Cost Of Health Care Services Research Articles

Risk assessments and structured care interventions for prevention of foot ulceration in diabetes: development and validation of a prognostic model.

Diabetes-related foot ulcers give rise to considerable morbidity, generate a high monetary cost for health and social care services and precede the majority of diabetes-related lower extremity amputations. There are many clinical prediction rules in existence to assess risk of foot ulceration but few have been subject to validation. Our objectives were to produce an evidence-based clinical pathway for risk assessment and management of the foot in people with diabetes mellitus to estimate cost-effective monitoring intervals and to perform cost-effectiveness analyses and a value-of-information analysis. We developed and validated a prognostic model using predictive modelling, calibration and discrimination techniques. An overview of systematic reviews already completed was followed by a review of randomised controlled trials of interventions to prevent foot ulceration in diabetes mellitus. A review of the health economic literature was followed by the construction of an economic model, an analysis of the transitional probability of moving from one foot risk state to another, an assessment of cost-effectiveness and a value-of-information analysis. The effects of simple and complex interventions and different monitoring intervals for the clinical prediction rules were evaluated. The main outcome was the incidence of foot ulceration. We compared the new clinical prediction rules in conjunction with the most effective preventative interventions at different monitoring intervals with a 'treat-all' strategy. Data from an electronic health record for 26,154 people with diabetes mellitus in one Scottish health board were used to estimate the monitoring interval. The Prediction Of Diabetic foot UlcerationS (PODUS) data set was used to develop and validate the clinical prediction rule. We searched for eligible randomised controlled trials of interventions using search strategies created for Ovid® (Wolters Kluwer, Alphen aan den Rijn, the Netherlands), MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Randomised controlled trials in progress were identified via the International Standard Randomised Controlled Trial Number Registry and systematic reviews were identified via PROSPERO. Databases were searched from inception to February 2019. The clinical prediction rule was found to accurately assess the risk of foot ulceration. Digital infrared thermometry, complex interventions and therapeutic footwear with offloading devices were found to be effective in preventing foot ulcers. The risk of developing a foot ulcer did not change over time for most people. We found that interventions to prevent foot ulceration may be cost-effective but there is uncertainty about this. Digital infrared thermometry and therapeutic footwear with offloading devices may be cost-effective when used to treat all people with diabetes mellitus regardless of their ulcer risk. The threats to the validity of the results in some randomised controlled trials in the review and the large number of missing data in the electronic health record mean that there is uncertainty in our estimates. There is evidence that interventions to prevent foot ulceration are effective but it is not clear who would benefit most from receiving the interventions. The ulceration risk does not change over an 8-year period for most people with diabetes mellitus. A change in the monitoring interval from annually to every 2 years for those at low risk would be acceptable. Improving the completeness of electronic health records and sharing data would help improve our knowledge about the most clinically effective and cost-effective approaches to prevent foot ulceration in diabetes mellitus. This study is registered as PROSPERO CRD42016052324. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 62. See the NIHR Journals Library website for further project information.

Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation

BackgroundEthiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system’s objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies’ employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies’ employees in northwest Ethiopia.MethodsAn institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies’ employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance.ResultsOverall, 32% (95% CI: 27.7–36.2) of the government-owned companies’ employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69–27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12–2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39–0.92), work experience (AOR: 0.49, 95% CI: 0.26–0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04–0.71) were significantly associated with acceptance of SHI among government-owned companies’ employees.ConclusionsOne-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.

Combining Microfinance and Health in Reducing Poverty-Driven Healthcare Costs: Evidence From the Philippines.

