Optum’s de-identified Clinformatics Data Mart database. In this duration, distinct patients were identified and further classified by age, gender, and place of service. To determine the influence in pre- and during COVID-19 for each of the stratification variables, a year-wise comparison was done. Chi-square test of significance was performed for categorical variables. We observed the number of anorexia and bulimia cases among patients with eating spectrum disorders increased significantly during the pandemic (1st January 2020 – 31st December 2020) (p<.01). In the case of teenagers and adults, anorexia was found to have increased by 20% and 5%, respectively, while OED was found to have increased by 6% and 2%, respectively during pandemic. When stratified by gender, only anorexia (females [21%], men [10%] and OED (females [26%], males [18%] showed a substantial increase during the pandemic. Healthcare resources utilization: for inpatients, anorexia and OED increased significantly (10% and 3%), bulimia decreased significantly (5%); for office visits, anorexia increased significantly (3%), bulimia and OED decreased significantly (8% and 3%). Anorexia, bulimia, and OED showed a significant increase in outpatient visits (71%, 68%, 76% respectively); and in telehealth services (2,152%; 1,924%; and 1,727% respectively) (p<.01). An increased exacerbation in eating spectrum disorder was observed during the pandemic, especially in telehealth services. With the increase in cases, health care resource utilization across various settings is pressed. Better treatment and programs may be required to curb this impact and decrease the overall burden.

Temporary Mechanical Circulatory Support for Transcatheter Aortic Valve Replacement

IntroductionThis study aimed to characterize the use of temporary mechanical circulatory support (tMCS) among patients undergoing transcatheter aortic valve replacement (TAVR) using a nationally representative database. Materials and methodsThe 2012-2018 National Inpatient Sample was queried for adult patients who underwent isolated TAVR. The tMCS group was comprised of those who required extracorporeal membrane oxygenation, percutaneous ventricular assist device, or intra-aortic balloon pump during index hospitalization. We evaluated temporal trends in the utilization of tMCS using Cuzick's test. Furthermore, a multivariable logistic regression was used to identify factors associated with tMCS use and its impact on in-hospital mortality, selected complications, and nonhome discharge. ResultsOf an estimated 215,925 patients who underwent TAVR, 3085 (1.4%) required tMCS during their hospital course. The most common modality of tMCS was intra-aortic balloon pump (49%), followed by extracorporeal membrane oxygenation (27%) then percutaneous ventricular assist device (18%). Seven percent of tMCS patients were supported by > 1 device. The annual incidence of tMCS usage decreased over the study period, from 3% in 2012 to 1% in 2018 (P-trend < 0.01). Nonelective admission, congestive heart failure, coagulopathy, and liver disease were strong independent predictors of requiring tMCS. Patients requiring tMCS had a 31.8% in-hospital mortality rate (adjusted odds ratio = 23, 95% confidence interval 18.5-28.5), longer length of stay (9 d versus 3, P < 0.001), and higher costs ($84,600 versus $48,100, P < 0.001) than those who did not. ConclusionsThe use of tMCS during TAVR has decreased over time but remains associated with a 23-fold increased mortality rate and significant clinical and resource utilization burden.

Economic and health care resource utilization burden of central nervous system metastases in patients with metastatic melanoma.

