Changes In Health Care Costs Research Articles

Changes in healthcare costs and utilization for Medicaid recipients who received supportive housing through a payer-community-based housing partnership.

To evaluate healthcare cost and utilization changes among Medicaid and dually eligible participants of a supportive housing program implemented by a managed care organization and community-based organization. Healthcare claims were reviewed retrospectively for 80 program participants in one urban Pennsylvania county between 1/1/2018 and 9/28/2023 who had ≥6 months of claims data in both pre- and post-housing periods. Eligibility included age >18 years, Medicaid/Special Needs Plan enrollment, and housing need. Due to limited housing units, potential participants were prioritized by medical need and history of unplanned care. Healthcare cost and utilization were compared during pre- (i.e., 12 months before housing initiation) and post-periods (i.e., 12 months after housing initiation). Compared to the pre-period, significantly lower medical (-40.4%, p = 0.004), emergency department (-62.7%, p = 0.02), and total (-33.3%, p = 0.02) costs of care were observed in the post-period. Significantly lower primary care (-50.0%, p = 0.0003), specialist (-31.3%, p = 0.02), and emergency department (-50.0%, p = 0.03) utilization were also observed. Healthcare cost and utilization among medically complex individuals were lower with supportive housing. Future evaluations with randomized designs can address the potential causal impact of supportive housing as a healthcare intervention on specific outcomes.

P221 Validity of the Self-administered Comorbidity Questionnaire in patients with Inflammatory Bowel Disease

Abstract Background The International Consortium for Health Outcomes Measurement (ICHOM) has defined a standard set of outcome measures for inflammatory bowel disease (IBD) to capture effectiveness of care delivery processes by systematic collection of outcomes. However, several case-mix variables can confound the outcome measures and should be adjusted for before interpreting and comparing outcomes. To account for the impact of comorbidities, the self-assessed comorbidity questionnaire (SCQ), containing 36 questions on presence, treatment and limitation of thirteen diseases, was selected by ICHOM. As the SCQ has been validated for other diseases, but not for IBD, we aimed to assess the validity of the SCQ for measuring comorbidities in a population of IBD patients. Methods Data in this study was extracted from a prospective study evaluating quality of care of IBD patients treated with a biologic or new small molecule. We assessed criterion validity by comparing patient-reported and clinician-reported presence (as noted in the electronic health record) of the thirteen diseases of the SCQ using Cohen’s kappa. Construct validity was assessed by evaluating the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life (EQ-5D-5L), IBD-related healthcare and productivity costs and prevalence of disability. We assessed responsiveness by measuring the correlation between changes in the SCQ and changes in healthcare costs, productivity costs and quality of life after 15 months. Results A total of 642 patients were included. Median age was 49, 56% were female and 60% had Crohn’s disease. Median SCQ at baseline was 1.75 (IQR: 0.01 – 4.00) and increased to 2 (IQR: 0.26-4.00) after 15 months of follow-up. Fair agreement was found for most comorbidities, but agreement was poor for back pain, arthritis, blood diseases, stomach diseases, kidney diseases and depression (Table 1). Significant correlations were found between the SCQ and CCI, clinician-reported SCQ, quality of life, prevalence of disability and productivity costs, but not with healthcare costs (Table 2). A change in the SCQ after 15 months was negatively correlated with a change in quality of life, but not with a change in healthcare or productivity costs. Conclusion The SCQ seems a useful tool to adjust for case-mix for health-related quality of life in IBD patients, but does not relate to IBD-attributable healthcare or productivity costs. The SCQ does not always agree with the electronic health record, which may be due to inadequate capture of comorbidities in the electronic health record or because patients may confuse comorbidities and complications of IBD.

Validity of the self-administered comorbidity questionnaire in patients with inflammatory bowel disease.

