Healthcare Resource Consumption Research Articles

The Impact of Payment Reform on Pediatric Craniofacial Fracture Care in Maryland.

Retrospective, quasi-experimental difference-in-differences investigation. Pediatric craniofacial fractures are often associated with substantial morbidity and consumption of healthcare resources. Maryland's All Payer Model (APM) represents a unique case study of the health economics surrounding pediatric craniofacial fractures. The APM implemented global hospital budgets to disincentivize low-value care and encourage preventive, community-based efforts. The objective of this study was to investigate how this reform has impacted pediatric craniofacial fracture care in Maryland. Children (≤18 years) receiving inpatient craniofacial fracture-related care in Maryland between January, 2009 through December, 2016 were investigated. New Jersey was used for comparison. Data were abstracted from the Kid's Inpatient Database (Healthcare Cost and Utilization Project). Between 2009-2016, 3,655 pediatric patients received inpatient care for craniofacial fractures in Maryland and New Jersey. Prior to APM implementation, around 20% of Maryland patients received care outside of urban teaching hospitals. After APM implementation, less than 6% of patients received care outside of urban teaching hospitals (p = 0.003). Implementation of the APM in Maryland also resulted in fewer pediatric craniofacial fracture admissions than New Jersey, though this only reached borderline significance (adjusted difference-in-differences estimate: -1.1 fewer admissions, 95% confidence interval: -2.1 to 0.0, p = 0.05). Inpatient costs for pediatric craniofacial care and mean did not change post-APM. Maryland's APM consolidated pediatric craniofacial fracture inpatient care at urban, teaching hospitals. Inpatient costs and lengths of stay did not change after policy implementation, but overall admission rates decreased. Such considerations are important when considering national expansion of global hospital budgeting.

Development of a predictive model for integrated medical and long-term care resource consumption based on health behaviour: application of healthcare big data of patients with circulatory diseases

BackgroundMedical costs and the burden associated with cardiovascular disease are on the rise. Therefore, to improve the overall economy and quality assessment of the healthcare system, we developed a predictive model of integrated healthcare resource consumption (Adherence Score for Healthcare Resource Outcome, ASHRO) that incorporates patient health behaviours, and examined its association with clinical outcomes.MethodsThis study used information from a large-scale database on health insurance claims, long-term care insurance, and health check-ups. Participants comprised patients who received inpatient medical care for diseases of the circulatory system (ICD-10 codes I00-I99). The predictive model used broadly defined composite adherence as the explanatory variable and medical and long-term care costs as the objective variable. Predictive models used random forest learning (AI: artificial intelligence) to adjust for predictors, and multiple regression analysis to construct ASHRO scores. The ability of discrimination and calibration of the prediction model were evaluated using the area under the curve and the Hosmer-Lemeshow test. We compared the overall mortality of the two ASHRO 50% cut-off groups adjusted for clinical risk factors by propensity score matching over a 48-month follow-up period.ResultsOverall, 48,456 patients were discharged from the hospital with cardiovascular disease (mean age, 68.3 ± 9.9 years; male, 61.9%). The broad adherence score classification, adjusted as an index of the predictive model by machine learning, was an index of eight: secondary prevention, rehabilitation intensity, guidance, proportion of days covered, overlapping outpatient visits/clinical laboratory and physiological tests, medical attendance, and generic drug rate. Multiple regression analysis showed an overall coefficient of determination of 0.313 (p < 0.001). Logistic regression analysis with cut-off values of 50% and 25%/75% for medical and long-term care costs showed that the overall coefficient of determination was statistically significant (p < 0.001). The score of ASHRO was associated with the incidence of all deaths between the two 50% cut-off groups (2% vs. 7%; p < 0.001).ConclusionsASHRO accurately predicted future integrated healthcare resource consumption and was associated with clinical outcomes. It can be a valuable tool for evaluating the economic usefulness of individual adherence behaviours and optimising clinical outcomes.

Healthy ageing for a healthy planet: do sustainable solutions exist?

