Healthcare Resource Consumption Research Articles

The cost of keeping patients waiting: retrospective treatment-control study of additional healthcare utilisation for UK patients awaiting elective treatment.

Long waiting times for elective hospital treatments are common in many countries. This study seeks to address a deficit in the literature concerning the effect of long waits on the wider consumption of healthcare resources. We carried out a retrospective treatment-control study in a healthcare system in South West England from 15 June 2021 to 15 December 2021. We compared weekly contacts with health services of patients waiting over 18 weeks for treatment ('Treatments') and people not on a waiting list ('Controls'). Controls were matched to Treatments based on age, sex, deprivation and multimorbidity. Treatments were stratified by the clinical specialty of the awaited hospital treatment, with healthcare usage assessed over various healthcare settings. Wilcoxon signed-rank tests assessed whether there was an increase in healthcare utilisation and bootstrap resampling was used to estimate the magnitude of any differences. A total of 44,616 patients were waiting over 18 weeks (the constitutional target in England) for treatment during the study period. There was an increase (p < 0.0004) in healthcare utilisation for all specialties. Patients in the Cardiothoracic Surgery specialty had the largest increase, with 17.9 [interquartile-range: 4.3, 33.8] additional contacts with secondary care and 17.3 [-1.1, 34.1] additional prescriptions per year. People waiting for treatment consume higher levels of healthcare than comparable individuals not on a waiting list. These findings are relevant for clinicians and managers in better understanding patient need and reducing harm. Results also highlight the possible 'false economy' in failing to promptly resolve long elective waits.

Loneliness impact on healthcare utilization in primary care: A retrospective study

BackgroundAn increased number of patients seek help for loneliness in primary care. ObjectiveTo analyze whether loneliness was associated with a higher utilization of healthcare facilities. MethodsObservational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data. ResultsA total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6–9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year. ConclusionLoneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.

Italian healthcare resource consumption for patients on hemodialysis treated for chronic kidney disease-associated pruritus (CKD-aP).

Chronic kidney disease-associated pruritus (CKD-aP) affects patients on hemodialysis. This study identified hemodialysis patients presumably affected or not affected by CKD-aP and integrated healthcare costs, from the perspective of the Italian administrative healthcare data. Through cross-linkage of Italian administrative healthcare data collected between 2015 and 2017 (accrual period) in the database of Fondazione ReS (Ricerca e Salute), patients undergoing in-hospital/outpatient hemodialysis were selected. Cohorts with and without CKD-aP were created based on the presence/absence of CKD-aP-related treatment (according to common clinical practice and guidelines) supplies and assessed in terms of CKD-aP-related treatments and mean healthcare costs per capita paid by the Italian National Health Service (INHS). Of 1,239 people on hemodialysis for ≥2 years, CKD-aP affected 218 patients. Patients with CKD-aP were older and with more comorbidities. During the follow-up year, on average, the INHS spent €37,065 per case, €31,286 per control and € 35,988 per non-CKD-aP subject. High-efficiency dialytic therapies performed to people on hemodialysis with CKD-aP largely weighed on the overall mean annual cost. This real-world study identified patients on chronic hemodialysis potentially treated for CKD-aP. Interestingly, high-efficiency dialysis seems the most frequent and expensive choice for the treatment of CKD-aP. The discovery of appropriate and effective treatments for this condition might offer cost offsets.

Asthma and obstructive sleep apnea: Unveiling correlations and treatable traits for comprehensive care.

Asthma and obstructive sleep apnea (OSA) are common respiratory disorders. They share characteristics such as airway obstruction, poor sleep quality, and low quality of life. They are often present as comorbidities, along with obesity, gastroesophageal reflux disease (GERD), and allergic rhinitis (AR), which impacts the disease's control. In recent years, there has been discussion about the association between these conditions and their pathophysiological and clinical consequences, resulting in worse health outcomes, increased healthcare resource consumption, prolonged hospital stays, and increased morbidity and mortality. Some studies demonstrate that treatment with continuous positive airway pressure (CPAP) can have a beneficial effect on both pathologies. This review summarizes the existing evidence of the association between asthma and OSA at their pathophysiological, epidemiological, clinical, and therapeutic levels. It intends to raise awareness among healthcare professionals about these conditions and the need for further research.