BACKGROUND: In patients with metastatic melanoma, central nervous system (CNS) involvement is associated with poor prognosis, increased costs, and higher health care resource utilization (HCRU); however, previous cost-estimate studies were conducted before widespread use of targeted therapies and immunotherapies. OBJECTIVE: To estimate costs and HCRU in patients with metastatic melanoma with and without CNS metastases in the current treatment era following introduction of targeted therapies and immunotherapies. METHODS: This real-world retrospective cohort study used data from the IQVIA PharMetrics Plus claims database to estimate and compare costs and HCRU in patients with metastatic melanoma by presence or absence of CNS metastases between January 2011 and June 2019. Patients with at least 2 melanoma claims, at least 2 metastatic claims, and continuous enrollment at least 6 months before and at least 1 month after first metastatic diagnosis were included. Mean per-patient-per-month (PPPM) costs are reported in 2019 US dollars. Analyses were also conducted by time period of first metastatic diagnosis: 2011-2014 (reflecting BRAF inhibitor monotherapy and anti-CTLA-4 therapy) and 2015-2019 (reflecting availability of BRAF and MEK inhibitor combinations and anti-PD-1/PD-L1 therapies). RESULTS: Of 4,078 patients, 1,253 (30.7%) had CNS metastases. Patients with CNS metastases were more likely to receive any treatment (89.1% vs 58.9%; P < 0.001), including systemic treatment (73.3% vs 55.4%; P < 0.001) and radiation (65.8% vs 11.8%; P < 0.001), and to have brain imaging any time after metastatic diagnosis (98.3% vs 67.2%; P < 0.001). In patients with CNS metastases, 40.0% had dexamethasone 4 mg within 30 days of CNS metastatic diagnosis. Patients with CNS metastases incurred higher total mean PPPM costs ($29,953 vs $14,996; P < 0.001). The largest contributors were total radiology ($2,351 vs $1,110), targeted therapies ($2,499 vs $638), and immunotherapies ($7,398 vs $5,036). HCRU and costs were higher in patients with vs without CNS metastases regardless of time period of first metastatic diagnosis. In patients with CNS metastases, use of any systemic treatment was increased in 2015-2019 vs 2011-2014 (81.2% vs 64.5%; P < 0.001), including chemotherapy (68.1% vs 50.0%; P < 0.001), immunotherapy (60.9% vs 30.1%; P < 0.001), and/or targeted therapies (32.7% vs 27.4%; P = 0.05). Mean total PPPM costs for patients with CNS metastases increased from $28,183 in 2011-2014 to $31,569 in 2015-2019 (P < 0.001); main drivers were immunotherapies and targeted therapies. CONCLUSIONS: CNS metastases occur frequently in patients with metastatic melanoma and are associated with significantly increased economic burden compared with patients without CNS metastases; the largest contributors to total costs in the current treatment era are radiology, targeted therapies, and immunotherapies. Brain imaging remains underused, and there is an opportunity to improve outcomes through early detection of CNS metastases, potentially reducing the high HCRU and costs associated with CNS metastases. DISCLOSURES: This study was funded by F. Hoffmann-La Roche Ltd. The sponsor was involved in the study design, data collection, data analysis, manuscript preparation, and publication decisions. Seetasith and Lee are employed by and report stock ownership in Genentech, Inc. Bartley and McKenna were employed by Genentech, Inc., at the time of this study and report stock ownership. Tawbi reports grants and personal fees from Genentech/Roche, Novartis, BMS, and Merck; grants from GSK and Celgene; and personal fees from Eisai, outside the submitted work. Kent, Burton, and Haydu have nothing to disclose. The results of this study were presented in part at the AMCP Nexus 2020 Virtual Meeting, October 19-23, 2020.

Opportunity Cost Comparison of Venous Closures: Radiofrequency Versus Cyanoacrylate Ablative Techniques

Chronic venous insufficiency is a costly pathology affecting up to 30% of the US population. Prior studies have highlighted the substantial burden of resource utilization and work-loss costs associated with this disease, estimating upwards of 2 million workdays per year lost in the United States alone. Endovenous closure of refluxing superficial veins has proven to substantially improve health-related quality of life. Despite the shift from inpatient to outpatient ablation procedures, these minimally invasive techniques can still lead to loss of working days and economic disability.

