Healthcare Utilization Costs Research Articles

Prescription drug, healthcare utilization, and lost earnings cost of behavioral interventions for fear of cancer recurrence in breast cancer survivors.

e24095 Background: Breast cancer survivors experience distress due to the fear of cancer recurrence. Acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) can treat the fear of cancer recurrence. However, no study has applied economic evaluation methods to estimate ACT and CBT behavioral intervention costs for breast cancer survivors. Methods: 384 adult stage I-IIIA breast cancer survivors with fear of cancer recurrence were randomly assigned to either the ACT (n = 128), CBT (n = 128), or enhanced usual care (EUC, n = 128) groups. Through micro-costing, we assessed the societal perspective cost of behavioral interventions using 2022 dollars. Per-capita drug costs, healthcare utilization, and lost productivity were calculated using participant survey data. Drug costs were estimated using Micromedex’s Red Book wholesale unit price. The 2022 Medicare Physician Fee Schedule for Indiana estimated healthcare utilization costs from outpatient, inpatient, and emergency visits. Lost productivity costs included work loss, productivity loss, and unpaid work loss, valued by Indiana's mean hourly wage. We assessed the cost differences between baseline (T1) and after the 6-week intervention period (T2). We evaluated between-group differences with Bonferroni's tests for each pairwise group comparison and within-group differences with a paired t-test at a p-value of < 0.05. Results: The mean total per-capita cost change from T1 to T2 in the ACT, CBT, and EUC groups was -$563, -$1622, and -$981, respectively (Table 1). This cost reduction stemmed from drug and healthcare utilization. There was no significant between-group difference in total cost at T1 or T2 and no significant between-group or within-group cost change from T1 to T2. Conclusions: Our cost estimates will be updated at 6 and 12 months of intervention and combined with changes in quality of life and mental health metrics to assess the cost-effectiveness of ACT and CBT for fear of breast cancer recurrence. Clinical trial information: NCT05364450 . [Table: see text]

Healthcare resource utilization and costs in patients with a newly confirmed diagnosis of lupus nephritis in the United States over a 5-year follow-up period

BackgroundWe aimed to describe healthcare resource utilization (HCRU) and healthcare costs in patients with newly confirmed lupus nephritis (LN) in the United States over a 5-year follow-up period.MethodsThis retrospective, longitudinal cohort study (GSK Study 214102) utilized administrative claims data to identify individuals with a newly confirmed diagnosis of LN between August 01, 2011, and July 31, 2018, based on LN-specific International Classification of Diseases diagnosis codes. Index was the date of first LN-related diagnosis code claim. HCRU, healthcare costs, and incidence of systemic lupus erythematosus (SLE) flares were reported annually among eligible patients with at least 5 years continuous enrollment post-index.ResultsOf 2,159 patients with a newly confirmed diagnosis of LN meeting inclusion and exclusion criteria, 335 had at least 5 years continuous enrollment post-index. HCRU was greatest in the first year post-LN diagnosis across all categories (inpatient admission, emergency room [ER] visits, ambulatory visits, and pharmacy use), and trended lower, though remained substantial, in the 5-year follow-up period. Among patients with LN and HCRU, the mean (standard deviation [SD]) number of ER visits and inpatient admissions were 3.7 (4.6) and 1.8 (1.5), respectively, in Year 1, which generally remained stable in Years 2–5; the mean (SD) number of ambulatory visits and pharmacy fills were 35.8 (25.1) and 62.9 (43.8), respectively, in Year 1, and remained similar for Years 2–5. Most patients (≥ 91.6%) had ≥ 1 SLE flare in each of the 5 years of follow-up. The proportion of patients who experienced a severe SLE flare was higher in Year 1 (31.6%) than subsequent years (14.3–18.5%). Total costs (medical and pharmacy; mean [SD]) were higher in Year 1 ($44,205 [71,532]) than subsequent years ($29,444 [52,310]–$32,222 [58,216]), driven mainly by inpatient admissions (Year 1: $21,181 [58,886]; subsequent years: $7,406 [23,331]–$9,389 [29,283]).ConclusionsPatients with a newly confirmed diagnosis of LN have substantial HCRU and healthcare costs, particularly in the year post-diagnosis, largely driven by inpatient costs. This highlights the need for improved disease management to prevent renal damage, improve patient outcomes, and reduce costs among patients with renal involvement.

Tobacco Exposures are Associated With Healthcare Utilization and Healthcare Costs in Pregnant Persons and Their Newborn Babies.