The International Consortium for Health Outcomes Measurement has selected the self-administered comorbidity questionnaire (SCQ) to adjust case-mix when comparing outcomes of inflammatory bowel disease (IBD) treatment between healthcare providers. However, the SCQ has not been validated for use in IBD patients. We assessed the validity of the SCQ for measuring comorbidities in IBD patients. Cohort study. We assessed the criterion validity of the SCQ for IBD patients by comparing patient-reported and clinician-reported comorbidities (as noted in the electronic health record) of the 13 diseases of the SCQ using Cohen's kappa. Construct validity was assessed using the Spearman correlation coefficient between the SCQ and the Charlson Comorbidity Index (CCI), clinician-reported SCQ, quality of life, IBD-related healthcare and productivity costs, prevalence of disability, and IBD disease activity. We assessed responsiveness by correlating changes in the SCQ with changes in healthcare costs, productivity costs, quality of life, and disease activity after 15 months. We included 613 patients. At least fair agreement (κ > 0.20) was found for most comorbidities, but the agreement was slight (κ < 0.20) for stomach disease [κ = 0.19, 95% CI (-0.03; 0.41)], blood disease [κ = 0.02, 95% CI (-0.06; 0.11)], and back pain [κ = 0.18, 95% CI (0.11; 0.25)]. Correlations were found between the SCQ and the clinician-reported SCQ [ρ = 0.60, 95% CI (0.55; 0.66)], CCI [ρ = 0.39, 95% CI (0.31; 0.45)], the prevalence of disability [ρ = 0.23, 95% CI (0.15; 0.32)], and quality of life [ρ = -0.30, 95% CI (-0.37; -0.22)], but not between the SCQ and healthcare or productivity costs or disease activity (|ρ| ⩽ 0.2). A change in the SCQ after 15 months was not correlated with a change in any of the outcomes. The SCQ is a valid tool for measuring comorbidity in IBD patients, but face and content validity should be improved before being used to correct case-mix differences.

Changes in healthcare costs and survival in the era of immunotherapy and targeted systemic therapy for melanoma.

ObjectivesMelanoma treatment has evolved over the past decade with the adoption of adjuvant and palliative immunotherapies and targeted therapies and changes in use of sentinel node biopsy. The impact on real-world healthcare costs and outcomes is uncertain. Here we examine changes in healthcare costs and survival using administrative data.&#x0D; ApproachUsing data from the universal healthcare system in Ontario, Canada, we examine a propensity-matched, retrospective cohort of patients aged 20+ years with Stage I-IV invasive cutaneous melanoma from 2018-2019 compared with those from 2007-2012. The primary outcomes were public payer’s mean healthcare per-person costs, and overall survival (OS). Costs were estimated with an established case-mix and claim-based costing algorithm for Ontario, in which person-level costs are allocated for the various healthcare utilizations over time. Standardized mean differences were used to compare costs, and the log-rank test and Cox regression were used to compare survival among stage-stratified, propensity-score matched cohorts.&#x0D; ResultsWe identified 1,138 patients with melanoma from 2018-2019 and 7,654 from 2007-2012. After stage stratification and propensity-matching (N=1,101 per cohort), sentinel lymph node biopsy (62.3% vs. 43.4%) and systemic therapy use (27.3% vs. 12.5%) were more frequent in 2018-2019 compared to 2007-2012. 2018-2019 patients had greater mean healthcare (including systemic therapy) costs compared to 2007-2012 with Stage II ($27,835 vs. $21,179), III ($90,508 vs. $46,242) and IV disease ($118,398 vs. $46,500). There was a seven-to-twelve-fold increase in mean systemic therapy costs for treated patients with Stage III ($68,207 vs. $9,832) and IV disease ($80,905 vs. $6,883). OS was greater in 2018-2019 versus 2007-2012 (2-year OS: 87.8% [95% Confidence Interval {CI}: 85.8-89.6%] vs. 83.7% [95% CI: 81.3-85.7%]; Hazard Ratio {HR}: 0.72 [95% CI: 0.59-0.89]; p&lt;0.05).&#x0D; ConclusionThese real-world data highlight trade-offs with adoption of new effective systemic therapies for melanoma, with a greater economic burden to the healthcare system but an associated improvement in survival. Such evolving paradigm changes may prompt dynamic evaluations of healthcare resources and policies to ensure cancer care is sustainable.