Prolonged Improvement in Patient-Reported Outcomes (PROs) and Well-being in Older Patients With Treatment-Naïve (TN) Chronic Lymphocytic Leukemia Treated With Ibrutinib (Ibr): 3-Year Follow-up of the RESONATE-2 Study

Prolonged Improvement in Patient-Reported Outcomes (PROs) and Well-being in Older Patients With Treatment-Naïve (TN) Chronic Lymphocytic Leukemia Treated With Ibrutinib (Ibr): 3-Year Follow-up of the RESONATE-2 Study

PCN60 Healthcare Resource Utilization Burden in the Management of Triple-Class Exposed Patients With Relapsed/Refractory Multiple Myeloma: Results From the ITEMISE Study

Patients with relapsed/refractory multiple myeloma (RRMM) who are triple-class exposed (TCE) to a proteasome inhibitor (PI), immunomodulatory drug, and anti-CD38 antibody have a poor prognosis. Current understanding around management of these patients and associated healthcare resource utilization (HCRU) is limited outside the US. Here, we report findings from the ITEMISE study regarding management, HCRU, and end-of-life (EoL) care for TCE patients with RRMM in Canada and Europe. This study utilized a 3-phase Delphi-like approach consisting of in-depth interviews with 7 hematology experts, the development of a cross-sectional survey fielded to hematologists across Belgium, Canada, France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland, and the UK from August to October 2020, and a final consensus workshop of hematology experts to validate the results. Hematologists considered HCRU post-TCE, including treatment options, outcomes, and the frequency of hospital visits. Pooled survey findings for all countries were analyzed using descriptive statistics including measures of central tendency and spread. 202 hematologists completed the survey (60% from academic hospitals, 38% from public hospitals, and 2% from private practice). An estimated 56% of patients received active treatment post-TCE; most frequently immunomodulatory drug-, anti-CD38 antibody-, or PI-based regimens (received by 23%, 18%, and 15% of patients, respectively). Patients were estimated to have a median of 2 outpatient visits prior to and during the first treatment post-TCE, and 2 unplanned hospitalizations. During EoL care, an estimated 79% of patients received care outside of hospital, with 2 unplanned hospitalizations of 6 bed days per stay. Survey findings indicate the intent to actively treat TCE patients with a range of combination regimens including PIs, immunomodulatory drugs, and anti-CD38 antibodies. The HCRU burden associated with the management of patients post-TCE highlights the significant need for better treatment options to improve patient prognosis, thereby reducing HCRU across Europe and Canada.

Rationale and protocol for randomized study of transrectal and transperineal prostate biopsy efficacy and complications (ProBE-PC study).

Rrisk of infection and hospitalization after transrectal prostate biopsy (TRBx) has been increasing worldwide. Several modified antibiotic regimens have met with variable success in preventing such infections. Transperineal prostate biopsy (TPBx) is increasingly recommended as the preferred alternative due to apotentially lower risk of post-biopsy infections. Aim of this review is to define the magnitude of post-biopsy complications andthe effectiveness of preventive strategies, including TPBx approach. We performed a focused review of literature on infectious complications after TRBx and detailedthe use ofvarious preventive measures. We summarized the effectiveness of several preventive measures, including TPBx, and outlined the inconsistencies in reported outcomes. We identified potential barriers to the uptake of TPBx, including the gap in knowledge such as lack of high-quality evidence. Several antibiotic prophylaxis protocols, including targeted and augmented, have been utilized for TRBx without demonstrating a clearly superior regimen. Of the non-antibiotic preventive measure, povidone-iodine rectal prep appears to be most effective strategy. Several single-arm cohort studies havereported very low rates of infections after TPBx and demonstrated the feasibility of an office-based procedure. However, barriers to the adoption of TPBx exist including retrospective data, andconflicting results showing minimal reduction in complicationswith increased burden of resource utilization. Presently, there are no randomized studies comparing the infectious complications after TRBx and TPBx. We discuss the rationale and protocol for a randomized controlled trial to determine the comparative effectiveness of biopsy techniques. TPBx approach has the potential to lower the rate of post-biopsy infectionsand hospitalizations. However, there are several barriers to widespread adoption of this approach including inconsistenciesin reported outcomes and lack of Level-1 evidence. Randomized controlled studies are requiredto directly compare the infectious complications associated with eachbiopsy procedure.

Association of In-Hospital Surgical Bleeding Events with Prolonged Hospital Length of Stay, Days Spent in Critical Care, Complications, and Mortality: A Retrospective Cohort Study Among Patients Undergoing Neoplasm-Directed Surgeries in English Hospitals.

