Difference In Total Expenditure Research Articles

Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

Nearly 40% of US youth aged 2 to 19 years do not have a body mass index (BMI) in the healthy weight category. However, there are no recent estimates for BMI-associated expenditures using clinical or claims data. To estimate medical expenditures among US youth across all BMI categories along with sex and age groups. This cross-sectional study used IQVIA's ambulatory electronic medical records (AEMR) data set linked with IQVIA's PharMetrics Plus Claims database from January 2018 through December 2018. Analysis was performed from March 25, 2022, through June 20, 2022. It included a convenience sample of a geographically diverse patient population from AEMR and PharMetrics Plus. The study sample included privately insured individuals with a BMI measurement in 2018 and excluded patients with pregnancy-related visits. BMI categories. Total medical expenditures were estimated using generalized linear model regression with γ distribution and log-link function. For out-of-pocket (OOP) expenditures, a 2-part model was used that included logistic regression to estimate the probability of positive expenditures followed by generalized linear model. Estimates were shown with and without accounting for sex, race and ethnicity, payer type, geographic region, age interacted with sex and BMI categories, and confounding conditions. The sample included 205 876 individuals aged 2 to 19 years; 104 066 were male (50.5%) and the median age was 12 years. Compared with those with healthy weight, total and OOP expenditures were higher for all other BMI categories. Differences in total expenditures were highest for those with severe obesity ($909; 95% CI, $600-$1218) followed by underweight ($671; 95% CI, $286-$1055) compared with healthy weight. Differences in OOP expenditures were highest for those with severe obesity ($121; 95% CI, $86-$155) followed by underweight ($117; 95% CI, $78-$157) compared with healthy weight. Having underweight was associated with higher total expenditures at ages 2 to 5 years and 6 to 11 years by $679 (95% CI, $228-$1129) and $1166 (95% CI, $632-$1700), respectively; having severe obesity was associated with higher total expenditures at ages 2 to 5 years, 6 to 11 years, and 12 to 17 years by $1035 (95% CI, $208-$1863), $821 (95% CI, $414-$1227), and $1088 (95% CI, $594-$1582), respectively. The study team found medical expenditures to be higher for all BMI categories when compared with those with healthy weight. These findings may indicate potential economic value of interventions or treatments aimed at reducing BMI-associated health risks.

Abstract 10157: Incremental Medical Expenditure and Effectiveness of Early Non-invasive Cardiac Testing in Suspected Acute Coronary Syndrome

Introduction: The relationship between medical expenditure and long-term effectiveness of early (within 72 hours) non-invasive cardiac stress testing (NIT) in reducing future acute myocardial infraction (AMI) is not well understood. We estimated the value of early NIT after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS). Methods: This was a retrospective cohort study of adult (18+) patients with chest pain, presenting at EDs within the Kaiser Permanente Southern California health system from 10/2015-12/2018. We analyzed the direct medical expenditure associated with medical office visits, hospital facility and ED visits, pharmacy utilization, hospice stays, skilled nursing stays, home health, dialysis, laboratory and radiology utilization during the one year following the index chest pain ED visit. We also identified incidence of AMI during the 1-year follow-up. We used 2-stage residual inclusion instrumental variables (IV) techniques to evaluate the marginal effect of early NIT on total all cause expenditure as well as subgroups of utilization. We used control functions IV techniques to evaluate the marginal effect of NIT on AMI and calculated the number needed to treat (NNT) as the inverse of the absolute risk reduction. All models adjusted for socio-demographics, cardiovascular disease (CVD) history and treatment and non-CVD comorbidities. Results: The cohort included 91250 patients (mean age 58 years, female 58%) and 19% received early NIT. The marginal difference in total expenditure between the early NIT vs controls was $2,583 (95% CI $591 to $4,575) and was mainly related to the index ED visit (Table 1). Those who received early NIT had slightly lower risk of AMI during the 1-year follow-up (risk reduction 1.3% (-1.9% to -0.7%) resulting in NNT of 75. Conclusions: Early NIT offers minor risk reduction of AMI but with an increase of $2583 in expenditure. With a NNT of 75, the cost to avoid one AMI is estimated to be $193,725.