Cost-effectiveness of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness: the MULTI study V

IntroductionEconomic evaluations of lifestyle interventions for people with mental illness are needed to inform policy makers and managers about implementing such interventions and corresponding reforms in routine mental healthcare.ObjectivesWe aimed to evaluate changes in healthcare costs 18 months after the implementation of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness (MULTI) versus treatment as usual (TAU).MethodsIn a cohort study (n=114; 65 MULTI, 49 TAU), we retrospectively retrieved cost data in Euros on all patient sessions, ward stay, medication use, and hospital referrals in the quarter year at the start of MULTI (Q1 2014) and after its evaluation (Q3 2015). We used linear regression analyses correcting for baseline values and differences between groups, calculated quality-adjusted life years (QALY) and deterministic incremental cost-effectiveness ratios, and performed probabilistic sensitivity analyses.ResultsAdjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B=-736.30, 95%CI: -2145.2–672.6). Corresponding probabilistic sensitivity analysis accounting for uncertainty surrounding the parameters showed MULTI was dominant over TAU with a saving in total costs of €417.48 (95%-CI: -2,873.2–2,042.1) against 0.06 improvement in QALY (95%-CI: -0.08–0.20). Costs saving estimates were statistically non-significant showing wide confidence intervals.ConclusionsRegardless of cost savings, MULTI did not increase healthcare costs while improving QALY and additional previously observed health outcomes. This indicates that starting lifestyle interventions does not need to be hampered by costs. Potential societal and economic value may justify investment to support implementation and maintenance. Further research is needed to study this hypothesis.DisclosureNo significant relationships.

Changes in healthcare costs following engagement with a virtual mental health system: a matched cohort study of healthcare claims data

The COVID-19 pandemic has exacerbated the pressing need for mental health services. Digital mental health interventions could increase access to care and be an effective approach to reducing anxiety and depression at scale; however, research on their impact on healthcare expenditure is in the nascent stage and requires further investigation. The current study used claims data to examine the associations between use of an on-demand digital mental health platform and healthcare utilization costs compared to a matched control cohort. The study found that there were no significant differences between cohorts in total healthcare costs and pharmacy costs. There was a 16.8% reduction in outpatient costs (p=.08). On-demand digital mental health interventions can serve as a scalable approach to addressing the current mental health demands and potentially lower outpatient costs.

Cost-Effectiveness of a Multidisciplinary Lifestyle-Enhancing Treatment for Inpatients With Severe Mental Illness: The MULTI Study V.

Economic evaluations of lifestyle interventions for people with mental illness are needed to inform policymakers and managers about implementing such interventions and corresponding reforms in routine mental healthcare. We aimed to evaluate changes in healthcare costs 18 months after the implementation of a multidisciplinary lifestyle-enhancing treatment for inpatients with severe mental illness (MULTI) versus treatment as usual (TAU). In a cohort study (n = 114; 65 MULTI, 49 TAU), we retrospectively retrieved cost data in Euros on all patient sessions, ward stay, medication use, and hospital referrals in the quarter year at the start of MULTI (Q1 2014) and after its evaluation (Q3 2015). We used linear regression analyses correcting for baseline values and differences between groups, calculated deterministic incremental cost-effectiveness ratios for previously shown changes in physical activity, metabolic health, psychosocial functioning, and additionally quality of life, and performed probabilistic sensitivity analyses including cost-effectiveness planes. Adjusted regression showed reduced total costs per patient per quarter year in favor of MULTI (B = -736.30, 95%CI: -2145.2 to 672.6). Corresponding probabilistic sensitivity analyses accounting for uncertainty surrounding the parameters showed statistically non-significant cost savings against health improvements for all health-related outcomes in MULTI compared to TAU. It is concluded that MULTI did not increase healthcare costs while improving health outcomes. This indicates that starting lifestyle interventions does not need to be hampered by costs. Potential societal and economic value may justify investment to support implementation and maintenance. Further research is needed to study this hypothesis.

Cost-effectiveness of an 8-week supervised education and exercise therapy programme for knee and hip osteoarthritis: a pre–post analysis of 16 255 patients participating in Good Life with osteoArthritis in Denmark (GLA:D)

ObjectivesTo evaluate 1-year cost-effectiveness of an 8-week supervised education and exercise programme delivered in primary care to patients with symptomatic knee or hip osteoarthritis (OA).DesignA registry-based pre–post study linking patient-level...