Identifying healthcare utilization and costs associated with active and passive smoking during pregnancy could help improve health management strategies. Data are from the Newborn Epigenetics STudy (NEST), a birth cohort enrolled from 2005 to 2011 in Durham and adjacent counties in North Carolina, United States. Participants included those for whom prenatal serum samples were assayed and for whom administrative data were obtainable (N = 1045). Zero-inflated poisson regression models were used to assess associations between cotinine, adjusted for covariates (eg, race and ethnicity, age at delivery, cohabitation status, and education), and health care utilization outcomes. Generalized linear regression models were used to estimate average total charges. Simulation models were conducted to determine the economic benefits of reducing secondhand smoke and smoking during pregnancy. Increasing levels of cotinine were positively associated with parent's number of emergency department (ED) visits (coefficient[b] = 0.0012, standard error [SE] = 0.0002; p < .001), the number of ICU hours (b = 0.0079, SE = 0.0025; p = .002), time spent in the ICU (b = 0.0238, SE = 0.0020, p < .001), and the number of OP visits (b = 0.0003, SE = 0.0001; p < .001). For infants, higher cotinine levels were associated with higher number of ED (b = 0.0012, SE = 0.0004; p = .005), ICU (b = 0.0050, SE = 0.001; p < .001), and OP (b = 0.0006, SE = 0.0002; p < .001) visits and longer time spent in the ED (b = 0.0025, SE = 0.0003; p < .001), ICU (b = 0.0005, SE = 0.0001; p < .001), and IP (b = 0.0020, SE = 0.0002; p < .001). Simulation results showed that a 5% reduction in smoking would correspond to a potential median cost savings of $150 533 from ED visits of parents and infants. Our findings highlight the importance of smoke exposure cessation during pregnancy to reduce health care utilization and costs for both parents and infants. This study reinforces the importance of reducing smoking and secondhand smoke exposure during pregnancy. Focusing on expanding cessation services to this group could help reduce morbidities observed within this population. Furthermore, there is the potential for healthcare cost savings to healthcare systems, especially for those with high delivery numbers. These cost savings are represented by potential reductions in ED, OP, and ICU hours and visits.

Health Insurance Matters: Insurance Coverage and Health Service Use Among Direct Care Workers in the United States

ObjectivesDirect care workers (DCWs) play a central role in supporting individuals' health and well-being across care settings, yet may face barriers to accessing health care themselves, particularly because of high rates of uninsurance. DesignAn observational study using pooled National Health Interview Survey (NHIS) data from 2014 to 2018. Setting and ParticipantsThe sample included survey respondents employed as direct care workers (DCWs), including hospital aides, home care workers, and nursing and residential care aides. MethodsWe used bivariate analyses to compare differences in health insurance coverage and health service use, defined in terms of access, utilization, and affordability, among DCWs by care setting. We then used stepwise multivariable logistic regression analyses to explore the associations between insurance coverage and health service use. ResultsThe sample included 1499 DCWs. Compared with hospital aides, home care workers and nursing and residential care aides had lower insurance coverage rates, were more likely to rely on Medicaid, and reported lower health care utilization and higher cost barriers. Health insurance through Medicaid was associated with the highest odds of health care access and utilization and the lowest odds of cost barriers for DCWs. Conclusions and ImplicationsGiven the projected 9.3 million total job openings in the direct care workforce from 2021 to 2031, policy and practice interventions designed to support DCWs' health are essential for ensuring continuous and quality care for older adults and people with disabilities and serious illness.

Cost of out-of-hospital cardiac arrest survivors compared with matched control groups

IntroductionSocietal costs of out-of-hospital cardiac arrest (OHCA) survivors may be extensive due to high health care utilization and sick leave. Knowledge of the costs of OHCA survivors may guide decision-makers to prioritize health resources. AimThe aims of the study were to evaluate the costs of OHCA survivors from a societal perspective, and to compare these costs to the costs of individuals with non-cardiac arrest myocardial infarction (MI) and individuals with no cardiac disease (non-CD). MethodsFrom the Danish OHCA Registers, survivors, with a cardiac arrest between 2005–2018 were identified. Each case was assigned one MI control and one non-CD control, matched on gender and age. Based on register data, costs of healthcare utilization, sick leave, vocational rehabilitation, disability pension and other social benefits one year before event and five years after, were estimated. ResultsIn total 5,646 OHCA survivors were identified with associated control groups. The mean costs for OHCA survivors during the 6-year period were €119,106 (95%CI: 116,297–121,916), with €83,472 (95%CI: 81,392–85,552) being healthcare costs. Mean costs of OHCA survivors were €49,132 higher than the MI-control group and €100,583 higher than the non-CD control group. ConclusionsTotal costs of OHCA survivors were considerably higher than costs of MI- and non-CD controls. Hospital costs were highest during the first year after event, and work inability during the second to fifth year with sick leave and later disability pension as main burdens.