The role of the general practictioner in the management of urinary calculi.

The prevalence of kidney stones tends to increase worldwide due to dietary and climate changes. Disease management involves a high consumption of healthcare system resources which can be reduced with primary prevention measures and prophylaxis of recurrences. In this field, collaboration between general practitioners (GPs) and hospitals is crucial. a panel composed of general practitioners and academic and hospital clinicians expert in the treatment of urinary stones met with the aim of identifying the activities that require the participation of the GP in the management process of the kidney stone patient. Collaboration between GP and hospital was found crucial in the treatment of renal colic and its infectious complications, expulsive treatment of ureteral stones, chemolysis of uric acid stones, long-term follow-up after active treatment of urinary stones, prevention of recurrence and primary prevention in the general population. The role of the GP is crucial in the management and prevention of urinary stones. Community hospitals which are normally led by GPs in liaison with consultants and other health professional can have a role in assisting multidisciplinary working as extended primary care.

EPH255 Healthcare Resource Consumption of Patients with Cardiovascular Events after Exacerbations of Chronic Obstructive Pulmonary Disease in Italy: Results from the EXACOS-CV Study

EPH255 Healthcare Resource Consumption of Patients with Cardiovascular Events after Exacerbations of Chronic Obstructive Pulmonary Disease in Italy: Results from the EXACOS-CV Study

EPH200 Healthcare Resource Consumption of Patients with Chronic Obstructive Pulmonary Disease Treated with Triple and Dual Therapy and Experiencing an Acute Exacerbation

EPH200 Healthcare Resource Consumption of Patients with Chronic Obstructive Pulmonary Disease Treated with Triple and Dual Therapy and Experiencing an Acute Exacerbation

EPH137 Healthcare Resource Consumption and Direct Costs of Patients Newly Diagnosed with Acute Myeloid Leukemia from a Large Italian Administrative Database

EPH137 Healthcare Resource Consumption and Direct Costs of Patients Newly Diagnosed with Acute Myeloid Leukemia from a Large Italian Administrative Database

PT8 Five-Year Healthcare Resource Consumption and Direct Costs of Women with a New Diagnosis of Hr+/HER2- Breast Cancer Primary or Advanced: Analysis of a Large Italian Administrative Database

PT8 Five-Year Healthcare Resource Consumption and Direct Costs of Women with a New Diagnosis of Hr+/HER2- Breast Cancer Primary or Advanced: Analysis of a Large Italian Administrative Database

Comparison of Condensed to Standard Schedule of High Dose Cytarabine Consolidation for Acute Myeloid Leukemia in First Complete Remission

Background Traditionally, acute myeloid leukemia (AML) consolidation therapy for patients less than 60 years old with low to intermediate risk disease has been treated with high dose cytarabine (HDAC) cycles given on days 1, 3, and 5 (HDAC-135). However, more recent publications have assessed alternative dosing, namely administering HDAC on days 1, 2, and 3 (HDAC-123). National Comprehensive Cancer Network (NCCN) Guidelines for AML discuss this alternative dosing for HDAC and do not recommend one over another. A prospective study found that there was no cumulative hematologic toxicity and no change in survival when comparing HDAC-123 to HDAC-135 5. As a result, Northside Hospital began using HDAC-123 in patients less than 60 years old for AML consolidation therapy. The purpose of this study was to assess the safety, efficacy, and health care resource consumption associated with HDAC-135 versus the condensed HDAC-123 regimen at Northside Hospital. Methods This single-center, retrospective study included patients with AML between 18 and 60 years old who received at least one cycle of HDAC-123 or HDAC-135 at Northside Hospital Atlanta's outpatient clinic from January 1, 2018 to January 1, 2023. The primary outcome was time to hematologic recovery of white blood cell (WBC), absolute neutrophil count (ANC), and platelets. Secondary endpoints were the amount of transfusions needed, incidence of documented infections, rate of hospital admission, and length of hospital stay. Results A total of 51 patients were included. Twenty one patients received a cumulative total of 39 cycles of HDAC-123 and 30 patients received a cumulative total of 57 cycles of HDAC-135. Overall, baseline characteristics were similar between groups although hemoglobin and hematocrit were significantly lower in the HDAC-123 group. In the HDAC-123 group compared to the HDAC-135 group, the median day of WBC recovery was 15 and 24 days, respectively (p &amp;lt; 0.001). The median day of ANC recovery was 16 and 28 days, respectively (p &amp;lt; 0.001). The median day of platelet recovery was 16 and 20 days, respectively (p &amp;lt; 0.001). Conclusion The results of this retrospective review support the findings of other studies. HDAC-123 demonstrated a significantly reduced time to WBC, ANC, and platelet recovery compared to HDAC-135. HDAC-123 was also was associated with lower rates of microbiologically documented infections but did require more RBC transfusions. HDAC-123 may be preferred over HDAC-135 for consolidation therapy in patients less than 60 years old.