Healthcare cost reduction and psychiatric symptom improvement in posttraumatic stress disorder patients treated with intensive short-term dynamic psychotherapy

IntroductionPosttraumatic stress disorder (PTSD) is associated with significant psychiatric morbidity and high healthcare costs. ObjectiveThe aim of this pilot study was to evaluate changes in healthcare costs and general psychiatric symptom severity in patients with PTSD following intensive short-term dynamic psychotherapy (ISTDP). MethodHealthcare services cost and utilization data were compiled at intake, prior to starting ISTDP and then assessed annually for three years thereafter. Two validated self-report scales, the Brief Symptom Inventory and the Inventory of Interpersonal Problems, were administered at intake and termination. ResultsResults showed significant reductions in physician costs and physician visits at one-year post-treatment, with these persisting over the three-year follow-up period. There were also large but statistically non-significant reductions in hospital costs. At termination, self-reported psychiatric symptoms and interpersonal problems were reduced. ConclusionThese preliminary findings suggest that ISTDP may lead to healthcare cost reductions and general psychiatric symptom improvement in patients with PTSD, with healthcare utilization benefits maintained at long-term follow up. Future research directions were discussed.

Economic modeling to evaluate the impact of chronic myeloid leukemia therapy management on the oncology care model in the US

Objective: To develop an economic model to evaluate changes in healthcare costs driven by restricting usage of branded tyrosine kinase inhibitors (TKIs) through substitution with generic imatinib among chronic myeloid leukemia (CML) patients in a typical Oncology Care Model (OCM) practice, and examine the impact on Performance-Based Payment (PBP) eligibility.Methods: An Excel-based economic model of an OCM practice with 1,000 cancer patients during a 6-month episode of care was developed. Cancer types and proportions of patients treated in the practice were estimated from an OCM report. All-cause healthcare costs were obtained from published literature. It was assumed that if a practice restricts usage of branded TKIs for newly-diagnosed CML patients, 80% of the market share of branded imatinib and 50% of the market shares of 2nd-gen TKIs would shift to generic imatinib. Among established TKI-treated patients, it was assumed that 80% of the market share of branded imatinib and no patients treated with 2nd-gen TKIs would shift to the generic.Results: Four CML patients were estimated for a 1,000-cancer patient OCM practice with a total baseline healthcare cost of $51,345,812 during a 6-month episode. If the practice restricts usage of branded TKIs, the shift from 2nd-gen TKIs to generic imatinib would reduce costs by $12,970, while shifting from branded to generic imatinib lowers costs by $25,250 during a 6-month episode. Minimum reductions of $3,013,832 in a one-sided risk model and $2,372,010 in a two-sided risk model are required for PBP eligibility; the shift from 2nd-gen TKIs to generic imatinib would account for 0.4% and 0.5% of the savings required for a PBP, respectively.Conclusions: This analysis indicates that the potential cost reduction associated with restricting branded TKI usage among CML patients in an OCM setting will represent only a small proportion of the cost reduction needed for PBP eligibility.

Analysis of a clinical pathway for home enteral nutrition in the Region of Murcia. Consumption and associated expenses and adaptation to the National Health System Guide

ObjectiveTo analyze the compliance with the Guide for home enteral nutrition (HEN) of the Spanish national health system of the prescriptions made in a specific area (Health Area I of the Region of Murcia) before and after implementation of a clinical pathway based on that guide, and to compare the changes in healthcare costs of diet therapy during the 2007–2014 period in the Regional and National Health system. MethodA descriptive study to quantify compliance with the main criteria of the HEN guide before (2010) and after (2013–2014) implementation of the clinical pathway. Changes in health expenditure and consumption during the 2007–2014 period were also analyzed. ResultsAll markers of compliance with the national HEN guide improved after implementation of the clinical pathway. In addition, Murcia has one of the Spanish lowest expenditures per population, below the national average. ConclusionThe clinical pathway implemented improves compliance with the national guide of prescriptions to patients in the Region of Murcia while containing health resources expenditure and consumption, thus making diet therapy prescription more sustainable.

Perioperative surgical home models and enhanced recovery after surgery.