Epidemiology and Healthcare Utilization in Pediatric Multiple Sclerosis and Neuromyelitis Optica: A Nationwide Population-Based Study in South Korea (2016-2020).

Pediatric multiple sclerosis (MS) and neuromyelitis optica (NMO) are rare acquired demyelinating syndrome with limited epidemiological data available, particularly in non-Western setting. This study aimed to demonstrate the epidemiology of pediatric MS and NMO in South Korea and to analyze of healthcare utilization and economic burden associated with these conditions. Using a nationwide population-based database from the Korean Health Insurance Review and Assessment Service database, we identified pediatric cases (age < 20 years) of MS and NMO from 2016 to 2020. We analyzed incidence, prevalence, healthcare utilization and medical costs. The study found low age-standardized incidence and prevalence rates for pediatric MS and NMO in South Korea. There was a marked disparity in healthcare utilization between urban and rural areas. Most healthcare interactions occurred in tertiary hospitals in urban settings, particularly in Seoul. The study also highlighted the substantial economic burden associated with the management of rare diseases, with annual variability in medical costs. Pediatric MS and NMO are extremely rare in South Korea, with significant regional disparity in healthcare utilization. The findings emphasize the need for targeted healthcare policies to improve access and reduce disparities, particularly for chronic and rare diseases requiring specialized care.

Abstract PO3-10-04: Palliative Care, Healthcare Utilization, and Disparities in Deceased Breast Cancer Patients in U.S. Hospitals: Analysis of National Inpatient Sample

Abstract Objective: This study aims to explore the characteristics of receiving palliative care and the patterns of utilization among breast cancer patients using a large-scale representative population-based sample. Methods: A retrospective analysis was performed on hospitalization data obtained from the National Inpatient Sample (NIS) covering the period from January 2016 to December 2019. The objective of the study was to investigate the characteristics and disparities associated with the provision of palliative care to breast cancer patients who had passed away, and to evaluate its impact on healthcare utilization as indicated by discounted hospital charges and length of stay (LOS). To achieve this, multivariate linear and logistic regression analyses were conducted, with the data stratified according to age, race, Charlson comorbidity index, insurance status, patient's zip code, and hospital characteristics. The classification and identification of the study population were performed using ICD-10 codes. Results: In the study, a total of 6,325 deceased breast cancer patients were identified from hospitalization records. Among them, 59.16% (n=3,742) received palliative care during their hospital stay. Multivariate linear regression analysis revealed that patients who received palliative care experienced a significant reduction in LOS by an average of 0.67 days (-1.246 to -0.898, p = 0.02) compared to those who did not receive palliative care. Furthermore, the palliative care group exhibited lower total charges, with a mean decrease of $21,392 (-28205 to -14578, p=0.00) compared to the non-palliative care group. Multivariate logistic regression analysis indicated that patients with black race had lower odds of receiving palliative care, while those with higher household income and patients admitted to larger hospitals had higher odds of receiving palliative care. Additionally, patients with private insurance had a higher probability of receiving palliative care compared to other insurance groups. Conclusion: Palliative care has demonstrated its benefits in reducing healthcare utilization costs and length of stay for breast cancer patients. However, disparities exist in access to palliative care, particularly among Black patients and those with lower household income. Larger hospitals and patients with private insurance show higher rates of palliative care utilization. Addressing these disparities is crucial to ensure equitable access, optimize patient outcomes, and improve resource allocation. Integrating palliative care into breast cancer hospitalizations requires targeted interventions. Further research and implementation efforts are needed to enhance the availability and delivery of palliative care services for all patients, regardless of their demographics or socioeconomic backgrounds. Health policymakers should consider these findings in their resource allocation decisions as palliative care plays an increasingly important role in cancer treatment. Odds of Receiving Palliative care among deceased breast cancer patients XX XX Length Of Stay and Total Charges XX XX Citation Format: Rushin Patel, Zalak Patel, Mrunal Patel, Darshil Patel, Afoma Onyechi, Akshit Chitkara, Femina Patel. Palliative Care, Healthcare Utilization, and Disparities in Deceased Breast Cancer Patients in U.S. Hospitals: Analysis of National Inpatient Sample [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-10-04.

