Care Costs Research Articles

A Personal Health Record for patients with multiple sclerosis: A 2-year evaluation study

Abstract Background Multiple sclerosis (MS) is a chronic disease impacting the central nervous system, affecting 2.8 million people worldwide. Effective self-management is crucial for treating chronic diseases, including MS. Personal health records (PHRs) show promise in supporting self-management, potentially empowering patients and enhancing their engagement in treatment and health. However, implementation challenges persist. Objectives This study aimed to) assess the feasibility and usability of the PHR according to patients and healthcare professionals (HCPs), and 2) evaluate implementation determinants, and exploring preliminary effects on a range of outcomes related to the quality, efficiency, and costs of care, as well as health-related outcomes. Methods A mixed-methods study was conducted in a Dutch hospital. Quantitative data from 80 patients and 12 HCPs were collected via questionnaires at baseline (T0), after one (T1) and 2 years (T2). Focus group interview were conducted at T2 with 7 patients and 4 HCPs. Results Most patients never logged in during the first year and logged in a couple of times during the second year, with 15 minutes per log-in session. The HCPs mainly logged in a couple of times per year, averaging six minutes per session. Patients’ and HCPs’ usability and satisfaction scores were below average and moderate respectively. Various facilitators and barriers were identified, including knowledge gaps, staff capacity issues, and ICT obstacles. No significant differences were found in preliminary effects. Qualitative data highlighted benefits in terms of gaining insight into health data but revealed challenges with log-in issues and information retrieval. Conclusions Implementation challenges hindered PHR adoption. The evolving nature of PHRs requires ongoing evaluation and adaptation to optimize their potential benefits. Utilizing a participatory design approach and a dedicated implementation team could enhance adoption and maximize benefits. Key messages • A personal health record (PHR) for patients with MS was evaluated within the care setting of a Dutch hospital, demonstrating limited usability and moderate satisfaction. • Diverse obstacles impeded the adoption and uptake of the PHR, but potential solutions lie in continuous development with a participatory design approach and dedicated implementation team.

Duration, Cost, and Escalation of Care Events for Physical Therapy Management of Low Back Pain in Service Members With Limb Loss.

Physical therapy (PT) is recommended as a primary treatment for low back pain (LBP), a common and impactful musculoskeletal condition after limb loss. The purpose of this brief report is to report the duration and cost of PT care, and subsequent escalation of care events, for LBP in service members with and without limb loss. This was a retrospective cohort, descriptive study. Service members with and without limb loss (matched) who received PT for LBP at a military treatment facility from 2015 to 2017 were included. Duration of PT care, number of PT visits, and escalation of care events 1 year after PT were extracted from medical records. Escalation of care events was identified as epidural steroid injections, referrals to specialists (e.g., orthopedists, spine surgeons, and pain management), and LBP-related hospitalizations.LBP-related PT encounters were queried; duration of care, number of visits, and cost of care were quantified. Escalation of care events, including opioid prescription, epidural steroid injections, specialty referrals, and hospitalizations, were identified up to 1 year after PT care. The average course of PT care for LBP was 12.9 more visits, 48.7 days longer, and $764.50 more expensive in service members with limb loss (n = 16) vs. those without limb loss (n = 48). Higher rates of opioid prescriptions and specialty referrals were observed in service members with limb loss. This study suggests that service members with limb loss and LBP received higher quantities and longer durations of PT than those without limb loss, yielding a nearly 4 times higher cost of PT.

Predictors and Interdependence of Quality of Life in a Random Sample of Long-Term Young Breast Cancer Survivors and Their Biological Relatives.