PurposeTo evaluate the association of in-hospital surgical bleeding events with the outcomes of hospital length of stay (LOS), days spent in critical care, complications, and mortality among patients undergoing neoplasm-directed surgeries in English hospitals.Patients and MethodsThis is a retrospective cohort study using English hospital discharge data (Hospital Episode Statistics [HES]) linked to electronic health records (Clinical Practice Research Datalink [CPRD]). HES includes information on patient demographics, admission and discharge dates, diagnoses and procedures, days spent in critical care, and discharge status. CPRD includes information on patient demographics, diagnoses and symptoms, drug exposures, vaccination history, and laboratory tests. Patients aged ≥18 years who underwent selected neoplasm-directed surgeries between 1-Jan-2010 and 29-February-2016: hysterectomy, low anterior resection (LAR), lung resection, mastectomy, and prostate surgery were included. The primary independent variable was in-hospital surgical bleeding events identified by diagnosis of haemorrhage and haematoma complicating a procedure or reopening/re-exploration and surgical arrest of postoperative bleeding. Outcomes included LOS, days spent in critical care, in-hospital complications (diagnoses of infections, acute renal failure, vascular events), and in-hospital mortality, identified during surgery through discharge. Multivariable regression was used to examine the adjusted association of bleeding events with outcomes.ResultsThe study included 26,437 neoplasm-directed surgeries (hysterectomy=6092; LAR=2957; lung=1538; mastectomy=12,806; prostate=3044). Incidence proportions of bleeding events were: hysterectomy=1.9% (95% confidence interval=1.1–2.5%); LAR=3.0% (CI=2.3–3.6%); lung=1.8% (CI=1.1–2.5%); mastectomy=1.6% (CI=1.3–1.8%); prostate=1.0% (CI=0.6–1.3%). In adjusted analyses, bleeding events were associated with: prolonged LOS: 3.1 (CI=1.1–6.3) mastectomy to 5.7 (CI=3.6–8.2) LAR days longer; more days spent in critical care: 0.4 (CI=0.03–0.27) mastectomy to 6.5 (CI=2.5–13.6) hysterectomy days more; and higher incidence proportions of all examined complications; all P<0.05.ConclusionThis study quantifies a substantial clinical and healthcare resource utilization burden associated with surgical bleeding among patients undergoing neoplasm-directed surgery in England hospitals.

Three-Dimensional Nonlinear Cooperative Salvo Using Event-Triggered Strategy

This work proposes two different three-dimensional (3D) cooperative guidance strategies for a group of interceptors aiming a simultaneous interception of a stationary target. The guidance commands for many-to-one engagement scenario are derived considering nonlinear engagement kinematics and an improved time-to-go estimate that takes the interceptors’ heading errors into account. A resource allocation technique is used, which provides flexibility in apportioning the required lateral acceleration in the pitch and the yaw planes. The proposed strategies use the notions of sliding mode control, which is known for its finite-time convergence and better disturbance rejection capabilities. With the proposed techniques, and under various interaction topologies, the multi-interceptor group is able to simultaneously intercept the target, both at an impact time specified in advance as well as when the impact time is decided during engagement itself. The control is executed in an event-triggered fashion, thereby reducing the resource utilization burden while guaranteeing satisfactory closed-loop performance of the guidance strategies. Finally, various engagement scenarios have been considered in simulations to support the theoretical claims.

Real-World Clinical and Economic Outcomes and the Role of Bevacizumab in Patients With Non-Small-Cell Lung Cancer With Liver Metastases.