Medication adherence star ratings measures, health care resource utilization, and cost.

To examine the association between missed CMS Star Ratings quality measures for medication adherence over 3 years for diabetes, hypertension, and hyperlipidemia medications (9 measures) and health care utilization and relative costs. Retrospective cohort study. The study examined eligible patients who qualified for the diabetes, statin, and renin-angiotensin system antagonist medication adherence measures in 2018, 2019, and 2020 and were continuously enrolled in a Medicare Advantage prescription drug plan from 2017 through 2021. Atotal of 103,900 patients were divided into 4 groups based on the number of adherence measures missed (3 medication classes over 3 years): (1) missed 0 measures, (2) missed 1measure, (3) missed 2 or 3 measures, and (4) missed 4 or more measures. To achieve a quality measure, patients had to meet the Pharmacy Quality Alliance 80% threshold of proportion of days covered during the calendar year. The mean age of the cohort was 71.1 years, and 49.9% were female. Compared with patients who missed 0 of 9 adherence measures, those who missed 1 measure, 2 or 3 measures, and 4 or more measures experienced 12% to 26%, 22% to 42%, and 24% to 50% increased risks, respectively, of all-cause and diabetes-related inpatient stays and all-cause and diabetes-related emergency department visits (all P values < .01). Additionally, patients who missed 1, 2 or 3, and 4 or more adherence measures experienced 14%, 19%, and 20% higher monthly medical costs, respectively. Missing Star Ratings quality measures for medication adherence was associated with an increased likelihood of health care resource utilization and increased costs for patients taking medications to treat diabetes, hypertension, and hyperlipidemia.

Preoperative Anemia Prior to Gynecologic Surgery is Associated With Increased Healthcare Costs

To compare healthcare utilization costs between anemic and non-anemic patients undergoing elective hysterectomy and myomectomy for benign indications from the date of surgery to 30-days postoperatively. Retrospective population-based cohort study. Single-payer publicly funded healthcare system in Ontario, Canada between 2013-2020. Adult women (≥18 years of age) who underwent elective hysterectomy or myomectomy (laparoscopic/laparotomy) for benign indications. Our exposure of interest was pre-operative anemia, defined as the most recent hemoglobin value <12g/dL on the complete blood count measured before the date of surgery. Our primary outcome was healthcare costs (total and disaggregated) from the perspective of the single-payer publicly funded healthcare system. Of the 59,270 patients in the cohort, 11,802 (19.9%) had pre-operative anemia. After propensity matching, standardized differences in all baseline characteristics (N=10,103 per group) were <0.10. In the matched cohort, the mean total healthcare cost per anemic patient was higher compared to cost per non-anemic patient ($6,134.88 ± $2,782.38 vs. $6,009.97 ± $2,423.27, p<0.001). Anemic patients, compared to non-anemic patients, had a higher mean difference in total healthcare cost of $124.91 per patient (95%CI $53.54 - $196.29) translating to an increased cost attributable to anemia of 2.08% (95%CI 0.89% - 3.28%, p<0.001). In a subgroup analysis of patients undergoing hysterectomy (N=9041), the cost was also significantly higher for anemic patients (mean difference per patient of $117.67, 95%CI $41.58 - $193.75). For those undergoing myomectomy (N=1062) the difference in cost was not statistically significant (mean difference $186.61, 95%CI -$17.42 - $390.65). Pre-operative anemia was associated with significantly increased healthcare resource utilization and costs for patients undergoing elective gynecologic surgery. Although the cost difference per case was modest, when extrapolated to the population level, this difference could result in substantially significant cost to the healthcare system, attributable to pre-operative anemia.

Is the QCI framework suited for monitoring outcomes and costs in a teaching hospital using value-based healthcare principles? A retrospective cohort study

ObjectivesThe objective is to develop a pragmatic framework, based on value-based healthcare principles, to monitor health outcomes per unit costs on an institutional level. Subsequently, we investigated the association between...