Association of Roux-en-Y Gastric Bypass With Postoperative Health Care Use and Expenditures in Canada

Results of previous studies are mixed regarding the economic implications of a Roux-en-Y gastric bypass (RYGB). To assess the 5-year incremental health care use and expenditures after RYGB. This population-based cohort study conducted in Ontario, Canada, used a difference-in-differences approach to compare health care use and expenditures between patients who underwent a publicly funded RYGB from March 1, 2010, to March 31, 2013, and propensity score-matched control individuals who did not undergo a surgical bariatric procedure. The study period allowed for a minimum 60 months of follow-up because, at that time, the most recent date for which administrative data on health care and expenditures were available was March 31, 2018. Data sources included the Ontario Bariatric Registry linked to several Ontario health administrative databases and the Electronic Medical Record Administrative Data Linked Database. Health care use and expenditures data for 5 years before and 5 years after the index date (procedure date for RYGB group; random date for controls) were analyzed. Data analyses were performed March 12, 2019, to March 10, 2020. RYGB procedure. The primary outcome was total health care expenditures. The final propensity score-matched cohorts comprised 1587 individuals in the RYGB group (mean [SD] age, 47 [10.2] years) and 1587 controls (mean [SD] age, 47 [12.2] years); each group had 1228 women (77.4%) and a mean body mass index (calculated as weight in kilograms divided by height in meters squared) of 46. Mean total health care expenditures (2017 Canadian dollars) per patient in the RYGB group increased from CAD $15 594 (95% CI, CAD $14 743 to CAD $16 614) (US $12 008 [95% CI, US $11 353 to US $12 794]) in the 5 years before the procedure to CAD $30 389 (95% CI, CAD $28 789 to CAD $32 232) (US $23 401 [95% CI, US $22 169 to US $24 821]) over the 5 years after the procedure, a difference of CAD $14 795 (95% CI, CAD $13 172 to CAD $16 480) (US $11 393 [95% CI, US $10 143 to US $12 691]). For the control group, mean total health care expenditures per individual increased from CAD $16 109 (95% CI, CAD $14 727 to CAD $17 591) (US $12 405 [95% CI, US $11 341 to US $13 546]) 5 years before the index date to CAD $20 073 (95% CI, CAD $18 147 to CAD $22 169) (US $15 457 [95% CI, US $13 974 to US $17 071]) 5 years after the date, a difference of CAD $3964 (95% CI, CAD $2250 to CAD $5875) (US $3053 [95% CI, US $1733 to US $4524]). Overall, the difference-in-differences estimate of the net cost of RYGB was CAD $10 831 (95% CI, CAD $8252 to CAD $13 283) (US $8341 [95% CI, $6355 to $10 229]) over the 5-year period. This amount excluded the mean (SD) cost associated with the index date: CAD $6501 (CAD $1087) (US $5006 [US $837]) for the RYGB cohort and CAD $9 (CAD $72) (US $7 [US $55]) for the controls. The cost differential was primarily associated with increased hospitalizations in the first months immediately after RYGB. Expenditures leveled off in year 3 after the index date; differences in total expenditures between the RYGB and control cohorts were not statistically significantly different in years 4 and 5. Health care expenditures in the 3 years after publicly funded RYGB were higher in patients who underwent the procedure than in control individuals, but the costs were similar thereafter. This finding suggests the need to decrease hospital and emergency department readmissions after surgical bariatric procedures because such use is associated with increased spending.

The Effects of Community Health Center Care on Medical Expenditures for Children and Adults: Propensity Score Analyses.

This study examines whether community health center (CHC) patients have lower medical expenditures. Using 2011-2012 Medical Expenditure Panel Survey data, propensity score methods are used to compare annual expenditures for adults and children receiving at least half their ambulatory care at CHCs versus those who did not. For children, CHC use was associated with 35.3% lower total medical expenditures ($627), 40.0% lower ambulatory expenditures ($279), and 49.1% lower prescription drug expenditures ($157) (all Ps < .05). For adults, the reduction in hospital expenditures for CHC users ($529) was statistically significant at a P < .10 threshold. Estimated differences in total expenditures and other expenditure categories were not statistically significant for adults.

Health Care Expenditures for University and Academic Medical Center Employees Enrolled in a Pilot Workplace Health Partner Intervention.

To evaluate the impact of a pilot workplace health partner intervention delivered by a predictive health institute to university and academic medical center employees on per-member, per-month health care expenditures. We analyzed the health care claims of participants versus nonparticipants, with a 12-month baseline and 24-month intervention period. Total per-member, per-month expenditures were analyzed using two-part regression models that controlled for sex, age, health benefit plan type, medical member months, and active employment months. Our regression results found no statistical differences in total expenditures at baseline and intervention. Further sensitivity analyses controlling for high cost outliers, comorbidities, and propensity to be in the intervention group confirmed these findings. We find no difference in health care expenditures attributable to the health partner intervention. The intervention does not seem to have raised expenditures in the short term.