Quality of life (QOL) among young breast cancer survivors (YBCS) is often worse than QOL of older breast cancer survivors or age-matched peers without a history of cancer. Families commonly support YBCS, particularly during treatment, but little is known about long-term YBCS and family member QOL. The purpose of this study was to identify demographic, clinical, and psychosocial predictors of physical and mental QOL in YBCS and biological relatives and investigate associations between their QOL (i.e., QOL interdependence). This secondary data analysis includes a random sample of long-term YBCS (≤ 45 years old at diagnosis) and up to two female relatives at baseline (post-treatment) and 18-month follow-up. The sample consists of 189 dyads (YBCS and one relative) and 121 triads (YBCS and two relatives). Actor-partner interdependence models (APIMs) were used to estimate the influence of YBCS's and relatives' demographic, clinical, and psychosocial factors on their own QOL (actor effects) and the other persons' QOL (partner effects). For YBCS and relatives, QOL at the baseline was associated with their QOL at 18-months. YBCS's perceived cancer risk was associated with their own and relatives' QOL. Older relatives' physical QOL at baseline was associated with younger relatives' physical QOL at follow-up. Age, race, marital status, years since diagnosis, education, out-of-pocket costs of care, routine sources of care, income, family support, fear of recurrence, anxiety, and depression were also significant predictors of QOL. Findings revealed independent and interdependent effects on QOL. These predictors point to potential targets of support for families. ClinicalTrials.gov ID: NCT01612338.

Timeliness of Documentation and Costs of Care in Adults Newly Diagnosed with CKD

Timeliness of Documentation and Costs of Care in Adults Newly Diagnosed with CKD

Understanding the Impact of the Kidney Care Choices (KCC) Model on Utilization and Cost of Care

Understanding the Impact of the Kidney Care Choices (KCC) Model on Utilization and Cost of Care

A multifunctional electronic dressing with textile-like structure for wound pressure monitoring and treatment

In the treatment of infected wounds in bedridden or lying chair patients with mobility problems, improper wound care can lead to wound deterioration, prolong disease pain, increase treatment and care costs, and bring heavier psychological, physical, and economic burdens to patients. In the process of wound recovery, patients with mobility problems mainly face the comprehensive problems of poor air permeability, wound pressure could not be monitored, wound infection and slow healing. Therefore, in the process of wound care for such patients, it is imperative to develop a gas permeable dressing that can monitor the patient’s wound compression status in real time and promote wound healing. Here, we developed a textile-shaped gel dressing with pressure-responsive properties. Polydopamine (PDA)-silver coated calcium phosphate nanoparticles (CPNPs）and vascular endothelial growth factor (VEGF) were introduced into the gel to give the gel good antibacterial and therapeutic effects, while enhancing the pressure resistance of the gel to meet the needs of wound pressure monitoring. The textured gel morphology greatly improves the gas permeability of the gel and further improves the pressure sensitivity of the gel. This multifunctional textile-like gel dressing provides a new strategy for the development of treatment monitoring integrated dressing and has broad application prospects.

Lichen Sclerosus is a high-cost diagnosis, compounded by comorbid conditions

Introduction and Objective: In the past decade, there have been significant advancements in understanding the etiology, molecular mechanisms, and best treatment options for lichen sclerosus (LS). However, to date, there is a lack of published data on the costs of care, associated comorbidities, and quality of life related to the condition. Therefore, this study aims to investigate the global costs associated with the treatment of LS using a contained insurance dataset. Methods: Deidentified 12-month data from 2022 to 2023 for a northeastern private insurer of teachers and municipal workers was queried to analyze costs associated with a diagnosis of LS (ICD-10 code L90.0). Comorbidities were also queried. Descriptive statistics were utilized to describe the population’s expenditures. Johns Hopkins Adjusted Clinical Groups (ACG) risk assessment was utilized to determine future costs. Z-tests were utilized to determine the differences in rates of comorbidities, and T-tests for differences in cost. Results: The database included all 4,306 members. Average annual cost per member was $9,280, average age was 35.5 years, behavioral health prevalence was 26%, and 53% were female. Cost for members with a behavioral health condition was $18,125 (2.0-fold) and $6,219 average cost for members without (0.7-fold). LS was present in 161 (3.7%) members, with average age of 42.0, prevalence of behavioral health 37%, and 62% were female. The presence of lichen sclerosus was associated with a 3.5-fold increase in average cost per member ($32,437 annually). For those with LS and a behavioral health condition, cost was $53,539 (5.8-fold average per member) compared to $19,901 (2.1-fold average plan cost) for those with LS and no BH condition. Median cost for those with LS was $8,755 compared to $2,056 for the entire cohort which was a significant difference (P < 0.0001). Incidence of behavioral health conditions, low back pain, obesity, chronic obstructive pulmonary disease, hyperlipidemia and hypertension were increased in the LS group versus the plan population (P < 0.01). Pharmaceutical expenditure for those with LS was a median of $267.58 compared to $94.80 average for the entire cohort (P < 0.0001). Conclusions: The presence of LS in this privately insured population significantly raises costs, exacerbated by elevated rates of mental health and other comorbidities, highlighting the need for comprehensive care addressing these complexities to improve health outcomes and reduce overall expenses.