Gastric Alimetry® Testing and Healthcare Economic Analysis in Nausea and Vomiting Syndromes

BackgroundChronic nausea and vomiting syndromes (CNVS), gastroparesis and functional dyspepsia (FD) are complex disorders. Body Surface Gastric Mapping (BSGM), a new test of gastric function, using Gastric Alimetry® (Alimetry, New Zealand) may be useful for de-escalating healthcare utilisation. This study aimed to define healthcare costs and estimate health economic impacts of implementing this test in patients with chronic gastroduodenal symptoms.MethodsConsecutive patients at a tertiary referral centre evaluated with Gastric Alimetry were included. Frequency and cost data relating to medical investigations, hospital and outpatient presentations were evaluated. Costs of healthcare utilisation were calculated, and the potential cost savings of implementing Gastric Alimetry within a diagnostic decision-tree model were estimated.ResultsOverall, 31 consecutive patients (mean age 36.1 years; 83.9% female; predominant symptoms: nausea [83.9%], pain [61.3%], vomiting [67.7%] and bloating [35.5%]) completed Gastric Alimetry testing. Repeat gastroscopy and abdominal CT rates were 29% (8/28) and 85% (11/13), respectively. Gastric Alimetry testing identified spectral abnormalities in 45.2% of patients, and symptom profiling classified a further 29.1% of patients. Median annualised cost difference after test introduction was NZ$-12,032. Estimated reductions in investigation-related costs when incorporating Gastric Alimetry into the diagnostic workflow model were approximately NZ$1,300 per patient.ConclusionsHealthcare utilisation and confirmatory testing rates remain high in nausea and vomiting syndromes. This study presents real-world data, together with a decision-tree analysis, showing Gastric Alimetry can streamline clinical care pathways, resulting in reduced healthcare utilisation and cost.

Real-world treatment patterns and medical costs of prostate cancer patients in Switzerland – A claims data analysis

BackgroundProstate cancer (PC) is the most prevalent cancer in men in Switzerland. However, evidence on the real-world health care use of PC patients is scarce. The aim of this study is to describe health care utilization, treatment patterns, and medical costs in PC patients over a period of five years (2014–2018). MethodWe used routinely collected longitudinal individual-level claims data from a major provider of mandatory health insurance in Switzerland. Due to the lack of diagnostic coding in the claims data, we identified treated PC patients based on the treatments received. We described health care utilization and treatment pathways for patients with localized and metastatic PC. Costs were calculated from a health care system perspective. ResultsA total of 5591 PC patients met the inclusion criteria. Between 2014 and 2018, 1741 patients had outpatient radiotherapy for localized or metastatic PC and 1579 patients underwent radical prostatectomy. 3502 patients had an androgen deprivation therapy (ADT). 9.5% of these patients had a combination therapy with docetaxel, and 11.0% had a combination with abiraterone acetate. Docetaxel was the most commonly used chemotherapy (first-line; n = 413, 78.4% of all patients in chemotherapy). Total medical costs of PC in Switzerland were estimated at CHF 347 m (95% CI 323–372) in 2018. ConclusionMost PC patients in this study were identified based on the use of ADT. Medical costs of PC in Switzerland amounted to 0.45% of total health care spending in 2018. Treatment of metastatic PC accounted for about two thirds of spending.

P105 Healthcare use by women with Joint hypermobility and Ehlers-Danlos syndromes in Northumberland