Healthy ageing for a healthy planet: do sustainable solutions exist?

Treatment-Resistant Depression in a Real-World Setting: First Interim Analysis of Characteristics, Healthcare Resource Use, and Utility Values of the FondaMental Cohort.

Background: Major depressive disorder (MDD) is among the most common psychiatric disorders. One-third of patients are usually unresponsive to several lines of treatment. This study aimed to describe the FondaMental French cohort of patients with treatment-resistant depression (TRD) and to estimate utility and healthcare resource use outcomes. Methods: Patients with TRD were evaluated prospectively over four years (baseline, 6, 12, 18, 24, 36 and 48 months) in a real-world clinical setting. Interim analyses focused on the first two consecutive years. Four MDD-related states (major depressive episode (MDE), response, remission, recovery) were defined based on the MADRS (Montgomery–Åsberg depression rating scale) and other clinical events. Health status was assessed with the EuroQol 5 Dimensions 5 Level (EQ-5D-5L) questionnaire. Utility values were estimated as preference measures that the patients assigned to their overall health status. Results: This study was based on 252 patients with TRD. The mean utility value by health state was 0.41, 0.63, 0.80, and 0.90, for MDE, response, remission, and recovery, respectively. At baseline, 59% of patients had an MADRS score of at least 28. Their baseline average utility value was lower compared to the other patients (0.43 versus 0.58, p < 0.001). This significant difference persisted at the following visits. The rate of patients in MDEs having at least one hospitalisation for depression or other reasons than depression was generally higher than that in the other health states. Conclusion: This study documented patterns in healthcare resource consumption, quality of life, and other characteristics in patients with TRD, both globally and by health state and depression severity.

PSS7 Real-World Analysis of the Pharmaco-Utilization of Intravitreal Vascular Endothelial Growth Factor (VEGF) Inhibitors and Healthcare Costs Among Patients with WET Age-Related Macular Degeneration (WAMD) in Italy

To analyse the pharmaco-utilization of VEGF inhibitors and healthcare costs among wAMD-patients in Italian real-world settings. This retrospective observational analysis was based on administrative databases of 2 regions and 3 Local Health Units in Italy, accounting approximately 6million health-assisted individuals. Patients were included during January/2010—December/2017, if they were ≥50 years old and presented a prescription for VEGF inhibitors (aflibercept/pegaptanib/ranibizumab) and/or i)discharge diagnosis (ICD-9-CM-code=362.52) for wAMD or ii)injections of vitreous substitute (procedural/specialistic code=14.75). Patients with injections of vitreous substitute presenting diabetes diagnosis, dexamethasone intravitreal implant or diagnosis for other ophthalmic pathologies with indications for intravitreal treatments were excluded. Patients were followed-up from index-date (corresponding to the first match with inclusion criteria) to December 2018. Pharmaco-utilization and cost analyses were performed only on alive patients prescribed VEGF inhibitors. Preliminary results showed that 1,287 wAMD-patients were included (51.6% male). Mean age±SD was 73.4±9.8. Patients’ distribution by age decades was: 10.7% in 50-59 age decade, 21.9% in 60-69, 38.2% in 70-79,29.2% ≥80 years old. Mean follow-up length was 4.0±2.1 years; during this time, 153 (11.9%) patients died. VEGF inhibitors were prescribed to 795 patients: 204 (25.7%) aflibercept, 14 (1.8%) pegaptanib, 577 (72.6%) ranibizumab. Mean number of VEGF inhibitor prescriptions decreased during follow-up: 3.6±2.0 (4.0±1.9 aflibercept, 3.6±2.1 pegaptanib, 3.4±2.0 ranibizumab) during 1st year, 1.1±1.9 (0.9±1.5 aflibercept, 0.4±0.9 pegaptanib, 1.2±2.0 ranibizumab) for 2nd year and 0.9±1.8 (0.1±0.5 aflibercept, none pegaptanib, 1.0±1.9 ranibizumab) for 3rd year. During 1st year of follow-up, mean healthcare costs were €6,075.88 for aflibercept-users, €7,737.70 for pegaptanib-users and €5,894.80 for ranibizumab-users. 72.3% of treatment costs per patient prescribed VEGF inhibitor was related to VEGF inhibitor therapies. Treatment costs were €3,545.09(aflibercept-users), €3,212.92(pegaptanib-users), €3,446.13(ranibizumab-users). VEGF inhibitors prescriptions were observed to decrease over time, suggesting a trend of under-treatment among wAMD-patients analysed that could ultimately lead to the worsening of clinical outcomes and higher consumption of healthcare resources.