The cost of caring: a scoping review of qualitative evidence on the financial wellbeing implications of unpaid care to older adults

The cost of caring: a scoping review of qualitative evidence on the financial wellbeing implications of unpaid care to older adults

Discharge Follow-Up of Patients in Primary Care Does Not Meet Their Care Needs: Results of a Longitudinal Multicentre Study.

Adequate coordination between healthcare levels has been proven to improve clinical indicators, care costs, and user satisfaction. This is more relevant to complex or vulnerable patients, who often require increased care. This study aims to evaluate the differences between hospital discharge follow-up indicators, including number of general practitioners' (GPs) and community nurses' (CNs) consultations, presentiality of consultations, type of first post-discharge consultation, and time between hospital discharge and first consultation. Vulnerable and non-vulnerable patients were compared. A longitudinal retrospective study was carried out in the north of Tenerife on the post-discharge care of patients discharged from the Canary Islands University Hospital (Spanish acronym HUC) between 1 January 2018 and 31 December 2022. The results obtained show deficiencies in the care provided to patients by primary care (PC) after being discharged from the hospital, including delayed first visits, low presentiality of those visits that were less frequent even with increased patient complexity, scarce first home visits to functionally impaired patients and delays in such visits, and a lack of priority visits to patients with increased follow-up needs. Addressing these deficiencies could help those most in need of care to receive PC, thus reducing inequalities and granting equal access to healthcare services in Spain.

Clinical Outcomes, Costs, and Value of Surgery Among Older Patients with Colon Cancer at US News and World Report Ranked Versus Unranked Hospitals.

US News and World Report (USNWR) hospital rankings influence patient choice of hospital, but their association with surgical outcomes remains ill-defined. We sought to characterize clinical outcomes and costs of surgery for colon cancer among USNWR top ranked and unranked hospitals. Using Medicare Standard Analytic Files, patients aged ≥65 years undergoing surgery for colon cancer were identified. Hospitals were categorized as 'ranked' or 'unranked' based on USNWR cancer hospital rankings. One-to-one matching was performed between patients treated at ranked and unranked hospitals, and clinical outcomes and costs of surgery were compared. Among 50 ranked and 2522 unranked hospitals, 13,650 patient pairs were compared. Overall, 30-day mortality was 2.13% in ranked hospitals versus 3.68% in unranked hospitals (p<0.0001), and the overall paired cost difference was $8159 (p<0.0001). As patient risk increased, 30-day mortality differences became larger, with the ranked hospitals having 30-day mortality of 7.59% versus 11.84% for unranked hospitals among the highest-risk patients (p<0.0001). Overall paired cost differences also increased with increasing patient risk, with cost of care being $72,229 for ranked hospitals versus $56,512 for unranked hospitals among the highest-risk patients (difference = $14,394; p=0.02). The difference in cost per 1% reduction in 30-day mortality was $9009 (95% confidence interval [CI] $6422-$11,597) for lowest-risk patients, which dropped to $3387 (95% CI $2656-$4119) for highest-risk patients (p<0.0001). Treatment at USNWR-ranked hospitals, particularly for higher-risk patients, was associated with better outcomes but higher-cost care. The benefit of being treated at highly ranked USNWR hospitals was most pronounced among high-risk patients.