Abstract Background/Aims In 2017, the diagnosis of Joint Hypermobility Syndrome was withdrawn and combined with hypermobile form of Ehlers-Danlos syndrome (hEDS). International Consortium on Ehlers-Danlos syndromes proposed new clinical criteria for hEDS and it recommended the concept of Hypermobility Spectrum Disorders (HSDs) when these criteria are not met. None of these three diagnostic terms JHS, HSD and hEDS fully explain the complexity of this heterogenous condition as the criteria do not take into account many co-morbidities such as anxiety, autism, ADHD, bowel and bladder issues, pregnancy complications, dysautonomia, allergies, and more. Health services are organised on the assumption that it is a benign musculoskeletal condition. Health burden from both joint hypermobility and the associated co-morbidities is not known as these patients are usually discharged after episodic care by most services that work in silos. Hence we sought to measure the pattern and costs of secondary NHS healthcare use in this patient group. Methods Using primary care clinical systems from 30 of 36 GP surgeries in Northumberland (approximately 300,000 total population), we determined the number of people with SNOMED codes synonymous to hypermobility; ‘Benign joint hypermobility’ or ‘Hypermobility syndrome’ was the code recorded in 90% of patients, with less than 10% coded as EDS or subtypes. For the purpose of statistical analysis, we grouped all under the newer diagnostic terms hEDS/HSD. RAIDR, the UK’s leading health intelligence tool, was used to compare secondary healthcare activity and costs between patients with and without hEDS/HSD in Northumberland. Results Prevalence of hEDS/HSD in GP records was 4.4 per 1000. Women of childbearing age are affected more than men (Male : Female ratio 3:1). Hospital admissions to General Medicine, Obstetrics &amp; Gynaecology, Surgery, and Orthopaedics were significantly higher in women with hEDS/HSD. Outpatient attendances to Rheumatology, Physiotherapy, Orthopaedics, and Obstetrics &amp; Gynaecology were also higher in women. Male patients with hEDS/HSD where younger than female patients; they presented more often to mental health, physiotherapy and paediatric outpatients compared to those without hEDS/HSD. The cost of secondary care treatment per patient with hEDS/HSD during 2022 was £932.37 compared to £731.88 in those without. For 1,302 patients with diagnoses synonymous with hEDS/HSD, the total additional cost for A&amp;E, Acute Inpatient and Outpatients in 2022 was £261,037. This excludes mental healthcare costs, although there were around twice the number of appointments. Conclusion We found a diagnosed prevalence of hEDS/HSD of one in 227 people in Northumberland. These patients have a significantly higher usage of secondary care, and thereby a higher average healthcare utilisation cost. The next steps would be expansion of this study, along with more in-depth analysis of reasons for secondary healthcare usage. This should inform commissioning of appropriate integrated health services for people with these complex conditions. Disclosure V. Saravanan: None. E. Reinhold: None. J. Demmler: None. I. Loughran: None. B. Frankel: None.

Economic Burden of Itch-Related Sleep Loss in Moderate-to-Severe Atopic Dermatitis in the United Kingdom.

Atopic dermatitis is associated with intense itch, which has been shown to cause sleep disruption that significantly impacts the lives of patients with atopic dermatitis. Despite this, little is known about its burden to the healthcare system and society. This study aimed to quantify the economic burden of itch-related sleep loss in moderate-to-severe atopic dermatitis in the UK. A literature-based decision-analytic model was developed from a healthcare payer and societal perspective. The model quantifies the economic burden by linking the severity of itch to the number of days of sleep disruption. The model captures the direct costs of healthcare resource utilization and treatment alongside the indirect costs of productivity loss from absenteeism and presenteeism at work over a 5-year time horizon. The patient population considered was patients aged ≥ 15 years with moderate-to-severe atopic dermatitis and itch-related sleep disruption. The model estimated that itch-related sleep disruption as a result of moderate-to-severe atopic dermatitis would affect an average of 821,142 people over the time horizon (2022 to 2026). This translates into an average net economic burden of £3.8 billion (£4687 per patient), with an average of 172 million days being affected by sleep disruption per year in the UK. The greatest contributor to the annual average net economic burden was productivity loss from absenteeism and presenteeism, each accounting for 34%. The direct costs (treatment costs and healthcare resource use) accounted for 32% of the net economic burden. The results showed a high and gradually increasing economic burden over the 5-year time horizon. Sleep disruption has a high economic burden and reducing itch may provide substantial direct and indirect savings. Quantifying the economic burden of itch-related sleep loss may provide support for analyses to inform public health policies for treatment of atopic dermatitis, particularly within the moderate-to-severe level.

Reduction in Diabetes-Related Hospitalizations and Medical Costs After Dexcom G6 Continuous Glucose Monitor Initiation in People with Type 2 Diabetes Using Intensive Insulin Therapy.