Abstract P6-07-05: Regional variation in Medicare expenditures for older women with localized breast cancer

Abstract Objectives: To characterize variation in Medicare expenditures on initial breast cancer care across hospital referral regions (HRRs) and to examine the relative contribution of patient characteristics and treatment factors to such variation. Methods: This was a retrospective cohort study using the 2003-2007 Surveillance, Epidemiology and End Results (SEER)-Medicare linked database and the Medicare 5% random sample of non-cancer beneficiaries. Each woman with localized (stage I-III) breast cancer (“case”) was matched to a woman without cancer (“control”) based on HRR, age, comorbidity and Medicare expenditure in the year prior to cancer diagnosis. We defined initial phase of care as the period from two months prior to breast cancer diagnosis (for cases) or index date (for controls) through 12 months after the diagnosis or index date. For each HRR, we calculated the risk-standardized cancer-related Medicare expenditure as the difference in total expenditure between cases and controls, using hierarchical generalized linear models to control for clustering by HRR and adjust for patient characteristics (age, race, comorbidity, and tumor characteristics) and treatment factors. Treatment factors were first assessed by whether different treatments were used (surgery, radiation therapy, chemotherapy, growth factors, and imaging services), and then assessed by specific treatment modalities (breast conserving surgery, radical mastectomy, intensity modulated radiation therapy, external beam radiation therapy, brachytherapy, traditional chemotherapy, biological therapy, growth factors, and imaging). All estimates were reported in 2009 U.S. dollars. Results: There were 35,055 patients with breast cancer and an equal number of controls in our cohort. After excluding HRRs with fewer than 25 cases, there were 78 HRRs in our final analysis. Unadjusted Medicare expenditure on breast cancer-related care averaged $19,207 per patient. HRRs in the highest quintile had an average expenditure of $23,522 per patient, which was $8,032 higher than HRRs in the lowest quintile (mean expenditure = $15,490). Patient characteristics explained only 18.5% of the difference in total cancer-related expenditure between the highest and lowest-expenditure quintiles. Treatment factors explained more variation across the HRRs. Adjustment for whether different treatments were used (e.g., chemotherapy: yes/no; radiation: yes/no) explained an additional 26.0% of the difference between the highest and lowest-expenditure HRR quintiles. In contrast, adjustment for specific treatment modalities (e.g., specific type of radiation) explained 36.4% of the variation. Variation in expenditures on radiation therapy contributed the most to the difference in total cancer-related expenditure between the highest and lowest-expenditure HRR quintiles. Conclusions: There is large regional variation in Medicare expenditures on initial breast cancer care, even after accounting for patient characteristics. Treatment factors (whether cancer therapies were used at all and the specific modality of therapy used) were important contributors to such regional variation. Future work exploring the relation between cancer treatment intensity, costs, and outcomes is warranted. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-07-05.

Consumers’ Attitude towards Branded Apparels: Gender Perspective

The relationship between consumers’ decision-making styles and their choice between domestic and imported brand clothing is investigated using a sample of Indian consumers. The objective of this paper is to gauge the factors affecting purchase decision taking gender perspective as base. Empirical findings are calculated using survey technique and chi square test with a sample of 320 participants in Delhi and NCR. The objective of this paper is to analyze the significance of demographic profile of consumers affecting the purchase decision of branded garments and to observe from gender perspective the consumer awareness about different apparel brands available in the Indian market and also to find out whether there is a significant difference in total expenditure on branded apparels done by males vis- a - vis females. The results exhibit no significant differences in the brand awareness, shopping frequency and shopping expenditure between males and females.

Long-term trends in use of and expenditures for cardiovascular medications in Canada.

Medication expenditures have become the fastest growing sector of costs within the Canadian health care system. Evaluation of the use of cardiovascular medications is important to determine the magnitude of the growth, to identify which medications dominate the landscape and to detect interprovincial differences in utilization. We describe long-term trends in the use of and expenditures for cardiovascular medications in Canada, by drug class and by province. For these analyses, we used volume and expenditure data related to prescriptions for cardiovascular medications obtained from IMS Health Canada's CompuScript Audit database for the period 1996-2006. Here, we describe national and provincial patterns of utilization and expenditures for specified classes of cardiovascular medications. The use of cardiovascular medications increased sharply in Canada during the study period, with related costs rising by over 200% during this period to surpass $5 billion in 2006. Changes in population demographics, risk factors and inflation appeared to account for about two-thirds of the observed growth in expenditures. Use of newer medication classes (statins, angiotensin-receptor blockers, angiotensin-converting-enzyme inhibitors), for which patented brand name medications predominate, accounted for almost one-third of the cost increases. Interprovincial differences in total expenditures for cardiovascular drugs portrayed a descending gradient from east to west, with greatest variability for the newer drug classes. Prescriptions and expenditures for cardiovascular medications in Canada escalated over the study period. Projected increases may reach potentially unsustainable levels. Greater emphasis on the use of cost-effective medications is required to limit further increases. Factors influencing interprovincial differences warrant further study.