‘ … You become a prisoner of your life’: A qualitative study exploring the experience of joint pain and accessing care in Hai, Tanzania

The increased prevalence of non-communicable diseases (NCDs) in recent years has led many Low- and Middle-Income Countries (LMICs), including Tanzania, to develop policies to manage their burden. Musculoskeletal (MSK) conditions, such as arthritis, account for 20% of all years lived with disability in LMICs, but the NCD strategies rarely address them. There is substantial research on the disruption MSK conditions cause to people's lives within High-Income Countries, but very little is known about the lived experiences in LMICs. We investigated the experience of MSK conditions in 48 in-depth qualitative interviews with participants from the Hai District in Tanzania, East Africa, all of whom had a MSK disorder (confirmed through clinical examination as part of a broader study). We found that loss of mobility and pain associated with MSK disorders severely limits people's everyday lives and livelihoods. Help from others, mainly those within a household, is necessary for most tasks and those with limited or no support experience particular problems. We found barriers to accessing care and treatment in the form of high direct and indirect (through travel) care costs within formal health services in Tanzania. We argue for increased attention to the growing problem of MSK disorders in LMICs and that this agenda should be driven by a patient-centred approach which designs services accessible to the target population and designed to recognise their embodied expertise.

Better Care, Same Cost - Reducing Unplanned Care for Multi-visit Patients: A Payer-Provider Model.

Many interventions implemented for multi-visit patients (MVP) have been developed to address patient-centric needs of these individuals and reduce unplanned care for ambulatory-sensitive conditions. More rigorous research is needed to better understand the impact of these interventions on changes in care utilization including unplanned care. To evaluate the impact of the Enhanced Care Program (ECP), a payer-provider collaborative model, on unplanned care use and cost of care. Using propensity methods, a comparison group was constructed using insurer membership files. Comparisons were performed using a difference-in-differences analysis. Patients enrolled in ECP through December 2019 were considered eligible for the study (n = 357). All patients had five or more ED visits in the past year or two or more inpatient hospitalizations in the past year prior to enrollment. ECP is a high-intensity outpatient intervention intended to reduce avoidable unplanned care such as ED visits and inpatient hospital stays through home visits, chronic/acute disease management, and intensive care coordination. The primary outcomes of interest were events per 100 members per year of ED use with return to home, unplanned inpatient and observational status admissions, and unplanned behavioral health inpatient admission, and cost of care per member per month. Overall total unplanned care encounters were significantly reduced with a difference-in-difference of 320 unplanned care encounters per 100 members per year in the intervention group (p < 0.05). The ECP group showed statistically significant decreases in costs of unplanned ED, unplanned observation admission, and unplanned inpatient behavioral medicine costs, but statistically significant increases in overall pharmacy costs and lab costs. Changes in total costs of care for the ECP group were not statistically different than the control group (p = 0.55). ECP showed significant reduction of unplanned care for MVP patients.

Complications and Healthcare Cost of Total Hip Arthroplasty in Patients with Depressive Disorder.

The purpose of this study was to determine whether the rates of (1) in-hospital lengths of stay (LOS), (2) readmissions, (3) medical complications, and (4) costs of care are higher for patients with depressive disorder (DD) undergoing primary total hip arthroplasty (THA) for treatment of femoral neck fractures (FNFs). A retrospective query of a national administrative claims database for patients undergoing primary THA from 2006 to 2014 was conducted. Patients with DD undergoing THA for treatment of FNF were 1:5 ratio propensity score matched to a cohort (DD=6,758, controls=33,708). Primary endpoints included LOS, 90-day medical complications, 90-day readmissions, and healthcare reimbursements. A P-value less than 0.05 was considered statistically significant. Longer LOS were observed for patients with DD compared to those without DD (5.6 days vs. 5.4 days, P<0.001). Similar readmission rates (29.9% vs. 25.0%, odds ratio [OR] 1.03, P=0.281) were observed between groups. The odds of 90-day medical complications were higher for patients with DD compared to control subjects (60.6% vs. 21.4%, OR 1.57, P<0.0001). Within the 90-day episode of care interval, patients with a history of DD incurred significantly higher healthcare expenditures ($21,382 vs. $19,781, P<0.001). Our findings showed longer LOS, higher odds of 90-day medical complications, and higher healthcare expenditures within the 90-day episode of care following a primary THA for treatment of FNF for patients with DD compared to the matched cohort. Thus, accordingly, patients with DD should receive counseling prior to undergoing surgery.

