Estimate Resource Utilization Research Articles

#1241 Healthcare resource utilisation in adults with chronic kidney disease by KDIGO categorisation in England: 2010-2019

Abstract Background and Aims Chronic kidney disease (CKD) is associated with high clinical burden for patients and substantial economic costs for healthcare systems. Detailed estimates of healthcare resource utilization (HCRU) for patients with CKD in the UK are limited, particularly by stage of CKD. This study assessed outpatient and non-elective inpatient HCRU by stage of CKD in England. Method This non-interventional study utilised data from primary care electronic health records from Clinical Practice Research Datalink (CPRD) AURUM and Hospital Episode Statistics (HES) admitted patient care (APC). Patients aged ≥18 years registered in CPRD with eligible linkage to HES between January 1, 2010 and December 31, 2019 with 2+ eGFR measurement during the period were identified. CKD was defined by eGFR <60 ml/min/1.73 m2 and/or presence of a uACR measurement ≥3 mg/mmol, both confirmed by a second measurement 90-365 days later. Start of follow-up (index) was set to the earliest date during the study period that CKD was confirmed. Follow-up for HCRU ended at earliest of death, administrative censoring, or 31st December 2019. Patients with end-stage kidney disease (eGFR <9 ml/min/1.73 m2) at index were excluded. Number of HCRU events for each HCRU category was estimated as rates per 1,000 person years (PY) for each calendar year based on cumulative number of events. Event rates were calculated as number of outcomes/total time at risk. Confidence intervals (95%) were calculated assuming a Poisson distribution. Age- and sex-adjusted rates were calculated to compare rates across CKD stages. Results Of 6.1 million adult patients meeting study inclusion criteria, 743,945 adults (12.2%) with CKD were identified. Mean age (SD) was 76.1 (11.5) years, 55.2% were female, and 89.8% White, contributing a total of 3,055,600 years of follow-up. Most (60.9%) patients had stage 3a CKD (eGFR 45-<59 ml/min/1.73 m2). Among patients with uACR measurements (44.4%), 48.0% were A1 (<3 mg/mmol), 44.4% A2 (3-30 mg/mmol), and 7.6% A3 (>30 mg/mmol). Overall, per 1000 PY, there were 24,763 primary care visits, 475 non-elective all-cause hospitalisations, 4,950 attended (722 unattended) outpatient visits, including 308 (43 unattended) outpatient nephrology visits and 368.1 attended (61.2 unattended) cardiology visits. For all HCRU categories, greater KDIGO risk category at index was associated with higher HCRU. For example, after age and sex adjustment, patients with CKD stage 3b had a mean of 0.53/PY non-elective all-cause hospitalisations compared to 0.77/PY for patients with CKD stage 4. Additionally, a mean of 5.18 outpatient visits per PY was observed for patients with CKD stage 3b, of which 0.91 were nephrology outpatient visits compared to 8.39 outpatient visits per PY for stage 4, of which 2.65 were nephrology outpatient visits. Generally, both lower eGFR and higher uACR were individually associated with higher HCRU. Conclusion This study demonstrates high HCRU for patients with CKD, with increasing rates of HCRU with lower kidney function and greater kidney damage. Patients with more advanced CKD contribute at a disproportionally higher rate of outpatient healthcare encounters and non-elective hospitalisations. Efforts to prevent the development and progression of CKD and improving clinical outcomes will reduce frequency and cost of HCRU.

Direct Variable Cost Comparison of Endoscopic Versus Open Carpal Tunnel Release: A Time-Driven Activity-Based Costing Analysis.

To improve the delivery of value-based health care, a deeper understanding of the cost drivers in hand surgery is warranted. Time-driven activity-based costing (TDABC) offers a more accurate estimation of resource utilization compared with top-down accounting methods. This study used TDABC to compare the facility costs of open carpal tunnel release (OCTR) and endoscopic carpal tunnel release (ECTR). We identified 845 consecutive, unilateral carpal tunnel release (516 open, 329 endoscopic) surgeries performed at an orthopaedic specialty hospital between 2015 and 2021. Itemized facility costs were calculated using a TDABC algorithm. Patient demographics, comorbidities, surgical characteristics, and itemized costs were compared between OCTR and ECTR. Multivariate regression was used to determine the independent effect of endoscopic surgery on true facility costs. Total facility costs were $352 higher in ECTR compared with OCTR ($882 versus $530). ECTR cases had higher personnel costs ($499 versus $420), likely because of longer surgical time (15 versus 11 minutes) and total operating room time (35 versus 27 minutes). ECTR cases also had higher supply costs ($383 versus $110). Controlling for demographics and comorbidities, ECTR was associated with an increase in personnel costs of $35.74 (95% CI, $26.32 to $45.15), supply costs of $230.28 (95% CI, $205.17 to $255.39), and total facility costs of $265.99 (95% CI, $237.01 to $294.97) per case. Using TDABC, ECTR was 66% more costly to the facility compared with OCTR. To reduce the costs related to endoscopic surgery, efforts to decrease surgical time and negotiate lower ECTR-specific supply costs are warranted. Economic and Decision Analysis Level II.