Cost of Patients with Alzheimer's Disease in Spain According to Disease Severity.

Alzheimer's disease (AD) has been associated with great healthcare and non-healthcare resource consumption. The aim of this study was to estimate the burden of AD in Spain according to disease severity from a societal perspective. A self-administered questionnaire was designed by the researchers and completed by the informal caregivers of patients with AD, reporting data on themselves as caregivers and on the AD patients for whom they care. The patients' sociodemographic and clinical data, their healthcare and non-healthcare resource consumption in the previous 12 months, and the impact of the disease on labor productivity were compiled. Data collected on informal caregivers included sociodemographic data and the impact of caring for a person with AD on their quality of life and labor productivity. Costs were estimated by multiplying the number of consumed resources by their unit prices. The cost of informal care was assessed using the proxy good method, and labor productivity losses were estimated using the human capital method. Costs were estimated by disease severity and are presented per patient per year in 2021 euros (€). The study sample comprised 171 patients with AD aged 79.1 ± 7.4 years; 68.8% were female, time from diagnosis was 5.8 ± 4.1 years, diagnosis delay was 1.8 ± 2.3 years, and the mean Cumulative Illness Rating Scale-Geriatric (CIRS-G) total was score 8.2 ± 6.0. According to disease severity, 14% had mild cognitive impairment or mild AD, 43.9% moderate AD, and 42.1% severe AD. The average annual cost per patient was €42,336.4 in the most conservative scenario. The greatest proportion of this cost was attributed to direct non-healthcare costs (86%, €36,364.8), followed by direct healthcare costs (8.6%, €3647.1), social care costs (4.6%, €1957.1), and labor productivity losses (less than 1%, €367.4). Informal care was the highest cost item, representing 80% of direct non-healthcare costs and 69% of the total cost. The total direct non-healthcare cost and total cost were significantly higher in moderate to severe disease severities, compared to milder disease severity. AD poses a substantial burden on informal caregivers, the national healthcare system, and society at large. Early diagnosis and treatment to prevent disease progression could reduce this economic impact.

Should the Carbon Footprint of Care be Taken into Account When Choosing a Treatment for Lymphoma? a Case Application on Mantle Cell Lymphoma