Antihypertensive deprescribing in frail long-term care residents (OptimizeBP): protocol for a prospective, randomised, open-label pragmatic trial

IntroductionAlthough antihypertensive medication use is common among frail older adults, observational studies in this population suggest blood pressure (BP) lowering may convey limited benefit and perhaps even harm. This protocol...

Cost-effectiveness analysis of proximal femoral nail versus bipolar hemiarthroplasty for femoral neck fracture

BackgroundHip fractures are a serious public health problem with high rates of morbidity, mortality, disability and care costs. The aim of the research was to perform cost effectiveness analysis of hip fracture treatments using proximal femoral nail and bipolar hemiarthroplasty surgeries.MethodsThe analysis was completed based on the perspectives of the paying institution and patient. A decision tree model was used to determine whether proximal femoral nail or bipolar arthroplasty was most cost effective for the management of a femoral neck fracture in this patient population.ResultsThe findings from the decision tree model suggested that ICERs for BHP were TRY 43,164.53 TL/QALY based on reimbursement and TRY 3,977.35 TL/QALY based on patient expenditures. Compared to the calculated threshold value of TRY 60.575 TL, we concluded BHP to be a cost-effective option. Moreover, all parameter changes yielded stable results on the one-way sensitivity analysis. When it comes to the probabilistic sensitivity analysis, BHP with specified threshold value was found to be cost-effective in all the comparisons. Currently available data the use of bipolar hemiarthroplasty as the more cost- effective treatment strategy in this specific population.ConclusionOverall, our findings showed HA as a cost-effective surgical technique at the calculated threshold in a population over 60 years of age. The impacts of HA on patients’ quality of life and costs are remarkable.

Real-World Evaluation of Treatment Pattern, Time to Next Treatment (TTNT), Health Care Resource Utilization (HCRU), and Cost of Care in Follicular Lymphoma (FL)

Real-World Evaluation of Treatment Pattern, Time to Next Treatment (TTNT), Health Care Resource Utilization (HCRU), and Cost of Care in Follicular Lymphoma (FL)

IBCL-516 Real-World Evaluation of Treatment Pattern, Time to Next Treatment (TTNT) Health Care Resource Utilization (HCRU), and Cost of Care in Follicular Lymphoma (FL)

IBCL-516 Real-World Evaluation of Treatment Pattern, Time to Next Treatment (TTNT) Health Care Resource Utilization (HCRU), and Cost of Care in Follicular Lymphoma (FL)

The incidence and prevalence of chronic wounds from a major plastic surgery service from a metropolitan city in south western Nigeria: A sixteen-year retrospective review

IntroductionChronic wound presents a burden to the patient due to the effect on their quality of life and cost of care. The exact prevalence is difficult to assess due to insufficient data, different study designs, and deferent study definitions of chronic wounds. There is limited data on the prevalence and the burden of chronic wound in our subregion. This study was therefore carried out to establish the burden of chronic wound in order to document a baseline data for monitoring progress, as well as provide information for advocacy on equitable distribution of resources for wound care. MethodThis was a retrospective review between January 2007 and December 2022. Data was analysed using SPSS. ResultA total of 866 patients with new chronic wounds were seen at an average of 54 cases per year. An average of 330 old and new chronic wounds are seen yearly. Chronic ulcers are developing at a rate of 1.2/1000 population, and the prevalence of chronic ulcer is 3.3/1000 population. Most patients were males (57.2 %), with a mean age of 41.7years ± 20.6. Post traumatic wound is the leading aetiology. Age correlates positively with aetiology, p=<0.001. Sickle cell and venous wounds are predominantly on the legs, p=<0.001. There is a correlation between increasing age and occurrence of chronic wound in the leg, p=<0.001. ConclusionPost traumatic wound is the leading cause of chronic wound in our subregion. There is a need to improve care of acute wounds to reduce the burden of chronic wounds.