PCN188 Identification of Patients with Chronic Myeloid Leukemia (CML), Multiple Myeloma (MM) and Myelodysplastic Syndromes (MDS) Using Real-World DATA: Findings from the Prihta - Ematologia project

The “PRIHTA-EMATOLOGIA” project was developed in collaboration with Veneto Region (Italy) to analyse patients with hematologic malignancies using administrative databases. Within the project, the present study aims to identify patients with CML, MM and MDS, to analyse their prevalence and to evaluate healthcare resource consumption and related costs by using real-world data. This observational retrospective cohort study was carried out by matching administrative and laboratory data with medical records from Veneto Region. Patients were identified between 01/01/2014—28/02/2018 by ICD-9-CM codes (205.10-205.11 for CML; 203.0 for MM; 238.72-238.73-238.74-238.75 for MDS) and/or by ATC codes of drugs used for CML (imatinib; nilotinib; dasatinib; ponatinib; bosutinib), MM (lenalidomide; thalidomide; bortezomib; pomalidomide; carfilzomib; elotuzumab; daratumumab; melphalan; plerixafor), MDS (azacitidine; lenalidomide). Costs analysis included hospitalizations, drug dispensations, and specialist visits/diagnostic tests and was conducted with the National Health Service perspective. Overall, 118 CML patient, 240 MM patients and 130 MDS patients were identified. Mean age ±SD was 64.6±14.7 in the CML, 69.6±11.4 in the MM and 73.2±9.7 in the MDS cohorts. Proportions of male were 57.6%, 50.4% and 58.5% among CML, MM and MDS patients, respectively. Prevalence was calculated to be 124.7 (CML), 228.8 (MM), 120.3 (MDS) per 1,000,000 health-assisted individuals. In each disease, peak prevalence was found between ages 70-79 years. The total annual costs for the last year of study period were €20,042, €30,730 and €11,092 for CML, MM and MDS, respectively. Costs were driven mainly by antineoplastic drugs in CML (€16,517) and MM (€19,654) cohorts, and by hospitalizations (€3,691) in MDS cohort. Administrative databases represent readily available sources of real-world data valuable for healthcare research purposes. Our findings show that these databases could be reliable tools to provide information on the epidemiology and the economic burden of hematologic malignancies as CML, MM and MDS.

PCN179 Real-World Evidence on Metastatic or Relapsing Head and Neck Cancer

To evaluate the healthcare resource consumption and costs in charge of the Italian National Health System (NHS) of patients with relapsing or metastatic head and neck (H&N) cancer. From the ReS administrative database, adult patients with primary/secondary hospital diagnosis (ICD9-CM code) of H&N cancer were selected in 2015 (accrual period). At least a lymph node and/or distant metastasis diagnosis was searched in the same discharge form (index date for metastatic cancer). Incidence of metastasis was ascertained by the absence in two years before this index date. Chemo/radiotherapy in the accrual (index date for relapsing cancer) identified relapse events, if it was administered at least 6 months after the last treatment occurred in the previous period. Patients were characterized by gender, age and comorbidities of interest. Two-year hospitalizations, outpatient specialist care and healthcare costs were analysed, in the NHS perspective. One-year disease progression was identified as further chemo/radiotherapy use or newly hospital diagnosed metastasis. Out of >7 million inhabitants in 2015, 126 adults (2.0x100,000 inhabitants) had relapsing or metastatic H&N cancer. Males were the 89.7%. Mean age (±SD) was 63±11. Mainly men and elders had comorbidities: arterial hypertension was the most common one (45.2% of the cohort). During the last life month of died subjects, the NHS spent €2,668/patient. In the first follow-up year, mean overall cost per patient was €15,781, while €7,458 in the second one (n=79 subjects alive). Hospitalizations accounted for the highest expenditure. In 1-year follow-up, the disease progressed for 14 patients (11.1% of the cohort). On average, each subject with/without disease progression yearly costed €14,791/€15,904, considering the whole clinical and demographic picture. In the light of the evolving diagnostic and therapeutic options for subjects with H&N cancer, the real-world evidence at the healthcare management service can help optimize patient outcomes and clinician resources.