OBJECTIVE While climate change represents the greatest threat of the current century on human health, the carbon footprint of the healthcare sector represents 7-10% of occidental countries green house gas (GHG) emissions. Purchases, mostly of drugs and medical devices, represent about 50% of emissions. Oncology and hematology are suspected to be particularly carbon intensive, as they require long term and frequent consumption of healthcare resources. Here, we estimate the carbon footprint associated with different therapeutic strategies (including chemo-free or high dose chemotherapy) in patients with Mantle Cell Lymphoma (MCL) and discuss their future health impacts. METHODS Standard immunochemotherapy based versus chemo-free strategies were compared both in 1) the ≤65 years old/fit and 2) in the &amp;gt;65 years old/unfit populations. Namely, we compared 1) immunochemotherapy induction (rituximab, dexamethasone, cytarabine, and a platinum derivative) followed by autologous stem-cell transplantation and 3-year rituximab maintenance (LyMa) to obinituzumab, ibrutinib, venetoclax combination (OIV), and 2) rituximab, bendamustine combination (RB) to rituximab, ibrutinib combination (RI). These treatment schemes were considered to have similar clinical efficacy in each sub-group of patients. Carbon footprints were estimated by considering drugs, medical devices, hospital stays, car journeys, medical biology and imaging consumption in the French context. Drug specific method (including production, packaging and transport with or without R&amp;D, sales, general and administrative costs), and non-drug specific methods using mean emission factors based on their costs (kgCO2eq/€ from the French Environment Agency (ADEME) and the US Environmentally-Extended Input-Output (USEEIO) models) were applied to estimate drug carbon footprints and were compared in a sensitivity analysis. Carbon footprints were translated into future disability adjusted life years (DALY, a metric similar to quality adjusted life years QALY) expected to be lost in the future using the ReCiPe 2016 model. RESULTS The carbon footprint of each therapeutic strategy varied from 6.6 to 69.1 tCO2eq. In each, &amp;gt;70% of the total carbon footprint was related to drug purchase. A larger fraction (10-70%) of the carbon footprint of biotherapies (rituximab, obinituzumab) and low-cost small molecules (cotrimoxazole, valaciclovir) is related to their production while it is smaller (&amp;lt;10%) for high-cost small molecules (ibrutinib, venetoclax) that require higher R&amp;D, sales, general and administrative costs. In the ≤65 years old/fit population, treating a patient with LyMa leads to the emission of 16.8 tCO2eq corresponding to an estimated 0.21 [95%CI 0.08-0.51] induced DALY. Treating a patient with OIV for 5 years leads to the emission of 69.1 t CO2eq (0.86 [0.35-2.09] DALY) whereas stopping the treatment at 2 years leads to the emission of 36.6 tCO2eq (0.46 [0.19-1.11] DALY). In the &amp;gt;65 years old/unfit population, treating a patient with RB leads to the emission of 6.6 tCO2eq (0.08 [0.03-0.2] DALY) while treating a patient with RI for 5 years leads to the emission of 41.1 tCO2eq (0.51 [0.21-1.25] DALY) whereas stopping the treatment at 2 years leads to the emission of 22.7 tCO2eq (0.28 [0.12-0.69] DALY). These estimates have to be taken with caution, as they are highly dependent on the method chosen. Using non-drug specific ADEME or USEEIO mean emission factors increase the carbon footprint of 2 year OIV from 36.6 tCO2eq to 164 tCO2eq and 313 tCO2eq, respectively. On the contrary, only accounting for drug production, packaging and transport diminishes its carbon footprint to 10.8 tCO2eq. Detailed discussion on the models, on the impact of R&amp;D and on the use of generic/biosimilar drugs will be provided at the congress. CONCLUSIONS Treatment of patients with MCL is associated with a significant carbon footprint. Integrating their carbon footprint in the therapeutic decisions (such as length of treatment) could lead to significant decreases in carbon emissions that could translate into less health damages to future generations. Drug specific carbon accounting methods seem more adapted than nonspecific ones to estimate the carbon footprint of high cost drugs . Future research is required to determine more precisely the carbon footprint of drugs and therapeutic strategies in patients with hematological malignancies.

Self-reported urinary incontinence in women is higher with increased age, lower educational level, lower income, number of comorbidities, and impairment of mental health. Results of a large, population-based, national survey in Portugal.

Urinary incontinence (UI) is a common condition in women. The aim of this study is to analyze women with self-reported UI, focusing on socio-demographic data, health-related conditions and comorbidities, and their impact on healthcare resources. We analyzed data from a population-based survey with a representative sample of Portuguese women aged ≥ 18years (n = 10,465). Women with self-reported symptoms of UI were distributed according to age, education level, and household income. The comparison of comorbidities and use of healthcare resources between the UI and non-UI groups was adjusted for age, education, and body mass index. We computed weighted prevalence and adjusted prevalence ratios with 95% confidence intervals using Poisson regression. Female UI prevalence was 9.9%, increasing with age (6.3% for 18- to 39-year-old, 40.8% for 75- to 85-year-old women). The prevalence decreased with education level (36.8% in women with no education, 4.6% in women with more than 12years of education) and household income (29.8% in the 2nd quintile of income, 9.9% in the 5th quintile). Women with UI had a higher level of comorbidities, especially cardiovascular, respiratory, and mental health disorders. UI was also associated with higher consumption of healthcare resources. UI is highly prevalent among Portuguese women. It increases with age, low education level, and low household income. The use of healthcare resources was higher, possibly related with associated comorbidities. Though obtained in a single European country, these data may be useful to design a comprehensive management of UI in other parts of the western world.