Outpatient remdesivir treatment program for hospitalized patients with coronavirus disease-2019: Patient perceptions, process and economic impact

BackgroundRemdesivir is FDA-approved for the treatment of hospitalized patients with severe COVID-19. Many patients improve clinically to allow for hospital dismissal before completing the 5-day course. In a prior work, patients who continued remdesivir in an outpatient setting experienced better 28-day clinical outcomes. Here, we assessed patients' perspectives and the economic impact of this outpatient practice. MethodsHospitalized patients who received remdesivir for COVID-19 at Mayo Clinic, Rochester, from 11/6/2020 to 11/5/2021 and were dismissed to continue remdesivir in the outpatient setting were surveyed. The cost of care was compared between those who remained hospitalized versus those who were dismissed. Results93 (19.8 %) among 470 eligible patients responded to the electronic survey. Responders were older than non-responders. The majority (70.5 %) had symptoms resolved by the time of the survey. Ten (11.4 %) patients had persistent symptoms attributed to long COVID-19. The majority were satisfied with the quality of care (82.3 %) and overall experience (76.0 %) in the infusion clinic. After adjusting for gender, comorbidity score, and WHO severity scale, the predicted costs for the groups were $16,544 (inpatient) and $9,097 (outpatient) per patient (difference of $7,447; p < .01). An estimate of 1,077 hospital bed-days were made available to other patients as a result of this transition to outpatient. ConclusionAn outpatient remdesivir program that allowed for early dismissal was perceived favorably by patients. The program resulted in significant cost and resource savings, the latter in terms of the availability of hospital beds for other patients needing critical services.

Epidemiology and healthcare resource utilisation associated with Duchenne muscular dystrophy

BackgroundThis study aimed to describe the prevalence of Duchenne muscular dystrophy (DMD) and associated healthcare resource utilisation and costs from an England perspective.MethodsPatients with DMD were selected by recorded diagnoses from the Clinical Practice Research Datalink Aurum database and matched to non-DMD controls. The point prevalence of DMD (2020) was estimated. Primary care, inpatient, outpatient, and A&E department contacts and prescription items emanating from primary care were aggregated and their costs were compared between cases and controls. People with DMD were further classified by ambulatory phase and ventilation status and respective costs presented.ResultsThe point prevalence of DMD in 2020 was 3.23 per 100,0000 (95% confidence interval [CI] 2.82–3.63). There was a significant increase in contacts in all healthcare sectors compared to controls: primary care (incidence rate ratios (IRR) = 3.19 (95% CI 3.11–3.28)), inpatient admissions (IRR = 9.24 (95% CI 8.19–10.46)), outpatient appointments (IRR = 11.44 (95% CI 10.95–11.96)) and accident and emergency (IRR = 1.65 (1.52–1.81)). Overall, healthcare costs were almost ten-fold higher (adjusted cost ratio (ACR = 9.33 (95% CI 6.75–12.91)). Healthcare costs increased with the progression of DMD: £2816, on average, in the ambulatory phase; £5700 in the non-ambulatory without-ventilation, and £7634 in the non-ambulatory with ventilation phase.ConclusionDMD was associated with almost a ten-fold increase in healthcare costs. Worsening DMD status, as characterized by non-ambulation and requirement for ventilation, was associated with increased costs. However, the use of standard tariffs may underestimate the true financial burden of the condition. This assessment excluded social care and carer costs some of which will encompass medical needs and may contribute significantly to the cost burden of DMD.