In recent years, numerous initiatives have been introduced to address changes in health-care costs, delivery methods, reimbursements, and the health-care needs of our aging population. The American Society of Anesthesiologists (ASA) defines the Perioperative Surgical Home (PSH) as a patient-centric, team-based model of care to help meet the demands of a rapidly approaching health-care paradigm emphasizing value, patient satisfaction, and a reduction in costs. Enhanced recovery pathways were initially established by a group of surgeons from Europe who formed a research group with the aim to explore the ultimate care pathway for patients undergoing colonic resections. Similar protocols were later expanded to various surgical specialties with promising outcomes. A PubMed and World Wide Web search was performed with the following key words: “ERAS®,” “enhanced recovery after surgery,” “PSH,” “perioperative surgical home,” “protocols,” “outcomes.” Articles found were published over a 20-year time range (1997-2017). In the present investigation, the most common elements of enhanced recovery protocols are reviewed. Review of how existence of a PSH model facilitates the creation of an enhanced recovery protocol and improves cost-efficiency, patient satisfaction, and clinical outcomes observed in enhanced recovery studies that are applicable to health-care systems universally is described.

Análisis de la vía clínica de nutrición enteral domiciliaria de la Región de Murcia. Consumo y gastos asociados y adecuación a la Guía del Sistema Nacional de Salud

ObjectiveTo analyze the compliance with the Guide for home enteral nutrition (HEN) of the Spanish national health system of the prescriptions made in a specific area (Health Area I of the Region of Murcia) before and after implementation of a clinical pathway based on that guide, and to compare the changes in healthcare costs of diet therapy during the 2007-2014 period in the Regional and National Health system. MethodA descriptive study to quantify compliance with the main criteria of the HEN guide before (2010) and after (2013-2014) implementation of the clinical pathway. Changes in health expenditure and consumption during the 2007-2014 period were also analyzed. ResultsAll markers of compliance with the national HEN guide improved after implementation of the clinical pathway. In addition, Murcia has one of the Spanish lowest expenditures per population, below the national average. ConclusionThe clinical pathway implemented improves compliance with the national guide of prescriptions to patients in the Region of Murcia while containing health resources expenditure and consumption, thus making diet therapy prescription more sustainable.

An integrated methodology for evaluating patient service quality

Customer satisfaction and perception of quality are important for the profitability and sustainability of any organisation. In healthcare, patients’ needs and perception of quality are dynamic considering the rapid changes in healthcare costs, technological advancements, and patient demographics. The purpose of this research is to explore the diverse range of patient needs based on the level of satisfaction and quality perception. A methodology is proposed to provide insights into the voice of the customer through visualisation of the relationship between the performance of quality attributes and customer satisfaction. Cronbach’s alpha is employed to ensure internal consistency in the instrument used to gather the voice of the customer. In addition, the chi-square test for goodness of fit is included in the proposed methodology to test the distribution. Fisher’s exact test value from the Chi-square test of independence is used to evaluate patients’ responses. The effect sizes were analyzed using Cramer’s V to determine the magnitude of effect between the variables. The proposed methodology enabled comparisons of patient responses by demographics. A cross-sectional study was conducted to explore the needs associated with the walk-in clinics in the United States and validate the proposed methodology.

Pharmacoeconomic and associated cost savings among women who were prescribed systemic conjugated estrogens therapy compared with those without menopausal therapy.

To explore changes in healthcare costs among postmenopausal women in a commercial population who were prescribed conjugated estrogens for menopausal symptoms. Using the MarketScan dataset from April 1, 2008 through September 30, 2012, postmenopausal women aged ≥45 years, who were prescribed conjugated estrogen tablets (Premarin), were identified. A comparative cohort of postmenopausal women with vasomotor symptoms without any menopause therapy was also identified. Women included were required to have continuous medical and pharmacy benefits for 6 months before and 12 months after index date, with baseline characteristics compared using chi-square and t tests. The 6 and 12-month change (difference in follow-up and baseline costs) in direct healthcare costs was calculated and a difference-in-differences model was used to compare the incremental change at 6 and 12 months in healthcare costs between the cohorts, adjusting for demographic and clinical characteristics. The study included 1,404 women who were prescribed conjugated estrogens, and 3,096 untreated women. Women prescribed conjugated estrogens were significantly younger (52 vs 54 years; P < 0.0001) and had a lower Charlson comorbidity index score (0.29 vs 0.41; P < 0.001) compared with the untreated women. After adjusting for baseline characteristics, women treated with conjugated estrogens showed a greater difference in the change in total healthcare costs (-$1,601 vs -$503; P = 0.044), including inpatient stay costs (-$1,431 vs -$28; P < 0.0001), between the baseline and follow-up periods compared with untreated women. Women who were prescribed oral conjugated estrogens had a significantly greater reduction in healthcare costs after treatment initiation compared with untreated postmenopausal women.