The role of microfinance in alleviating poverty and poor health is significant. Its health programs have been shown to improve healthcare utilization and strengthen a healthcare system. In the Philippines, microfinance's widespread presence is seen as instrumental in achieving the objectives of Healthy Philippines 2022, particularly in reducing poverty-driven healthcare costs. However, little is known on how microfinance can reduce the cost of healthcare services and treatment. Also, few studies that consider the practice of integrated microfinance and health programs in the Philippines have been seen. Secondary data was used to explore the structure and function of microfinance and health initiatives and their influence in mitigating healthcare costs. A review criterion was developed to examine the data using the three key elements identified in Ruducha and Jadhav's framework: organisational arrangement, health products and health outcomes. Findings revealed that most health initiatives are delivered through partnerships and collaboration, could favour a reduction in healthcare costs and protection from out-of-pocket health expenditure. They are designed to operate in three structures—subsidised or outreach, microinsurance and health loans, and patronage refunds. The cooperative's business venture providing pharmaceuticals facilitated access to affordable medicine and offered its members financial viability. Health loans and microinsurance also offered healthcare cost reductions; however, uptakes are low. The study found no data to assess the output of the completed health initiatives. More studies that will evaluate the integrated MFI health initiatives are recommended to further identify gaps, outcomes, or impacts of the program.

Ambulatory Health Care Service Use and Costs Among Commercially Insured US Adults With Congenital Heart Disease

Ambulatory Health Care Service Use and Costs Among Commercially Insured US Adults With Congenital Heart Disease

Producing insecurity: Healthcare access, health insurance, and wellbeing among American Indian elders.

Although health care is a treaty-guaranteed right for members of federally recognized tribes, decades of research describe persistent disparities in health and access to health services for American Indians. Despite gains in insurance enrollment after the passage of the 2010 Affordable Care Act, underfunding of the Indian Health Service and national debate over the new health law contributes to insecurity, especially among the majority of American Indians aged 55 and older who rely on public insurance. We consider the production of insecurity surrounding health care for American Indian elders, analyzing its pragmatic and affective consequences. Between June 2016 and March 2017, we conducted 96 quantitative surveys and in-depth qualitive interviews with American Indian elders aged 55 and older in two states in the U.S. Southwest. Interviews were recorded, professionally transcribed, and analyzed iteratively using open and focused coding. We found that elders consistently shared discourses of doubt, fear, and uncertainty that centered on: 1) interactions with healthcare providers and facilities, especially the IHS; 2) calculations regarding health insurance and the potential costs of healthcare services; and 3) dynamics at the national level around health policy, particularly for American Indians. We argue that persistent perceptions of healthcare insecurity present a major barrier to wellbeing that remains unaddressed by existing health policy interventions for this population, which focus predominately on individual-level knowledge and behavior.

Biomedical Manufacturing: A Review of the Emerging Research and Applications

Abstract Biomedical manufacturing, which has seen rapid growth over the past decade, is an emerging research area for the manufacturing community. This growth trajectory is exemplified and coupled with a broadening scope of applications with biomedical manufacturing technology, including advancements in the safety, quality, cost, efficiency, and speed of healthcare service and research. The goal of this topical review is to offer a comprehensive survey of the current state-of-the-art in biomedical manufacturing and to summarize existing opportunities and challenges as a basis to guide future research activities in this emerging area. This article categorizes the key manufacturing process types that are currently being leveraged for the biomedical field of use, including machining, joining, additive manufacturing, and micro-/multi-scale manufacturing. For each of these manufacturing processes, notable applications are cited and discussed to provide insights and perspectives into how manufacturing processes can play an integral role in creating new and more sophisticated healthcare services and products.

Income level and healthcare utilization in Calabar Metropolis of Cross River State, Nigeria

Throughout the world, socio-economic status differentials of individuals have a lot of influence on privileges and opportunities enjoyed by society members. The different social and economic positions of individuals and income levels oftentimes hinder them from effective use of health care facilities. It is against this background, that the study was designed to investigate income differentials and its influence on utilization of healthcare services among the people of Calabar Metropolis in Cross River State, Nigeria. Relevant body of literature were reviewed and survey design method was adopted. The instruments used were the questionnaire, interview and Focus Group Discussions (FGD). A sample of 360 respondents was selected using a multi-stage sampling procedure for the study. Data was presented using simple percentage calculation while Chi-Square and ANOVA statistical tool was used to test and ascertain the relationship between income level and healthcare services usage at 0.05 level of significance. Findings of the study revealed that level of income and occupational status of individual influence health care service utilization among people in Calabar Metropolis. At the end of the study, several recommendations were made among which were a general improvement of socio-economic status of the people in areas of availability and compulsory education, employment opportunities as well as equitable distribution of income and minimizing cost of health care services for effective and equal utilization.