Estimation of Postinfusion Resource Use and Total Costs of Care for Patients with R/R Follicular Lymphoma (FL) Receiving Lisocabtagene Maraleucel (liso-cel) in the TRANSCEND FL Study

Background: Liso-cel, an autologous, CD19-directed, 4-1BB CAR T cell product administered at equal target doses of CD8 + and CD4 + CAR + T cells, has previously demonstrated clinically meaningful responses in patients with R/R FL in the global phase 2 TRANSCEND FL study (NCT04245839). Limited evidence is published on estimates of health care resource utilization (HCRU) and cost of postinfusion care among patients with large B-cell lymphoma (LBCL) treated with liso-cel (Palomba ML, et al. Leuk Lymphoma 2021), and no evidence is currently available for patients with R/R FL. This analysis evaluated postinfusion HCRU and estimated cost of care across a 6-month period among patients treated with liso-cel in the TRANSCEND FL study. Methods: In this retrospective analysis, patient-level HCRU data from the TRANSCEND FL study database, including hospitalizations and length of hospital stay (LOS) for the entire hospitalization period postinfusion (standard inpatient [IP] and ICU days), diagnostics (eg, laboratory work and imaging), procedures (eg, dialysis and intubation), and medications (eg, oncology supportive care, prophylactics, and other AE management), were analyzed from the day of liso-cel infusion through 6 months of follow-up. Postinfusion costs (not including the cost of liso-cel) were estimated using a microcosting methodology in which HCRU in the 6-month period was identified and unit costs sourced from public databases or literature (adjusted to 2023 US dollars [USD] using the Consumer Price Index) were applied to each HCRU. Facility costs were sourced from the Healthcare Cost and Utilization Project National Inpatient Sample (2020) databases (Dasta JF, et al. Crit Care Med 2005), and the US Centers for Medicare and Medicaid Services (CMS) Hospital Outpatient Prospective Payment System (OPPS; 2023). Diagnostic and procedure costs were obtained from the CMS OPPS (2023), clinical laboratory fee schedule (2023), physician fee schedule (2023), durable medical fee schedule (2023), and Dasta 2005. Medication cost data were obtained from IBM ® Micromedex ® RED BOOK ® (2023) using wholesale acquisition cost and were uniformly applied across sites of care. Average total cost by month after liso-cel infusion was calculated among patients with ongoing status in that month. Patients censored due to data cutoff were excluded. Results: A total of 130 patients were treated with liso-cel in the TRANSCEND FL study, primarily in the fourth-line setting (45.4%). These patients had a median (range) age of 60 (23‒80) years and were predominantly male (83/130 [63.8%]) and White (69/130 [53.1%]); 45 (34.6%) had unknown race. Among patients who received liso-cel infusions, the estimated mean 6-month postinfusion total cost of care was $89,516 (Figure 1). Most 6-month costs ($77,088 [86.1%]) were incurred in Month 1 after infusion and were primarily driven by facility costs ($66,683 [74.5%]), namely standard IP hospitalization and ICU stays. HCRU and LOS (including standard IP hospitalization and ICU days) are shown in Table 1. Almost all patients were hospitalized in the standard IP setting (128/130 [98.5%]). Few patients were admitted to the ICU (4/130 [3.1%]), and 3/130 (2.3%) had an emergency department visit. Median (range) hospitalization time was 14 (3‒45) days for standard IP and 5 (3‒7) days for ICU stays. Some patients received corticosteroids (30/130 [23.1%]) or tocilizumab (31/130 [23.8%]), and few required intravenous immunoglobulin (11/130 [8.5%]), vasopressors (4/130 [3.1%]), lumbar puncture (2/130 [1.5%]), or mechanical ventilation (1/130 [0.8%]). No patients received dialysis. Conclusions: The majority of costs in the 6-month period after liso-cel infusion among patients with R/R FL in the TRANSCEND FL study were incurred in Month 1 and were facility related (IP and ICU hospitalizations and LOS). These findings, consistent with those previously reported for patients with LBCL treated with liso-cel, support that a single infusion of liso-cel is associated with significantly less HCRU and costs after the initial treatment period in the first month.