Medical Costs Associated with Severity of Chronic Kidney Disease in Type 2 Diabetes Mellitus in Singapore

This was a retrospective cross-sectional study to assess the impact of chronic kidney disease (CKD) and its severity in Type 2 diabetes mellitus (T2DM) on direct medical costs, and the effects of economic burden on CKD related complications in T2DM in Singapore. A total of 1,275 T2DM patients were recruited by the diabetes centre at Khoo Teck Puat Hospital from 2011-2014. CKD stages were classified based on improving global outcome (KDIGO) categories, namely the estimated glomerular filtration rate (eGFR) and albuminuria kidney disease. Medical costs were extracted from the hospital administrative database. CKD occurred in 57.3% of patients. The total mean cost ratio for CKD relative to non-CKD was 2.2 (P<0.001). Mean (median) baseline annual unadjusted costs were significantly higher with increasing CKD severity-S$1,523 (S$949), S$2,065 (S$1,198), S$3,502 (S$1,613), and S$5,328 (S$2,556) for low, moderate, high, and very high risk respectively (P<0.001). CKD (P<0.001), age at study entry (P=0.001), Malay ethnicity (P=0.035), duration of diabetes mellitus (DM; P<0.001), use of statins/fibrates (P=0.021), and modified Diabetes Complications Severity Index (DCSI) (P<0.001) were positively associated with mean annual direct medical costs in the univariate analysis. In the fully adjusted model, association with mean annual total costs persisted for CKD, CKD severity and modified DCSI. The presence and increased severity of CKD is significantly associated with higher direct medical costs in T2DM patients. Actively preventing the occurrence and progression in DM-induced CKD may significantly reduce healthcare resource consumption and healthcare costs.

Cost–utility analysis of second-line therapy with rituximab compared to tumour necrosis factor inhibitors in rheumatoid arthritis

Objective To compare direct costs and treatment utility associated with the second-line therapy with rituximab and tumour necrosis factor inhibitors (TNFis) (adalimumab, etanercept, and infliximab) in patients with Rheumatoid Arthritis (RA) using data from a prospective registry. Methods Health Assessment Questionnaire Disability Index (HAQ-DI) scores and RA-related healthcare resource utilization data (biologic agents and visits to rheumatologists) were extracted from a registry (Quebec, Canada) for patients with RA (n = 129) who had to discontinue a first-line TNFi and were treated with rituximab, adalimumab, etanercept, or infliximab as the second-line therapy between January 2007 and May 2016. A decision analytic model followed patients for 1 and 6 years. Treatment utility was measured as quality-adjusted life-years (QALYs) gained, which were calculated from HAQ-DI scores observed over the follow-up time. Quebec 2020 unit costs (Canadian Dollars, $) were used to value healthcare resource consumption. A probabilistic sensitivity analysis was performed with 10,000 Monte Carlo simulations to assess uncertainty around point-estimates of cost-utility. Results Over 1-year, rituximab and etanercept resulted in the effectiveness of 0.80 QALYs gained at the cost of $14,291and $18,880, respectively, and were dominant (i.e. associated with lower costs and more QALYs gained) compared to adalimumab (0.79 QALYs, $18,825) and infliximab (0.76 QALYs, $20,158). Over 6-years, rituximab (4.42 QALYs, $82,402) was dominant compared to adalimumab (4.30 QALYs, $101,420), etanercept (4.02 QALYs, $99,191), and infliximab (3.71 QALYs, $100,396). In the probabilistic analysis, rituximab was dominant over adalimumab, etanercept, and infliximab with the probability of 0.51, 0.62, and 0.65, respectively. Conclusion Real-world data revealed differences between alternative biologic agents used as the second-line therapy in terms of both treatment costs for the healthcare system and utility of treatment for patients. Therefore, new guidelines on the order of selecting and switching biologic agents should be explored.