Healthcare services use and costs for a cohort of high needs elderly diabetic patients

Abstract Background The worldwide prevalence of diabetes mellitus is increasing, which especially involves people aged &amp;gt;65 years. A recent study also found that almost 75% of adults with diabetes have two or more comorbid conditions. The aim of the study was to investigate the impact of comorbidities on health care service use and health care costs of an elderly diabetes cohort with high health care needs (HHCN), based on real-world data. Methods For the purposes of the present study, people with a diagnosis of diabetes, residing in the area served by the ex-ULSS4-Veneto LHU, and characterized as having HHCN, corresponding to ACG-RUBs 4 and 5 were considered. The comorbidities was assessed using clinical diagnoses that the ACG System assigns to single patients by combining different information flows. The presence of correlation between comorbidity classes and total annual health care costs and use was tested with Spearman Test. Moreover, the association between above mentioned variables was tested with a appropriate regression, adjusting for age and sex. Results Mean overall cost and drug cost ranged respectively from 6284 euro, 525 euro in a patient with only 1 comorbidity to 10752 euro and 1764 euro for a patient with more than 8 comorbidities. The study shows that all measures of health care services use (as emergency care accesses; number of outpatients visits; number of inpatients admissions) have a statistically significant correlation with comorbidities class. However, multivariate analyses revealed that no different use in hospitalization was associated with comorbidity class. A significant correlation was also detected among costs variables (total annual costs and pharmacy costs) and comorbidity classes. Conclusions The increase in total healthcare services use and costs due to the increased number of comorbidities was seen mainly for primary care services, highlighting the need of primary care to be strengthen in an ageing and multi-morbid population. Key messages Overall cost and drug cost for patients with more than 8 comorbidities are respectively almost doubled and more than threefold greater than those with only one comorbidities. The study revealed an increase in primary care services, suggesting an implementation of these services giving the aging population and the increase prevalence of comorbid diabetic patients worldwide.

Factors Influencing Urban Variations of Household’s Utilization of Public Primary Healthcare Facilities in Nakuru Town, Kenya

Utilization of public health care (PHC) facilities incorporates three major components including people, service and mode of transport linking them. The difference in components influencing the households' utilization of PHC facilities varies across the world. This paper investigates the factors influencing urban variations of households' utilization of public primary health care facilities. This study was carried out in Nakuru Town. The study adopted mixed method research that involved quantitative and qualitative approaches. These included: a descriptive cross-sectional household survey and a health facility evaluation survey. The results indicate that the major factors influencing households' utilization of public PHC facilities were cost of healthcare services (79.25%), availability of drugs within the public health care facilities (70.5%) and distance to health facility (68.75%). This paper shows that households in Nakuru town utilize public primary health care facilities for their medical services based on the physical conditions, financial conditions, health status and socio-economic characteristics. The paper thus recommends for the County Government of Nakuru to increase the number of public PHCs, improve the supply of essential drugs and also to use mobile clinics to reach the underserved areas within the town.

Plasma Treatment Limits Cutaneous Squamous Cell Carcinoma Development In Vitro and In Vivo.

Cutaneous squamous cell carcinoma (SCC) is the most prevalent cancer worldwide, increasing the cost of healthcare services and with a high rate of morbidity. Its etiology is linked to chronic ultraviolet (UV) exposure that leads to malignant transformation of keratinocytes. Invasive growth and metastasis are severe consequences of this process. Therapy-resistant and highly aggressive SCC is frequently fatal, exemplifying the need for novel treatment strategies. Cold physical plasma is a partially ionized gas, expelling therapeutic doses of reactive oxygen and nitrogen species that were investigated for their anticancer capacity against SCC in vitro and SCC-like lesions in vivo. Using the kINPen argon plasma jet, a selective growth-reducing action of plasma treatment was identified in two SCC cell lines in 2D and 3D cultures. In vivo, plasma treatment limited the progression of UVB-induced SSC-like skin lesions and dermal degeneration without compromising lesional or non-lesional skin. In lesional tissue, this was associated with a decrease in cell proliferation and the antioxidant transcription factor Nrf2 following plasma treatment, while catalase expression was increased. Analysis of skin adjacent to the lesions and determination of global antioxidant parameters confirmed the local but not systemic action of the plasma anticancer therapy in vivo.