Estrategias de prevención de la insuficiencia cardiaca: enfoque integral en diferentes momentos de la enfermedad

Heart failure (HF) is considered a public health problem that affects a significant proportion of the population, especially older adults, leading to substantial morbidity, mortality, and high healthcare costs. Therefore, it becomes necessary to adopt prevention strategies from initial medical care and follow-up as a primary healthcare measure. With the aging population, the increase in cardiovascular risk factors in the general population, a higher survival rate after cardiovascular ischemic events, and an increase in life expectancy, the prevalence and incidence of HF is expected to rise in the upcoming years. The development of symptomatic heart failure is associated with a worsening prognosis despite treatment in accordance with current guidelines, making it a significant source of healthcare resource consumption. Hence, it is relevant to discuss the levels of HF prevention through interventions on risk factors, the disease's progression in those in the early stages of HF, as well as in those in the established and advanced stages of the disease to understand the impact of preventive measures on prognosis when implemented at different stages of the disease.

Profile, Healthcare Resource Consumption and Related Costs in ANCA-Associated Vasculitis Patients: A Real-World Analysis in Italy.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare autoimmune diseases triggering inflammation of small vessels. This real-world analysis was focused on the most common AAV forms, granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA), to describe patients' demographic and clinical characteristics, therapeutic management, disease progression, and the related economic burden. A retrospective analysis was conducted on administrative databases of a representative sample of Italian healthcare entities, covering approximately 12 million residents. Between January 2010 and December 2020, adult GPA patients were identified by payment waiver code or hospitalization discharge diagnosis, and MPA patients by payment waiver code with or without hospitalization discharge diagnosis. Clinical outcomes were evaluated through AAV-related hospitalizations, renal failure onset, and mortality. Economic analysis included healthcare resource utilization deriving from drugs, hospitalizations, and outpatient specialist services. The related mean direct costs year/patient were also calculated in patients stratified by presence/absence of glucocorticoid therapy and type of inclusion criterion (hospitalization/payment waiver code). Overall, 859 AAV patients were divided into GPA (n=713; 83%) and MPA (n=146; 17%) cohorts. Outcome indicators highlighted a clinically worse phenotype associated with GPA compared to MPA. Cost analysis during follow-up showed tendentially increased expenditures in glucocorticoid-treated patients versus untreated (overall AAV: €8728 vs. €7911; GPA: €9292 vs. €9143; MPA: €5967 vs. €2390), mainly driven by drugs (AAV: €2404 vs. €874; GPA: €2510 vs. €878; MPA: €1881 vs. €854)and hospitalizations. Among AAV forms, GPA resulted in a worse clinical picture, higher mortality, and increased costs. This is the first real-world pharmaco-economic analysis on AAV patients stratified by glucocorticoid use on disease management expenditures. In both GPA and MPA patients, glucocorticoid treatment resulted in higher healthcare costs, mostly attributable to medications, and then hospitalizations, confirming the clinical complexity and economic burden for management of patients with autoimmune diseases under chronic immunosuppression.

Comparison of healthcare costs before and after a STEMI: A French national health data system-based cohort study