The impact of hospices on health care expenditures—the case of Taiwan

Cancer has been the leading cause of death in Taiwan since 1982, with nearly one out of four deaths caused by malignant neoplasm. The huge amount of money being spent in the acute care setting for terminally ill cancer patients does not increase their wellbeing. In this study, we employ an Instrumental Variable (IV) model to correct for the self-selection problem and use population-based insurance claim data to test two null hypotheses: there is no difference in total expenditures between hospice care and conventional care, and that there is no difference in total expenditures between hospital-based hospice care and home hospice care. Both null hypotheses are rejected.

The economic impact of psoriasis increases with psoriasis severity

Background: Psoriasis treatments are known to be costly, but little is known about the financial impact of psoriasis and the way in which it relates to the severity of the disease. Objective: This study was performed to obtain an estimate of the treatment costs faced by patients with psoriasis. Methods: A total of 578 anonymous mail surveys were distributed to patients with psoriasis; 318 surveys were returned (55%). Psoriasis severity was assessed with the previously validated Self-Administered Psoriasis Area Severity Index (SAPASI). Results: The total and out-of-pocket expenses to care for psoriasis were correlated with psoriasis severity ( r = 0.26, p = 0.0001). There were no sex ( p = 0.9) or racial ( p = 0.4) differences in total expenditures. Severity was correlated with how bothersome to the patient was the cost of treatment ( r = 0.30, p = 0.0001), the time required for treatment ( r = 0.38, p = 0.0001), and the time lost from work ( r = 0.23, p = 0.0001). Lower quality of life at work and in money matters also correlated with severity of psoriasis. Higher family income was associated with less time spent caring for psoriasis and less interference with work around the home. Conclusion: As expected, the expenses caring for psoriasis are greater for patients with more severe disease. These costs and other financial implications are associated with lower quality of life for patients with more severe psoriasis. (J Am Acad Dermatol 1997;37:564-9.)

Efficiency versus Equity in Economic Policy Analysis

In this paper we outline a new approach to welfare economics. The purpose of welfare economics is to provide an ordering of alter native economic policies. The most desirable economic policy is the policy yielding the highest level of social welfare. This principle can be used to evaluate a specific policy change or to select the optimal policy from a set of alternatives. Dupuit (1969) originated the appraisal of alternative economic policies in terms of their impact on consumer welfare. He proposed to measure individual welfare on the basis of preferences revealed by consumer behavior. The prices faced by the consumer and the corresponding quantities demanded were used to obtain estimates of consumer's sur plus.1 Hicks (1942) introduced measures of consumer's surplus based on compensating and equivalent variations in income or total expenditure. The intuition underlying Hicks's approach to welfare economics is straightforward. Lev els of welfare before and after a change in economic policy can be ordered by compar ing the required levels of total expenditure. For Hicks's compensating variation the dif ference in total expenditure is evaluated at prices prevailing after the change in policy. For the equivalent variation the difference is evaluated at prices before the policy change. Chipman and Moore (1980) have shown that a necessary and sufficient condition for Hicks's compensating variation to provide an appropriate ordering of economic policies is that individual preferences are homothetic. Homothetic preferences are inconsistent with well established regularities in the behavior of individual consumers, such as those reviewed by Houthakker (1957). Chipman and Moore recommend Hicks's equivalent variation. The individual expenditure function intro duced by McKenzie (1957) provides the sim plest approach for implementing Hicks's measures of welfare. The expenditure func tion gives the minimum level of total expend iture required to attain a stipulated level of utility as a function of the prices faced by the consumer. This level of expenditure can be derived from the indirect utility function, which gives the maximum attainable utility level as a function of prices and total expend iture. Jorgenson, Lau, and Stoker (1980, 1981, 1982) have developed methods for construct ing indirect utility functions and individual expenditure functions for a population of consumers. Exact measures of compensating variations based on these methods were intro duced by Jorgenson, Lau, and Stoker (1980). The corresponding exact measures of equiv alent variations were introduced by Jorgen son, Lau, and Stoker (1981). We describe these measures in Section 2 below. The approach to welfare measurement originated by Dupuit is limited to individual welfare. Under the Pareto principle a change in economic policy can be recommended if all consuming units are at least as well off under the policy change and at least one consuming unit is better off. This principle provides a partial ordering of economic poli cies. To obtain a complete ordering we re quire the concept of a social welfare function originated by Bergson (1938) and discussed by Samuelson (1982-1983). A social welfare function gives the level of social welfare as a function of the distribution of individual welfare over the population of consumers. Social welfare functions incor porate the effects of changes in economic policy on the welfare of individual con sumers. A requirement often imposed on so cial welfare functions is that they must obey the Pareto principle. Social welfare functions also include the impacts of policy changes on