Treatment patterns, health resource consumption, and costs of patients with migraine in an Italian real-world setting

Objective This study aimed to describe the demographic and clinical characteristics of migraineurs prescribed ≥1 migraine prophylactic therapy, and to analyze their therapeutic pathways, healthcare resource consumption, and related costs. Methods This retrospective analysis was based on administrative databases from two regions and three local health units in Italy. Adult patients with ≥1 discharge diagnosis for migraine or ≥1 prescription for migraine-specific drugs, or ≥1 emergency room visit for migraine from 1 January 2010 to 31 December 2016 were included if they had received ≥1 migraine prophylactic therapy between 1 January 2011 and 31 December 2015 (enrollment period). The first date of the last migraine prophylactic treatment was considered as the index date (ID). Patients were characterized 1-year prior ID and followed-up for 1 year afterwards. Results Of the 166,362 identified migraineurs, 32,794 (mean age: 45.9 ± 13.9 years, 19.2% male) who received migraine prophylaxis were included in the analysis. At ID, 31,629 patients had received 1 prophylactic treatment with antidepressants (51.2%), neuromodulators (28.1%), beta blockers (12.4%), other migraine preparations (7.8%), and botulinum toxin A (0.5%). Focusing on patients with one prophylactic treatment at ID, 85.4% did not have any previous therapeutic failures whereas 14.6% had ≥1 previous failure. During follow-up, 5% of patients made a therapeutic switch after a mean period of 103.4 ± 97.9 days. Total mean annual cost for patients receiving migraine prophylaxis was 1193.64€ during characterization and 1303.86€ during follow-up periods. Conclusion This real-world study gave insights on the characterization of migraineurs and patterns of prophylaxis utilization in Italian clinical settings, showing an underuse of prophylactic agents.

Consumption of healthcare resources in a bariatric surgery cohort

Consumption of healthcare resources in a bariatric surgery cohort

Delivering HDAC over 3 or 5 days as consolidation in AML impacts health care resource consumption but not outcome

AbstractPostremission treatment is crucial to prevent relapse in acute myeloid leukemia (AML). High-dose cytarabine delivered every 12 hours on days 1, 3, and 5 (HDAC-135) is the standard of care for younger adult patients with AML. Although this standard has been unsuccessfully challenged by other treatment regimens, including multiagent chemotherapy, the timing of HDAC administration has attracted little attention. Here, we retrospectively compared the safety, efficacy, and health care resource consumption associated with HDAC-135 and another standard, condensed HDAC-123 regimen, as consolidation treatment in younger AML patients in first complete response. This study included 221 patients (median age, 46.6 years; range, 18-60 years). HDAC-123 and HDAC-135 were used in 92 and 129 patients, respectively. Both regimens were associated with similar rates of relapse-free survival, cumulative incidence of relapse, nonrelapse mortality, and overall survival, including in core binding factor AML subgroup in which levels of minimal residual disease reduction were similar in both schedules. Hematological recovery times regarding neutrophils and platelets were significantly shorter in patients receiving HDAC-123, with an average difference of 3 to 4 days for each consolidation cycle. The total duration of hospitalization for the whole postremission program was shorter with HDAC-123 (32 days; interquartile ratio [IQR], 22.0,36.5) compared with HDAC-135 (41 days; IQR, 30.5, 50.0) (P< .0001). In conclusion, the condensed HDAC-123 regimen induced faster hematological recovery and therefore significantly reduced the length of hospital stay without affecting treatment response or outcome in younger AML patients.