Effects of Home-Based Physical Exercise on Days at Home and Cost-Effectiveness in Pre-Frail and Frail Persons: Randomized Controlled Trial

ObjectivesFrailty increases the risks of hospitalization, institutionalization, and death. Our objective was to study the effects of home-based physical exercise on the number of days spent at home among pre-frail and frail persons, versus usual care. In addition, utilization and costs of health care and social services, cost-effectiveness, and health-related quality-of-life (HRQoL) were explored. DesignRandomized controlled trial, with year-long supervised exercise for 60 minutes twice a week versus usual care. Follow-up for 24 months after randomization. Setting and ParticipantsA sample of 299 home-dwelling persons in South Karelia, Finland. Main inclusion criteria: ≥65 years, meeting at least 1 of the frailty phenotype criteria, Mini-Mental State Examination score ≥17. MethodsPrimary outcome, days spent at home over 24 months, was calculated deducting days in inpatient care, in nursing homes, and days after death. HRQoL was assessed (15D questionnaire) at baseline and at 3, 6, and 12 months. Utilization data were retrieved from medical records. ResultsThe participants' mean age was 82.5 (SD 6.3), 75% were women, 61% were pre-frail and 39% frail. After 24 months, there was no difference between groups in days spent at home [incidence rate ratio 1.03; 95% confidence interval (CI) 0.98–1.09]. After 12 months, the costs per person-year were 1.60-fold in the exercise group (95% CI 1.23–1.98), and after 24 months, 1.23-fold (95% CI 0.95–1.50) versus usual care. Over 12 months, the exercise group gained 0.04 quality-adjusted life-years and maintained the baseline 15D level, while the score in the usual care group deteriorated (P for group <.001, time 0.002, interaction 0.004). Conclusions and ImplicationsPhysical exercise did not increase the number of days spent at home. Exercise prevented deterioration of HRQoL, and in the frail subgroup, all intervention costs were compensated with decreased utilization of other health care and social services over 24 months.

Adoption of Mobile health Insurance Systems in Africa: evidence from Cameroon

The cost of health care services remains central concerns in low- and middle-income countries (LMIC), especially in Africa. One of the major challenges they face is how to efficiently reduce out-of-pocket spending. Health insurance systems are either inexistent or inefficient in many of these countries. In an attempt to implement and improve these systems, several countries have implemented mobile-supported health insurance systems (MHIS). Unfortunately, most of these programs have not crossed the pilot phases because of low adoption rates. Thus, this study sought to investigate the factors that influence the adoption of MHIS in LMIC. Using 263 valid responses collected during a 3-month survey in Cameroon, we found that coping appraisal and technology appraisal are important for the adoption of MHIS in LMIC. Precisely, performance expectancy, self-efficacy, response efficacy, facilitating conditions, and perceived cost explain 57.7% of the variance in behavioral intention to adopt MHIS. This study is based on empirically tested factors founded on the protection motivation theory (PMT) and the unified theory of acceptance and use of technology (UTAUT). Our contributions target health economists, technologists, policymakers, managers, researchers, and anyone interested in understanding the behavior of health insurance service consumers in LMIC and the pressures insurers and governments face during MHIS programs. We discuss the implications of our findings and further research that could help further explain MHIS adoption in LMIC.