BackgroundFew studies have investigated real-world healthcare costs following a myocardial infarction (MI) and, to our knowledge, none after an ST-elevation MI (STEMI) specifically. Producing such data is important in order to help evaluate the economic burden of STEMI, but also to feed economic evaluation models and eventually show the economic interest of reducing STEMI incidence. The aim of this study was to estimate the healthcare cost in the year preceding and the year following a STEMI in France, in order to estimate the surplus in healthcare resource consumption after a STEMI. MethodsThis study was conducted from the healthcare system perspective. The individual data from the HIBISCUS-STEMI cohort, which included patients with acute STEMI undergoing primary percutaneous coronary intervention, were matched with the French national health data system (Système National des Données de Santé, SNDS) using a probabilistic method. All expenses (in- and out-hospital) presented for reimbursement were taken into account to estimate a mean annual healthcare cost. ResultsA total 258 patients from the HIBISCUS-STEMI cohort were included in this economic study. The total mean healthcare cost was estimated at €3516 before the STEMI, and at €9980 after the STEMI. Hospitalizations constituted the largest cost item, 27 % of the total cost before the STEMI and 41.8 % after the STEMI (Δ + 338.8 %). Follow-up and rehabilitative care represented the second largest cost item (25.9 % before and 18 % after the STEMI, Δ + 96.7 %). Treatments represented 19.4 % of the total cost before the STEMI and 17.2 % after (Δ + 150.8 %). ConclusionsThis study shows a significant surplus (threefold) of healthcare resource consumption in the year following a STEMI compared to the year preceding the STEMI.

Percutaneous left atrial appendage closure in patients with gastrointestinal bleeding associated with oral anticoagulants

Introduction Percutaneous left atrial appendage closure (LAAC) has shown non-inferiority compared to oral anticoagulation (OAC) in preventing atrial fibrillation (AF)-related stroke. The objective of this study was to assess whether LAAC reduces the incidence of gastrointestinal bleeding (GIB) and/or chronic anaemia associated with OAC, as well as the consumption of healthcare resources. Materials and Methods Prospective, single-center study from 2016 to 2022, LAAC was performed. Clinical, analytical and healthcare resource consumption data were collected (endoscopies, blood transfusions, hospital admissions) prior and 6 months after LAAC. Results 43 patients were included, with an average age of 77.6 years. LAAC indication was upper, low and obscure GIB in 7 (16%), 8 (19%) and 28 patients (65%) respectively. GIB source was intestinal angiodysplasias in 27 patients (63%), occult origin in 12 (28%), and others (antral vascular ectasia, portal hypertension gastropathy, etc.) in 4 patients (9%). The mean number of packed red blood cells per patient before LAAC was (mean ± SD) 7.29 ± 5 vs 0.42 ± 1.3 (p < 0.001); endoscopic procedures were 4.34 ± 2.85 vs 0.27 ± 0.76 (p < 0.001); and hospitalizations 2.67 ± 2.14 vs 0.03 ± 0.17 (p < 0.001), with a hospital stay of 21.5 ± 17.3 vs 0.09 ± 0.5 days (p < 0.001) at 6 months post-intervention. Haemoglobin value increased from 8.1 ± 1.2g/dl to 12.4 ± 2.2g/dl (p < 0.001) at 6 months. No thromboembolic events were registered during a median follow-up of 16.6 months (range 6–65). Conclusions LAAC could be a safe and effective alternative to OAC in patients with non-valvular AF presenting significant, recurrent or potentially unresolvable GIB. This intervention also leads to important savings in the consumption of healthcare resources.

Real-World Evaluation of the Management, Treatment Pathways and Outcome of Melanoma Patients with Target Therapies in Italy.

In recent years, an increasing trend in the incidence of melanoma has been observed in Europe. Although early diagnosis and prompt intervention with local resection often results in positive outcomes, conversely, metastatic disease is still clinically challenging with a poor prognosis and a 5-year survival of around 30%. The growing awareness of melanoma biology and of antitumor immune responses has allowed the development of novel therapies targeted at specific molecular alterations occurring at advanced stages. This real-world analysis examined patients with melanoma in Italy, focusing on treatment patterns, outcome, time to discontinuation (TTD), and resource consumption. Two retrospective observational analyses were conducted for BRAF+ patients with metastatic melanoma and those with a positive sentinel lymph node biopsy in an adjuvant setting, retrieving data from the administrative databases covering 13.3 million residents. The cohort melanoma BRAF+ in metastatic setting comprised 729 patients with targeted therapy (TT) (n=671 with TT as first line and 79 as second line). Median TTD was 10.6months in first line and 8.1months in second line. Median overall survival from the start of first TT line was 27months and was 11.8months for patients with brain metastasis. In the dabrafenib plus trametinib patients, main healthcare resource consumption tended to increase in the presence of brain metastasis. The cohort with a positive sentinel lymph node biopsy under adjuvant therapy (n=289) included 8% patients treated with dabrafenib plus trametinib or tested BRAF+, 5% BRAF wild-type, and 10% under immunotherapy. Our findings provided an overview on TT utilization on metastatic melanoma patients in real clinical practice and highlighted an increased burden in brain metastatic patients.