Emergency department utilization following pediatric gastrostomy tube placement is driven by a small cohort of patients

PurposePediatric gastrostomy tubes (G-tubes) are associated with frequent postoperative problems and consumption of healthcare resources. We hypothesized that a small cohort of patients disproportionately drives healthcare resource utilization after G-tube insertion. This study aimed to characterize this population in order to implement evidence-based pathways to reduce healthcare utilization after G-tube insertion. MethodsAll surgically placed pediatric G-tubes at a quaternary care center between March 2011 and June 2018 were retrospectively reviewed. Healthcare utilization including radiographic studies, emergency department (ED) visits, hospital admissions, procedures, and diagnoses was abstracted. Encounter specific charges based on CPT codes were collected. Statistical analyses were performed with Mann Whitney U, Fisher's Exact Test, and multivariate nominal logistic regression. Institutional review board approval was obtained. ResultsDuring the study period, 189 patients underwent G-tube insertion; 24% of patients presented to the ED two or more times and accounted for 82% of ED visits. This cohort of high ED utilizers was more likely to present with G-tube dislodgement [both within the first three months (early) and after three months (late)], required more radiographic studies, and accrued significantly more charges compared to low ED utilizers. Multivariate analyses demonstrated high ED utilization was significantly associated with non-Caucasian race and the surgeon performing the procedure. ConclusionsAt our institution, a significant proportion of healthcare utilization following G-tube placement is consumed by a relatively small cohort of children. Future efforts will target patients with two or more G-tube related ED visits or an early G-tube dislodgement for additional education and integration with outpatient resources. Type of studyRetrospective study. Level of evidenceLevel II.

Management of prostate cancer patients during COVID-19 pandemic.

Prostate cancer patients’ management demands prioritization, adjustments, and a tailored approach during the unprecedented SARS-CoV-2 pandemic. Benefit of care from treatment must be carefully weighed against the potential of infection and morbidity from COVID-19. Furthermore, urologists need to be cognizant of their obligation for wise consumption of restricted healthcare resources and protection of the safety of their coworkers. Nonurgent in-person clinic visits should be postponed or conducted remotely via phone or teleconference. Prostate cancer screening, imaging, and biopsies may be suspended in general. Treatment may be safely deferred in low and intermediate risk patients. Surgery may be delayed in most high-risk patients and neoadjuvant ADT is generally not advocated prior to surgery. Initiation of long-term ADT coupled with EBRT subsequent to the pandemic may be favored as a feasible alternative in high-risk and very high-risk disease. In patients with cN1 disease, treatment within 6 weeks is advocated. Presurgery assessment should include testing for COVID-19 and preferably a chest imaging. In the presence of SARS-CoV-2 infection, surgery should be postponed whenever possible. All protective measurements suggested by national/international authorities must to be diligently followed during perioperative period. Strict precautions specific to laparoscopic/robotic surgery are required, considering the unproven but potential risk of aerosolization of SARS-CoV-2 virus and spillage with pneumoperitoneum. Regarding radiotherapy, shortest safe EBRT regimen should be favored and prophylactic whole pelvic RT and brachytherapy avoided. Chemotherapy should be avoided whenever possible.

Treatment Pattern Analysis and Health-care Resource Consumption on Patients with Psoriatic Arthritis or Ankylosing Spondylitis Treated with Biological Drugs in a Northern Italian Region.