Recommendations to protect patients and health care practices from Medicare and Medicaid fraud

Fraud is defined as knowingly submitting, or causing to be submitted, false claims or making misrepresentations of a fact to obtain a federal health care payment for which no entitlement would otherwise exist. In today’s health care environment, Medicare and Medicaid fraud is not uncommon. The negative impact of fraud is vast because it diverts resources meant to care for patients in need to the benefit of fraudsters. Fraud increases the overall costs for vital health care services and can potentially be harmful to Medicare and Medicaid beneficiaries. The objectives of this commentary are to describe the types and trends of Medicare and Medicaid fraud that are committed, and provide recommendations to protect patients and health care practices. Specifically, this article identifies types of Medicare and Medicaid fraud at beneficiary (patient) and provider level, and it can be intentional or unintentional. This article also describes the 3 primary laws that prohibit fraud and gives fraud case examples relevant to each law, including the False Claims Act, Anti-Kickback Statute, and the Stark Law. We also discuss currently trending and emerging areas, including opioid and pharmacogenetic testing; both have experienced heavier and higher-profile instances of fraud in today’s health care landscape. Last, the article summarizes detection methods and recommendations for health care providers and patients to protect themselves against fraud. Recommended strategies to combat fraud are discussed at policy, practice, and grassroots levels. Health care practitioners, including pharmacists, can use these strategies to protect themselves and their patients from becoming victims of fraud or unknowingly committing fraud.

Healthcare service utilization and cost among transition-age youth with autism spectrum disorder and other special healthcare needs.

Youth with autism spectrum disorder often have complex medical needs. Disruptions of healthcare during the transition from pediatric to adult healthcare may put youth with autism spectrum disorder at higher risk of medical emergencies and high medical costs. To understand healthcare utilization during the transition years, we conducted a study among transition-age youth (14-25 years old) receiving healthcare at Kaiser Permanente Northern California during 2014-2015. We examined differences in healthcare utilization and costs among youth with autism spectrum disorder (n = 4123), attention deficit and hyperactivity disorder (n = 20,6015), diabetes mellitus (n = 2156), and general population controls (n = 20,615). Analyses were also stratified by age and sex. Youth with autism spectrum disorder had the highest utilization of outpatient primary care, mental health, and psychotropic medications and the lowest utilization of obstetrics/gynecology and urgent care. Costs for youth with autism spectrum disorder were higher than those for attention deficit and hyperactivity disorder and general population peers and lower than for diabetes mellitus. Healthcare utilization patterns varied by age. Transition-age youth with autism spectrum disorder generally used healthcare at higher rates relative to attention deficit and hyperactivity disorder and general population peers but at similar or lower rates than diabetes mellitus peers, indicating this group's complex combination of psychiatric and medical healthcare needs. The relatively high utilization of psychiatric services and low utilization of women's health services in transition-age youth with autism spectrum disorder may have implications for long-term health and warrants additional research.

Impact of Behavioral Health Comorbidities on Health Care Costs Among Japanese Patients With Cancer.

Little is known about how behavioral health (BH) conditions affect health care costs of patients with cancer in Japan. The purpose of this study is to evaluate the magnitude of general medical claims expenditures for individuals with cancer who use or do not use BH services in Japan. The study used a health insurance claims database for more than 3 million enrollees in Japan. All health plan enrollees (18 y or older) who had tumors without metastasis or metastatic solid tumors defined by the Charlson Comorbidity Index were included in the study (n= 20,260). Measurements included total claims expenditures for BH and medical services. The proportion of enrollees using BH services was 12.8%. BH service users accounted for 17.7% of total health service spending. Mean annual cost of total health care services were 1.5 times higher in BH users than those with no BH use, whereas the median was 1.8 times higher. Mean annual medical cost alone for BH users was 1.3 times higher than that for non-BH users, whereas the median was 1.5 times higher. The findings suggest the importance for the Japanese medical system to address BH needs of patients with cancer and introduce fiscal efficiencies to cancer care. Strategic implementation of effective integrated care services for patients with cancer should be considered in Japan.

The Cost of Health Care Services in Urban and Intercity Road Traffic Accidents

The article's abstract is no available.

Cost-effectiveness of a specialist smoking cessation package compared with standard smoking cessation services for people with severe mental illness in England: a trial-based economic evaluation from the SCIMITAR+ study.