Liver metastases are associated with poor outcomes in patients with advanced non-small-cell lung cancer (aNSCLC). Nevertheless, the vasculature in the liver microenvironment may be conducive to the use of antiangiogenesis inhibitors to potentially improve outcomes. Limited real-world clinical and economic data are currently available for this patient subpopulation. Two retrospective cohort analyses were conducted using data from an electronic health record (n = 14,209) and a claims database (n = 9,017). Patients with aNSCLC with and without liver metastases were identified in each database. Patients with baseline liver metastases in the electronic health record database were further categorized into two subgroups-those who had or had not received bevacizumab-containing regimens. Multivariable Cox proportional hazards regression models were used to adjust for baseline characteristics to evaluate the effect of treatment of bevacizumab. Liver metastases were associated with significantly poorer survival (median overall survival, 6.3 months v 10.1 months) and higher costs and health care resource utilization-total per-patient-per-month costs of $27,589 versus $19,607. Cost differences were primarily driven by inpatient costs, including a two-fold increase in hospitalizations and a 1.7-fold higher mean length of stay. Treatment with bevacizumab was associated with improved survival. Whereas overall survival improved in patients with and without baseline liver metastases who received bevacizumab, the relative survival benefit was greater in patients with liver metastases (hazard ratio, 0.63 [95% CI, 0.50 to 0.81] v hazard ratio, 0.80 [95% CI, 0.74 to 0.86]). Patients with aNSCLC with liver metastases have poorer survival and a higher cost and health care resource utilization burden. Bevacizumab was associated with a survival benefit in patients with aNSCLC with liver metastases.

Consensus-Based Odor Source Localization by Multiagent Systems Under Resource Constraints.

With advancements in mobile robot olfaction, networked multiagent systems (MASs) are used in odor source localization (OSL). These MASs are often equipped with small microprocessors that have limited computing capabilities, and they usually operate in a bandwidth and energy-constrained environment. The exigent need for a faster localizing algorithm under communication and computational resource constraints invites many design challenges. In this paper, we have designed a two-level hierarchical cooperative control strategy for heterogeneous nonlinear MASs for OSL. The agents are forced toward consensus expeditiously once the information on the whereabouts of the source is attained. The synthesis of the controller occurs in a hierarchical manner-obtaining a group decision, followed by resource-efficient robust control. Odor concentration and wind information have been used in a group decision-making layer to predict a probable location of the source as a tracking reference. This reference is then fed to the control layer that is synthesized using event-triggered sliding-mode control (SMC). The advantage of using event-triggered control scheduling in conjunction with the SMC is rooted in retaining the robustness of the SMC while lowering the resource utilization burden. Numerical simulations confirm the efficiency of the scheme put forth.

Costs, resource utilization, and treatment patterns for patients with metastatic melanoma in a commercially insured setting

Objective:To estimate real-world healthcare costs, resource utilization, and treatment patterns among metastatic melanoma (MM) patients who received a therapy recommended in current treatment guidelines during 2011 and 2012, following approval in the US of novel therapies (ipilimumab and vemurafenib).Research design and methods:Administrative claims data were used in a retrospective, longitudinal, open cohort study. Adult MM patients were identified using ICD-9 codes. Therapy-based patient cohorts and index dates were defined by the first receipt of a therapy of interest: ipilimumab, vemurafenib, paclitaxel (alone and in combination), interleukin-2, dacarbazine (alone and in combination), or temozolomide. The follow-up period extended until the end of eligibility or data availability. A multivariate regression model was used to compare outcomes of the ipilimumab and vemurafenib cohorts, controlling for baseline and demographic characteristics.Main outcome measures:Direct healthcare costs (2013 US dollars) and utilization (incidence rates) were measured on a per-patient-per-month (PPPM) basis for each treatment cohort. Treatment patterns were assessed, including the frequency of patients receiving a second therapy of interest.Results:The study population included 834 patients (265 ipilimumab, 234 vemurafenib, 174 paclitaxel, 104 interleukin-2, 46 dacarbazine, and 11 temozolomide). Costs ranged from $10,879 PPPM (temozolomide) to $35,472 PPPM (ipilimumab). Adjusted total costs were $18,337 PPPM higher for the ipilimumab vs. the vemurafenib cohort (p < 0.001), primarily due to higher outpatient costs. Multivariate analysis did not find significant differences in resource utilization between ipilimumab and vemurafenib, except that ipilimumab patients had fewer outpatient visits (excluding treatment visits). Ipilimumab and vemurafenib patients received a second therapy of interest (12% and 11%, respectively) less frequently than interleukin-2 and dacarbazine patients.Conclusions:The cost and resource utilization burden of MM is high and varies substantially across treatment cohorts. The two novel therapies, ipilimumab and vemurafenib, have quickly been adopted and are the most frequently used therapies. The results observed during the approximately 6 month follow-up period may not be representative of the full clinical experience of patients with MM.