PurposeTo analyze the treatment patterns of psoriatic arthritis (PSA) or ankylosing spondylitis (AS) patients under biological therapies and to evaluate in this population the health-care resource consumption and related costs.Patients and MethodsA retrospective analysis was performed on administrative databases of the Veneto region. Patients ≥18 years with at least one prescription of biological drugs and a diagnosis at any level for PSA or AS from January 1, 2011 to December 31, 2016 (inclusion period) were included. Index date (ID) was defined as date of first biological drug prescription during inclusion period. Patients were characterized the year before ID and followed-up for one year after ID. The drug utilization profile in terms of adherence, persistence and therapeutic regimen changes, and the health-care resource consumption was analyzed during follow-up.ResultsA total of 2602 patients were included: 1857 with PSA and 745 with AS. In the PSA cohort, 40.3% of patients were prescribed adalimumab, 35.6% etanercept, 8.0% golimumab, 7.5% infliximab, 5.6% ustekinumab and 3.0% certolizumab. Percentage of PSA patients adherent to treatment was higher among ustekinumab patients (91.3%) and lower among etanercept users (54.3%). Persistence ranged from 53.2% (infliximab) to 70.3% (etanercept). Regarding AS cohort, 45.5% of patients were prescribed adalimumab, 26% etanercept, 17.3% infliximab, 9.7% golimumab and 1.5% certolizumab. Adherence ranged from 46.9% (etanercept) to 90.9% (certolizumab) and persistence from 62.8% (adalimumab) to 81.8% (certolizumab). Mean annual health-care costs (including costs for drug treatment, diagnostic services, specialist visits and hospital admissions) ranged from €9727 (certolizumab) to €14,994 (ustekinumab) among PSA patients and from €9875 (infliximab) to €12,991 (golimumab) among AS patients.ConclusionThis study in Veneto region gave a picture of biological treatment patterns among PSA and AS patients in a real-world setting. Our findings showed the high degree of variability concerning utilization of each biological drug and provided insight on the economic burden of both diseases.

ASO Author Reflections: Surveillance After Resection of Retroperitoneal Well-Differentiated Liposarcoma: A Balancing Act Between Earlier Recurrence Detection, Patient Anxiety, and Health Care Resource Expenditure.

ASO Author Reflections: Surveillance After Resection of Retroperitoneal Well-Differentiated Liposarcoma: A Balancing Act Between Earlier Recurrence Detection, Patient Anxiety, and Health Care Resource Expenditure.

The challenge of sustainability in healthcare systems: economic and organizational impact of subcutaneous formulations for rituximab and trastuzumab in onco-hematology

ABSTRACT Background: This study estimated the economic and organisational impact of using subcutaneous injection (SC) formulations of two monoclonal antibodies (rituximab and trastuzumab) in patients with non-Hodgkin's lymphoma (NHL) and HER2 + breast cancer (BC). Methods: The database of the Unit of Oncology and Haematology of the IRST of Meldola was used. The analysis was structured as follows: i) measurement of the volume of Day-Hospital activity; ii) identification of activities and time to complete the administration; iii) estimate the mean cost of an SC or IV (intravenous infusion); iv) estimate the impact of SC formulations on the volumes of activities provided; v) estimate the social impact of SC or IV formulations. Results: The use of an SC formulation was associated a significant reduction in the time that the patient takes to complete the administration (trastuzumab -1 hr 18 min; rituximab -2 hr 24 min) and in consumption of healthcare resources and related costs for trastuzumab (IV: € 1781; SC: € 1701) and rituximab (IV: € 2116; SC: € 1941). Conclusion: The adoption of the SC formulation for rituximab and trastuzumab can generate a greater value for both the national healthcare system and the patient compared to an IV formulation.

Characterization of Beta-lactamases among MDR gram negative bacilli from a tertiary care hospital in central Kerala