Trends in survival and costs among US multiple myeloma patients.

8046 Background: Survival among multiple myeloma (MM) patients has improved over time, but little is known about concurrent changes in healthcare costs. This study examined trends in both survival and healthcare costs over the same time periods in US MM patients. Methods: The MarketScan Commercial and Medicare claims dataset was used to identify 5199 adult patients diagnosed with MM from Jan. 2006 to Dec. 2014. Patients had no prior evidence of cancer, were continuously enrolled for &gt;12 months prior to MM diagnosis, and were followed through the earliest event (death, end of enrollment, or end of the study period (9/30/2015)). Multivariate GLM and Cox proportional hazards models estimated healthcare costs and survival probabilities, respectively, for two time periods during which patients were diagnosed with MM (2006-2010 vs 2011-2014) while controlling for demographic and clinical characteristics. The recycled prediction method was used to calculate the incremental cost estimates between the time periods. Results: Patients diagnosed in 2011-2014 had a 35% lower risk of death compared to those diagnosed in 2006-2010 (HR [95% CI] = 0.65 [0.57-0.74]. Patients diagnosed in 2011-2014 had 18% (95% CI: 6-31%) higher all cause and 26% (95% CI: 6-50%) higher MM-related per patient per month costs compared to those diagnosed in 2006-2010 (Table). Conclusions: Among MM patients, survival has improved at a greater rate than the increase in healthcare costs. In addition to improvements in MM treatment, changes in overall disease management may have contributed to both the increased expenditures and survival improvements observed in this study. [Table: see text]

Heavy workload during the 2016/17 winter was entirely predictable

Journal of Paramedic PracticeVol. 9, No. 2 CommentHeavy workload during the 2016/17 winter was entirely predictableRodney JonesRodney JonesSearch for more papers by this authorRodney JonesPublished Online:10 Feb 2017https://doi.org/10.12968/jpar.2017.9.2.52AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beeknoo N and Jones R (2016) The demography myth - how demographic forecasting vastly underestimates hospital admissions, and creates the illusion that fewer hospital beds or community-based bed equivalents will be required in the future. Brit J Med Medical Research 19(2): 1–27 Crossref, Google ScholarFilleul L, Ranoaritiana D, Balleydier E, Vandroux D, Jaffar-Bandjee M et al. (2016) A major impact of the influenza seasonal epidemic on intensive care units, Réunion, April to August 2016. Eurosurveillance 21(47) Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22649 (Accessed 24 November 2016) Google ScholarJones R (2014a) What is happening in unscheduled care? Journal of Paramedic Practice 5(2): 60-2 Link, Google ScholarJones R (2014b) A Study of an Unexplained and Large Increase in Respiratory Deaths in England and Wales: Is the Pattern of Diagnoses Consistent with the Potential Involvement of Cytomegalovirus? Brit J Med Medical Research 4(33): 5179–92 Crossref, Google ScholarJones R (2015a) Exploring trends in demand for urgent care. Journal of Paramedic Practice 7(10): 486–8 Link, Google ScholarJones R (201b5) Simulated rectangular wave infectious-like events replicate the diversity of time-profiles observed in real-world running 12 month totals of admissions or deaths. Fractal Geometry and Nonlinear Analysis in Medicine and Biology (FGNAMB) 1(3): 78–9 Google ScholarJones R (2015c) Are emergency admissions contagious? Brit J Healthc Manage 21(5): 227–35 Link, Google ScholarJones R (2015d) A previously uncharacterized infectious-like event leading to spatial spread of deaths across England and Wales: Characteristics of the most recent event and a time series for past events. British Journal of Medicine and Medical Research 5(11): 1361–80 Crossref, Google ScholarJones R (2016a) A presumed infectious event in England and Wales during 2014 and 2015 leading to higher deaths in those with neurological and other disorders. J Neuroinfectious Diseases 7(2): 1000213 Crossref, Google ScholarJones R (2016b) Deaths and the marginal changes in healthcare costs. Brit J Healthc Manage 22(10): 503–9 Link, Google ScholarJones R (2016c) Is cytomegalovirus involved in recurring periods of higher than expected death and medical admissions, occurring as clustered outbreaks in the northern and southern hemispheres? Brit J Med Medical Res 11(2): 1–31 Crossref, Google ScholarJones R (2016d) The unprecedented growth in medical admissions in the UK: the ageing population or a possible infectious/immune aetiology? Epidemiology (Sunnyvale): Open Access 6(1): 1000219 Crossref, Google ScholarJones R (2016e) Rising emergency admissions in the UK and the elephant in the room. Epidemiology (Sunnyvale): Open Access 6(4): 1000261 Google ScholarJones R (2016f) Deaths and the marginal changes in healthcare costs. Brit J Healthc Manage 22(10): 503–09 Link, Google ScholarJones R, Sleet G, Pearce O, Wetherill M (2016) Is the weekend effect in hospital mortality real, or is a fundamental weekly cycle in adult blood biochemistry, health and death a contributory factor? Brit J Med Medical Res 18(5): 1–28 Crossref, Google ScholarPublic Health England (2017) PHE weekly national influenza reports. Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/582000/Weekly_national_influenza_report_week_01_2017.pdf (Accessed 15 January 2017) Google Scholar FiguresReferencesRelatedDetails 2 February 2017Volume 9Issue 2ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 10 February 2017 Published in print 2 February 2017 Information© MA Healthcare LimitedPDF download