To evaluate the cost-effectiveness of a specialist smoking cessation package for people with severe mental illness DESIGN: Incremental cost-effectiveness analysis was undertaken from the UK National Health Service and Personal Social Services perspective over a 12-month time horizon. Total costs, including smoking cessation, health-care and social services costs and quality-adjusted life years (QALYs), derived from the five-level EuroQol 5-dimension (EQ-5D-5L), collected from a randomized controlled trial, were used as outcome measures. The bootstrap technique was employed to assess the uncertainty. Sixteen primary care and 21 secondary care mental health sites in England. Adult smokers with bipolar affective disorder, schizoaffective disorder or schizophrenia and related illnesses (n=526). A bespoke smoking cessation (BSC) package for people with severe mental illness offered up to 12 individual sessions with a mental health smoking cessation practitioner versus usual care (UC). Of the participants who were randomized, 261 were in UC group and 265 were in BSC group. BSC intervention cost was estimated from the treatment log. Costs of UC, health-care and social services and EQ-5D-5L were collected at baseline, 6- and 12-month follow-ups. Incremental costs and incremental QLAYs were estimated using regression adjusting for respective baseline values and other baseline covariates. The mean total cost in the BSC group was £270 [95% confidence interval (CI)=-£1690 to £1424] lower than in the UC group, while the mean QALYs were 0.013 (95% CI=-0.008 to 0.045) higher, leading to BSC dominating UC (76% probability of cost-effective at £20 000/QALY). A bespoke smoking cessation package for people with severe mental illness is likely to be cost-effective over 12months compared with usual care provided by the UK's National Health Service and personal social services.

Healthcare use and costs in adult cancer patients with anxiety and depression.

Anxiety and depression are common in individuals with cancer and may impact healthcare service use and costs in this population. This study examined the effects of anxiety alone, depression alone, and comorbid anxiety and depressive disorder on healthcare use and costs among patients with cancer. This was a retrospective cohort analysis of administrative data of patients aged 18 or older with an International Classification of Diseases, Ninth Revision diagnosis of cancer. Key outcomes were any visit to emergency department (ED), any inpatient hospitalization, length of hospital stays, and annual healthcare costs 1 year from cancer diagnosis. A total of 13,426 patients were included. Relative to patients with neither anxiety nor depression, those with anxiety alone, depression alone, or comorbid anxiety and depression were more likely to experience an ED visit and be hospitalized. Length of hospital stays were also longer and annual healthcare costs were significantly higher in all three clinical groups. Cancer patients with anxiety and depression were at greater risk for ED visits and hospitalizations, experienced longer hospital stays, and accrued higher healthcare costs. Future researchers should determine whether screening and treating comorbid anxiety and depression may decrease healthcare utilization and improve turnover wellbeing among cancer patients.

SAT0576 THE PREVALENCE OF RHEUMATOID ARTHRITIS: A SYSTEMATIC REVIEW OF POPULATION-BASED STUDIES.