Infections and mortality associated with multidrug- resistant Gram-negative bacilli (MDR GNB) have dramatically increased in all parts of the world. The present study was conducted to screen the burden of Gram negative multidrug resistance in our tertiary care hospital and to pave a stepping stone for the infection control team to tackle the problem effectively. A total of 300 non-repetitive MDR GNB isolates from the specimens received in our diagnostic Microbiology lab oratory for a period of one year were screened phenotypically for Extended spectrum β -lactamases (ESBL), AmpC betalactamases and Carbapenemases. Colistin and Tigecycline susceptibility E-test were also performed randomly on some carbapenemase producing organisms. Among the 300 MDR GNB isolates, ESBL and AmpC producers were 56% and 24% respectively. E.coli was the most common organism with ESBL (73%) and AmpC (46%) resistance mechanisms. Carbapenemase producers were 14.6% with predominant isolate being Acinetobacter spp (40%). Among the risk factors, 13% patients had immunosuppressive conditions like diabetes, 31% had insitu urinary catheters, 57.7% and 29.4% had prior antibiotic usage and hospitalisations respectively. Twenty five carbapenemase producing MDR GNB tested for Colistin MIC were in the susceptible range. 71% of Acinetobacter spp tested for Tigecycline showed resistant MIC values. Multidrug resistance has a significant adverse impact on clinical outcomes of patients &amp; leads to higher costs due to consumption of health-care resources. Adherence to simple measures like hand hygiene &amp; careful attention to barrier precautions can help in preventing the spread of these infections to a greater extent.

Healthcare resource utilization in patients on lipid-lowering therapies outside Western Europe and North America: findings of the cross-sectional observational International ChoLesterol management Practice Study (ICLPS)

BackgroundFew recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America.MethodsThis analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries.ResultsThe proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption.Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p <0.05).ConclusionsHealthcare resource consumption associated with adverse clinical outcomes was observed in patients on stable LLT in countries outside Western Europe and North America, particularly those at very-high cardiovascular risk and those who were difficult to treat.

Prognostic indicators for poor outcomes in low back pain patients consulted in primary care

BackgroundNon-specific low back pain (NSLBP) is the most prevalent musculoskeletal condition in western countries and is associated with persistent disability and high consumption of health care resources. NSLBP patients first seek primary health care services but the outcomes are often uncertain. This study aimed to examine the clinical course of the outcomes and to identify prognostic indicators for poor outcomes in NSLBP patients who consulted primary care.MethodsA prospective cohort study of 115 patients seeking treatment for NSLBP in primary care was conducted. Participants were consecutively recruited by their General Practitioners (GPs) and then assessed at baseline and 2 and 6 months later. Baseline assessment included socio-demographic and clinical data, psychosocial factors, pain, disability, and health related quality of life (HRQoL). Pain, disability, HRQoL and global perception of change were also assessed at 2 and 6-months’ follow-up. In addition, information regarding the GP’ practice was collected. Poor outcomes were determined according to the cut-off point used to define a persistent disabling condition and the minimal important change established for disability, pain and for global perception of change. The relationship between variables on baseline and poor outcomes was modulated through binary logistic regression analysis. The significance of associations was evaluated at ≤ 0.05 p-value with 95% confidence intervals (CI) and adjusted odds ratios (AOR).Results110 (94.8%) and 104 (89.7%) participants completed the follow-up assessment at 2 and 6 months, respectively. The mean age (±SD) was 48.06 ± 11.41, with 53.9%, (N = 62) reporting an acute presentation of NSLBP. Six months after GP consultation, 53.8% (N = 56) of the participants reported a persistent disabling condition. An “LBP episode of less than 12 weeks” [AOR: 0.26; 95% CI (0.10, 0.65); AOR: 0.34; 95% CI (0.14, 0.81); AOR: 0.21; 95% CI (0.09, 0.53)],”maladaptive psychosocial factors” [AOR: 2.06; 95% CI (1.40, 3.04); AOR: 1.82; 95% CI (1.27, 2.59); AOR: 1.72; 95% CI (1.20, 2.47)] were significantly associated with poor outcomes on disability, pain and global perception of change, respectively. Besides these factors, being employed reduces the chances of poor outcomes on disability [AOR 0.31; 95% CI (0.11, 0.92)].ConclusionsA large proportion of LBP patients seeking primary health care reported poor outcomes 6 months after GP consultation. Patients who report chronic LBP, maladaptive psychosocial factors and are unemployed have a significant increase in the risk of poor outcome. These findings suggest the need of implementing effective models of care able to provide early screening and appropriate treatment to those at greatest risk of a poor outcome.Trial registrationCurrent Controlled Trials NCT04046874 (August 6, 2019). Retrospectively registered.