Deaths and the marginal changes in healthcare costs

Changes in the absolute number of deaths (all-cause mortality) act via their impact on end-of-life care to affect marginal changes in NHS medical admissions, bed occupancy and costs. These effects are poorly understood. A very large and unexpected increase in deaths in 2015 offers the opportunity to explore the reasons for this and previous examples of periods of increased deaths. While the event in 2015 was large it is simply a further example of a long-term series of similar events. An influenza outbreak in early 2015 did make an additional contribution, however deaths had already begun to increase around mid-2014. Interaction between the agent causing the earlier increase in deaths and influenza appear highly likely. The resulting complex short-term trends in death imply that health and social care costs will show far higher volatility than that implied by simple demographic change.

Cost‐effectiveness of a nurse practitioner‐family physician model of care in a nursing home: controlled before and after study

To examine the cost-effectiveness of a nurse practitioner-family physician model of care compared with family physician-only care in a Canadian nursing home. As demand for long-term care increases, alternative care models including nurse practitioners are being explored. Cost-effectiveness analysis using a controlled before-after design. The study included an 18-month 'before' period (2005-2006) and a 21-month 'after' time period (2007-2009). Data were abstracted from charts from 2008-2010. We calculated incremental cost-effectiveness ratios comparing the intervention (nurse practitioner-family physician model; n=45) to internal (n=65), external (n=70) and combined internal/external family physician-only control groups, measured as the change in healthcare costs divided by the change in emergency department transfers/person-month. We assessed joint uncertainty around costs and effects using non-parametric bootstrapping and cost-effectiveness acceptability curves. Point estimates of the incremental cost-effectiveness ratio demonstrated the nurse practitioner-family physician model dominated the internal and combined control groups (i.e. was associated with smaller increases in costs and emergency department transfers/person-month). Compared with the external control, the intervention resulted in a smaller increase in costs and larger increase in emergency department transfers. Using a willingness-to-pay threshold of $1000 CAD/emergency department transfer, the probability the intervention was cost-effective compared with the internal, external and combined control groups was 26%, 21% and 25%. Due to uncertainty around the distribution of costs and effects, we were unable to make a definitive conclusion regarding the cost-effectiveness of the nurse practitioner-family physician model; however, these results suggest benefits that could be confirmed in a larger study.

PMH31 - Changes in Healthcare costs associated with the Treatment of Bipolar Disorder following initiation of Asenapine versus Aripiprazole

PMH31 - Changes in Healthcare costs associated with the Treatment of Bipolar Disorder following initiation of Asenapine versus Aripiprazole