Some people with type 2 diabetes (T2D) require intensive insulin therapy to manage their diabetes. This can increase the risk of diabetes-related hospitalizations. We hypothesize that initiation of real-time continuous glucose monitoring (RT-CGM), which continuously measures a user's glucose values and provides threshold- and trend-based alerts, will reduce diabetes-related emergency department (ED) and inpatient hospitalizations and concomitant costs. A retrospective analysis of US healthcare claims data using Optum's de-identified Clinformatics® Data Mart database was performed. The cohort consisted of commercially insured, CGM-naïve individuals with T2D who initiated Dexcom G6 RT-CGM system between August 1, 2018, and March 31, 2021. Twelve months of continuous health plan enrollment before and after RT-CGM initiation was required to capture baseline and follow-up rates of diabetes-related hospitalizations and associated healthcare resource utilization (HCRU) costs. Analyses were performed for claims with a diabetes-related diagnosis code in either (1) any position or (2) first or second position on the claim. A total of 790 individuals met the inclusion criteria. The average age was 52.8 (10.5) [mean (SD)], 53.3% were male, and 76.3% were white. For claims with a diabetes-related diagnosis code in any position, the number of individuals with ≥ 1 ED visit decreased by 30.0% (p = 0.01) and with ≥ 1 inpatient visit decreased by 41.5% (p < 0.0001). The number of diabetes-related visits and average number of visits per person similarly decreased by at least 31.4%. Larger relative decreases were observed for claims with a diabetes-related diagnosis code in the first or second position on the claim. Total diabetes-related costs expressed as per-person-per-month (PPPM) decreased by $341 PPPM for any position and $330 PPPM for first or second position. Initiation of Dexcom G6 among people with T2D using intensive insulin therapy was associated with a significant reduction in diabetes-related ED and inpatient visits and related HCRU costs. Expanded use of RT-CGM could augment these benefits and result in further cost reductions.

Outpatient CAR T-Cell Therapy as Standard of Care: Current Perspectives and Considerations.

Chimeric antigen receptor T-cell therapy (CAR-T) has altered the treatment landscape of several hematologic malignancies. Until recently, most CAR-T infusions have been administered in the inpatient setting, due to their toxicity profile. However, the advent of new product constructs, as well as improved detection and management of adverse effects, have greatly increased the safety in administering these therapies. CAR-T indications continue to expand, and inpatient administration is associated with increased healthcare resource utilization and overall cost. Therefore, transitioning CAR-T administration to the outpatient setting has been of great interest in an effort to improve access, reduce financial burden, and improve patient satisfaction. Establishment of a successful outpatient CAR-T requires several components, including a multidisciplinary cellular therapy team and an outpatient center with appropriate clinical space and personnel. Additionally, clear criteria for outpatient administration eligibility and for inpatient admission with pathways for prompt toxicity evaluation and admission, and toxicity management guidelines should be implemented. Education about CAR-T therapy and its associated toxicities is imperative for all clinical staff, as well as patients and their caregivers. Finally, rigorous financial planning and close collaboration with payers to ensure equitable access, while effectively managing cost, are essential to program success and sustainability. This review provides a summary of currently published experiences, as well as expert opinion regarding implementation of an outpatient CAR-T program.

Health Care Utilization and Direct Costs Prior to Subspecialty Care in Children with Chronic Pain Compared with Other Chronic Childhood Diseases: A Cohort Study

ObjectivesTo understand the burden associated with pediatric chronic pain (CP) on the healthcare system compared with other costly chronic diseases prior to subspecialty care. Study designIn this retrospective cohort study, we assessed all-cause healthcare utilization and direct healthcare costs associated with pediatric CP (n=91) compared with juvenile-onset arthritis (JA, n=135), inflammatory bowel disease (IBD, n=90), type 1 or type 2 diabetes (T1D, n=475, T2D, n=289), anxiety (n=7,193) and controls (n=273) two and five years prior to patients entering subspecialty care in Manitoba, Canada. Linked data from physician encounters, emergency department visits, hospitalizations, and prescriptions were extracted from administrative databases. Differences in healthcare utilization and direct healthcare costs associated with CP versus the other conditions were tested using negative binomial and zero-inflated negative binomial regression models, respectively. ResultsAfter adjustment for age at diagnosis, sex, location of residence, and socioeconomic status, CP continued to be associated with the highest number of consulted physicians and subspecialists and the highest number of physician billings compared with all other conditions (p<0.01, respectively). CP was significantly associated with higher physician costs than JA, IBD, T1D, T2D, or controls (p<0.01, respectively); anxiety was associated with the highest physician and prescription costs among all cohorts (p<0.01, respectively). ConclusionCompared with chronic inflammatory and endocrinologic conditions, pediatric CP and anxiety were associated with substantial burden on the healthcare system prior to subspecialty care, suggesting a need to assess gaps and resources in the management of CP and mental health conditions in the primary care setting.

Association of household net worth with healthcare costs after radical cystectomy using real-world data.