Profile and quality of life of the adult population in good health according to the level of vitality: European NHWS cross sectional analysis

BackgroundThe World Health Organization’s definition of health highlights the importance of mental and physical wellbeing and not only disease state. However, lack of awareness on the burden of impaired vitality and its impact on the quality of life of the general healthy population prevents healthcare providers from delivering appropriate solutions and advice. This study aims to better characterize this population in Europe and identify the profile and the health reported outcomes associated with impaired vitality.MethodsThis retrospective observational study included National Health and Wellness Survey (NHWS) data collected in healthy participants aged 18–65 years from five European Union countries in 2018. Socio-demographic and lifestyle characteristics, comorbidities, attitudes towards healthcare systems, Patient Activation Measure, health-related quality of life outcomes (EQ-5D), and work productivity and activity impairment were analysed according to SF-12 vitality score subgroups (≥ 60, 50– < 60, 40– < 50, < 40).ResultsA total of 24,295 participants were enrolled in the main analysis. Being a female, younger, having a lower income and being obese or having sleep and mental disorders was associated with an increased risk of impaired vitality. This was associated with a higher consumption of healthcare resources along with having a weak patient-physician relationship. Participants who were disengaged in the self-management of their health were 2.6 times more likely to have a low level of vitality. For participants in the lowest vitality group, odds of mobility problems increased by 3.4, impairment of usual activity by 5.8, increased of pain and discomfort by 5.6 and depression and anxiety by 10.3, compared with participants in the highest vitality group. Also, odds of presenteeism increased by 3.7, overall work impairment by 3.4 and daily activity losses by 7.1.ConclusionEvidence-based trends facilitate the identification of a healthy population with impaired vitality in real-world practice. This study highlights the actual burden of low vitality on daily life activities, particularly on mental health and reduced work productivity. Additionally, our results underline the importance of self-engagement in the management of vitality impairment and highlights the need to implement strategies to address this public health concern in the affected population (HCP-patient communication, supplements, meditation).

Impact of COPD Exacerbations and Burden of Disease in Spain: AVOIDEX Study.

Chronic obstructive pulmonary disease (COPD) is characterized by high morbidity and mortality, with a considerable consumption of healthcare resources (HRU). This study aims to obtain real world evidence regarding the consequences of COPD exacerbations and to provide updated data on the burden of this disease and its treatment. A retrospective study in seven Spanish regions was conducted among COPD patients diagnosed between 1/01/2010 and 31/12/2017. The index date was the diagnosis of COPD and patients were followed until lost to follow-up, death or end of the study, whichever occurred first. Patients were classified by patient pattern (incident or prevalent), type and severity of exacerbations, and treatments prescribed. Demographic and clinical characteristics were evaluated, together with the incidence of exacerbations, comorbidities, and the use of HRU, during the baseline (12 months before the index date) and the follow-up periods by incident/prevalent and treatment prescribed. Mortality rate was also measured. The study included 34,557 patients with a mean age of 70 years (standard deviation: 12). The most frequent comorbidities were diabetes, osteoporosis, and anxiety. Most patients received inhaled corticosteroids (ICS) with long-acting beta agonists (LABA), or long-acting muscarinic agonists (LAMA), followed by LABA with LAMA. Incident patients (N=8229; 23.8%) had fewer exacerbations than prevalent patients (N=26328; 76.2%), 0.3 vs 1.2 exacerbations per 100 patient-years. All treatment patterns present a substantial disease burden, which seems to increase with the evolution of the disease (ie moving from initial treatments to combination therapies). The overall mortality rate was 40.2 deaths/1000 patient-years. General practitioner visits and tests were the HRU most frequently required. The frequency and severity of exacerbations positively correlated with the use of HRU. Despite receiving treatment, patients with COPD suffer a considerable burden mainly due to exacerbations and comorbidities, which require a substantial use of HRU.