PHS71 - Burden of Melanoma among adults enrolled in medicaid program

Melanoma is the most common kind of cancer in the United States. Low socio-economic status is associated with a diagnosis of melanoma at an advanced stage and higher mortality. The objectives of this study were to examine the healthcare resource utilization and treatment profile of adults with melanoma enrolled in Medicaid program. The 2006-2008 Medicaid data for 36 states were used for the purpose of this study. A retrospective matched cohort study design was used. Study sample included individuals who were continuously enrolled in the Medicaid managed care program from 2006 to 2008, were between 18 to 65 years of age during the study period, had no previous history of cancer and had at least one inpatient and/or two outpatient claims for melanoma. Propensity scores were used to match melanoma patients with non-cancer controls (1:2 ratio). Melanoma-related healthcare use was determined in terms of inpatient (IP), emergency room (ER) visits, outpatient (OT) visits. Drug and treatment use (surgery or radiation therapy) was also studied. Wilcoxon rank sum tests were used to compare all-cause resource use between melanoma cases and non-cancer controls. 14,750 incident cases of melanoma in 2007 were identified. In terms of age, gender, and region, most were white (63.91%), female (72.80%), and from the northeast (32.56%) region of the country. Mean melanoma-related OT visits were significantly lower for blacks (4.038) as compared to whites (4.383). Melanoma surgery (78.75%) was the most commonly used treatment followed by radiation therapy (63.01%). Mean all-cause IP (0.229 vs 0.215), ER (3.637 vs 1.545), and OT visits (87.272 vs 52.785) were significantly higher for melanoma cases as compared to non-cancer controls. The healthcare resource and treatment use for melanoma varied by demographic characteristics. Melanoma diagnosis was found to be associated with significant healthcare resource utilization burden.

Assessment Of The Quality Of Life and Health Resource Utilization Burden Among Patients With Primary Immunodeficiency Disorder (PIDD) Prior To Treatment

Assessment Of The Quality Of Life and Health Resource Utilization Burden Among Patients With Primary Immunodeficiency Disorder (PIDD) Prior To Treatment

Economic Impact of Ventilator-Associated Pneumonia in a Large Matched Cohort

To evaluate the economic impact of ventilator-associated pneumonia (VAP) on length of stay and hospital costs. Design. Retrospective matched cohort study. Premier database of hospitals in the United States. Eligible patients were admitted to intensive care units (ICUs), received mechanical ventilation for ≥2 calendar-days, and were discharged between October 1, 2008, and December 31, 2009. VAP was defined by International Classification of Diseases, Ninth Revision (ICD-9), code 997.31 and ventilation charges for ≥2 calendar-days. We matched patients with VAP to patients without VAP by propensity score on the basis of demographics, administrative data, and severity of illness. Cost was based on provider perspective and procedural cost accounting methods. Of 88,689 eligible patients, 2,238 (2.5%) had VAP; the incidence rate was 1.27 per 1,000 ventilation-days. In the matched cohort, patients with VAP ([Formula: see text]) had longer mean durations of mechanical ventilation (21.8 vs 10.3 days), ICU stay (20.5 vs 11.6 days), and hospitalization (32.6 vs 19.5 days; all [Formula: see text]) than patients without VAP ([Formula: see text]). Mean hospitalization costs were $99,598 for patients with VAP and $59,770 for patients without VAP ([Formula: see text]), resulting in an absolute difference of $39,828. Patients with VAP had a lower in-hospital mortality rate than patients without VAP (482/2,144 [22.5%] vs 630/2,144 [29.4%]; [Formula: see text]). Our findings suggest that VAP continues to occur as defined by the new specific ICD-9 code and is associated with a statistically significant resource utilization burden, which underscores the need for cost-effective interventions to minimize the occurrence of this complication.