Background:Rheumatoid arthritis (RA) is a heterogeneous disease with unknown aetiology (1). The reported worldwide RA prevalence varies widely (2, 3), and it is unclear whether this is due to inconsistencies in defining populations or methodologies used to identify RA patients (3, 4). Accurate RA prevalence data are required to plan preventative, diagnostic, and management strategies to address raising health care service demands and costs associated with improved lifespan and level of disability (5, 6).Objectives:To estimate the prevalence of RA from international population-based studies and investigate the influence of prevalence definition, data sources, classification criteria and geographical area on RA prevalence.Methods:A systematic review of existing literature was performed using the Joanna Briggs Institute approach for the systematic review and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of ProQuest, MEDLINE, Web of Science, and EMBASE was undertaken to include population-based studies investigating RA prevalence between 1980 and 2019.Results:Sixty published population-based studies met the inclusion criteria over the study period. The mean point-prevalence of RA was 0.56% (range 0.00% to 2.70%) between 1986 and 2014. The period-prevalence was 0.51% (range 0.05% to 1.9%) between 1955 and 2015. RA point- and period-prevalence was higher in urban settings than rural settings, (0.69% vs 0.48%) and (0.54% vs 0.25%), respectively. The mean point- and period-prevalence were 0.56% (SD=0.52) and 0.57% (SD=0.41) and were lower in sampling population studies than in larger population databases studies (0.60% (SD=0.27) and 0.44% (SD= 0.26)). The highest period-prevalence of RA was observed in linked databases (0.80%, SD=0.1) where RA diagnosis was validated by rheumatologists.Conclusion:The average point- and period-prevalence of RA were 51/10,000 and 56/10,000 respectively. The RA prevalence was higher in urban areas than rural areas, suggesting an impact of environmental differences. Population database studies were more consistent than sampling studies, and linked databases appeared to provide the best estimate of RA period-prevalence when rheumatologists clinically verified RA.Table 1.The top five countries for the highest and lowest prevalence of RA in recent global estimate between 1980 and 2019.Global prevalence of RATop five countriesPrevalence (%)Highest1-Cuba2.702-Finland1.903-Lesotho1.804-USA1.075-Lebanon1.00Lowest1-Nigeria0.002-Taiwan0.05Taiwan0.10Taiwan0.123-Thailand0.124-India0.155-Philippines0.17

MON-141 Healthcare Services Utilization and Costs Associated with the Management of Patients Living with Acromegaly

Background: Acromegaly (ACRO) is a rare, chronic growth hormone hypersecretory disorder associated with increased morbidity and mortality. Limited information is available on the utilization and costs of healthcare by patients with ACRO. Aims: To assess the impact of ACRO healthcare utilization and costs by locations of care (LoC). Methods: A US database of prescription (Rx) drug and medical claims from Jan 2010 to Apr 2019 was analyzed. Patients with an ACRO diagnosis (Dx) were identified based on claims with ICD-9/-10 codes 253.0x/E22.0. The 12-month study period followed each patient’s first ACRO Dx in the database (the index date). ACRO patients included in the study had ≥ 2 ACRO Dxs > 30 days apart, or 1 ACRO Dx plus either a pituitary adenoma Dx or a pituitary surgery or radiosurgery claim during the study period. Costs were adjusted using the medical and Rx cost Consumer Price Indexes (CPIs). Study subjects were 18–65 yr old and had continuous eligibility during the study period. Eligible ACRO patients were matched with 20 subjects who did not have ACRO. Outcomes by LoC included costs, services, and likelihood of use and were compared using separate two-part regression models (logistic followed by generalized linear) for each outcome, controlling for demographic and job-related variables, region, and Charlson comorbidity index (CCI) scores. The likelihood models only used logistic regression. Data are shown as likelihoods or mean ± standard error. Findings are significant at P < 0.05. Results: A total of 60 patients with ACRO and 1200 controls were compared. Compared with controls, patients with ACRO had a higher likelihood of using the physician’s office (100% vs 91%, P < 0.0001), inpatient (22% vs 3%, P < 0.0005), outpatient (89% vs 38%, P < 0.0001), laboratory (62% vs 31%, P < 0.0001), and “other” locations (e.g., ambulance and claims without a specific location code, 55% vs 23%, P < 0.0001). Services performed at each LoC were higher for patients with ACRO (P < 0.01, all except outpatient hospital). Total costs were higher for the ACRO cohort compared with controls ($25,770 vs $4,059, P < 0.05). Costs by LoC were consistently higher (all reported P < 0.001) for patients with ACRO compared to controls, with differences highest in the following settings: outpatient hospital/clinic ($9,611 ± $1,793 vs $1,355 ± $74), inpatient ($8,646 ± $2,388 vs $739 ± $115), physicians’ office ($4,762 ± $678 vs$1,301 ± $43), other ($2,001 ± $583 vs $367 ± $29), and laboratory ($508 ± $93 vs $66 ± $4). Neither the costs nor likelihoods of treatment in the emergency department were significantly different between cohorts. Conclusions: Compared with commercially insured people without ACRO, patients with ACRO had greater health care utilization, in all care locations, indicating a greater burden and higher costs of ACRO patients on the healthcare system.