Financial toxicity of bladder cancer care may influence how patients utilize healthcare resources, from emergency department (ED) encounters to office visits. We aim to examine whether greater household net worth (HHNW) confers differential access to healthcare resources after radical cystectomy (RC). This population-based cohort study examined the association between HHNW and healthcare utilization costs in the 90 days post-RC in commercially insured patients with bladder cancer. Costs accrued from the index hospitalization to 90 days after including health plan costs (HPC) and out-of-pocket costs (OPC). Multivariable logistic regression models were generated by encounter (acute inpatient, ED, outpatient, and office visit). A total of 141,903 patients were identified with HHNW categories near evenly distributed. Acute inpatient encounters incurred the greatest HPC and OPC. Office visits conferred the lowest HPC while ED visits had the lowest OPC. Black patients harbored increased odds of an acute inpatient encounter (OR 1.22, 95% CI 1.16-1.29) and ED encounter (OR 1.20, 95% CI 1.14-1.27) while Asian (OR 0.76, 95% CI 0.69-0.85) and Hispanic (OR 0.74, 95% CI 0.69-0.78, p < 0.001) patients had lower odds of an outpatient encounter, compared to White counterpart. Increasing HHNW was associated with decreasing odds of acute inpatient or ED encounters and greater odds of office visits. Lower HHNW conferred greater risk of costly inpatient encounters while greater HHNW had greater odds of less costly office visits, illustrating how financial flexibility fosters differences in healthcare utilization and lower costs. HHNW may serve as a proxy for financial flexibility and risk of financial hardship than income alone.

Trends in Physiotherapy Interventions and Medical Costs for Parkinson's Disease in South Korea, 2011-2020.

Physiotherapy (PT), which is an effective strategy for managing Parkinson's disease (PD), can influence health care utilization. We analyzed trends in health care utilization, PT interventions, and medical costs among patients with PD. Using data from the Korean National Health Insurance Service from 2011 to 2020, we analyzed the number of patients with PD and their health care utilization and assessed the odds ratio (OR) for receiving regular PTs. Over 10 years, 169,613 patients with PD were included in the analysis. The number of patients with PD increased annually from 49,417 in 2011 to 91,841 in 2020. The number of patients with PD receiving PT increased from 4,847 (9.81%) in 2011 to 13,163 (14.33%) in 2020, and the number of PT prescriptions increased from 81,220 in 2011 to 377,651 in 2019. Medical costs per patient with PD increased from 1,686 United States dollars (USD) in 2011 to 3,202 USD in 2020. The medical expenses for each patient with PD receiving PT increased from 6,582 USD in 2011 to 13,475 USD in 2020. Moreover, regular PTs were administered to 31,782 patients (18.74%) and were administered only through hospitalization. Those patients in their 50s with disabilities demonstrated a high OR for regular PTs, whereas those aged 80 years or older and residing outside of Seoul had a low OR. The PD burden increased in South Korea between 2011 and 2020, as did health care utilization and medical costs. A significant increase in medical expenses can be associated with increased PD incidence and PT interventions. Regular PT applications remain restricted and have barriers to access.

ANESTHESIA, PAIN MANAGEMENT, AND PUBLIC HEALTH: A REVIEW OF TECHNIQUES AND STRATEGIES FOR COINFECTED PATIENTS

Coinfections, particularly in patients with HIV, hepatitis C, or tuberculosis, present complex challenges in anesthesia and pain management. This review examines the unique considerations, techniques, and strategies for providing safe and effective care to this vulnerable population. It explores the impact of coinfections on anesthesia outcomes, the role of multidisciplinary approaches, and the implications for public health. Patients with coinfections often have complex medical histories, including comorbidities and compromised immune systems, which can affect their response to anesthesia and pain management. Strategies such as preoperative optimization, tailored anesthetic plans, and close monitoring are crucial to mitigate risks and ensure positive outcomes. Multidisciplinary collaboration is essential in managing coinfections, involving anesthesiologists, infectious disease specialists, surgeons, and other healthcare professionals. This approach allows for comprehensive care that addresses the unique needs and challenges of coinfected patients. Public health implications of coinfections in anesthesia and pain management are significant, as they can impact healthcare resource utilization, treatment outcomes, and overall healthcare costs. Understanding the challenges and implementing effective strategies can lead to improved public health outcomes for this vulnerable population. In conclusion, coinfections present complex challenges in anesthesia and pain management, requiring tailored approaches and multidisciplinary collaboration. By addressing these challenges, healthcare providers can improve outcomes for coinfected patients and contribute to better public health outcomes overall.&#x0D; Keywords: Anesthesia, Pain Management, Public Health, Techniques, Coinfected Patients.