The economic impact of obesity in Kuwait: a micro-costing study evaluating the burden of obesity-related comorbidities

Objective44% of Kuwait’s population live with obesity and the health consequences place a significant burden on the public health system. This study provides an assessment of the cost burden of obesity-related comorbidities (ORC).MethodsA retrospective micro-costing analysis was conducted to quantify the direct cost associated with ORCs. ORCs and their cost categories were informed by a systematic literature review and validated by a local steering committee comprising three experts. Seventy public sector clinicians and eight hospital procurement staff were surveyed to provide healthcare resource utilization estimates and medical resource cost data, respectively. The annual cost of each ORC and the cost drivers were also validated by the steering committee.ResultsIndividuals in Kuwait with any single ORC incurred direct healthcare costs ranging 1,748–4,205 KWD annually. Asthma, chronic kidney disease and type 2 diabetes were the costliest ORCs, incurring an annual cost that exceeds 3,500 KWD per patient. Hypertension, angina and atrial fibrillation were the least costly ORCs. In general, costs were driven by drug costs and resources allocated to address treatment-related adverse events.LimitationsIn the absence of an official patient registry in Kuwait, our study provides a conservative estimate of direct costs derived from a nationwide survey. Additionally, the cost estimates in this study assumes that a patient with obesity will only experience one ORC. In reality, multi-morbid states may incur additional costs that are not currently captured.ConclusionsOur study confirms that ORCs generate a significant financial burden to the public payer. The study provides an economic case for policymakers to recognize the exigency for obesity prevention and control in accordance with the ORC prevalence, and the need for sustainable investments towards body-mass index management to prevent individuals from developing multiple comorbidities.

MT39 Incremental Costs of New Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement (TAVR)

Post-Transcatheter Aortic Valve Replacement (TAVR) complications requiring a new permanent pacemaker implantation (PPMI) have been associated with increased mortality and rehospitalization; however, there is a lack of contemporary evidence on the direct and indirect costs associated with PPMI post-TAVR, and this has meaningful implications for the economics of TAVR procedures. The objective of this study was to determine contemporary estimates of costs and resource utilization associated with post-TAVR PPMI.

Health Care Resource Utilization and Related Costs of Patients With CKD From the United States: A Report From the DISCOVER CKD Retrospective Cohort

It is well established that chronic kidney disease (CKD) results in a significant burden on patients' health and health care providers. However, detailed estimates of the health care resource utilization (HCRU) of CKD are limited, particularly those which consider severity, comorbidities, and payer type. This study aimed to bridge this evidence gap by reporting contemporary HCRU and costs in patients with CKD across the US health care providers. Cost and HCRU estimates of CKD and reduced kidney function without CKD (estimated glomerular filtration rate [eGFR]: 60-75 and urine albumin-to-creatinine ratio [UACR]:<30) were derived for US patients included in the DISCOVER CKD cohort study, using linked inpatient and outpatient data from the limited claims-EMR data set (LCED) and TriNetX database. Patients with a history of transplant or undergoing dialysis were not included. HCRU and costs were stratified by CKD severity using UACR and eGFR. Overall health care costs ranged from $26,889 (A1) to $42,139 (A3), and from $28,627 (G2) to $42,902 (G5) per patient per year (PPPY), demonstrating a considerable early disease burden which continued to increase with declining kidney function. The PPPY costs of later stage CKD were particularly notable for patients with concomitant heart failure ($50,191 [A3]) and those covered by commercial payers ($55,735 [A3]). Health care costs and resource use associated with CKD and reduced kidney function pose a substantial burden across health care systems and payers, increasing in line with CKD progression. Early CKD screening, particularly of UACR, paired with proactive disease management may provide both an improvement to patient outcomes and a significant HCRU and cost saving to health care providers.

Poor Patient Compliance Limits the Attainability of Patient-Reported Outcome Measure Completion Thresholds for the Comprehensive Care for Joint Arthroplasty Model

BackgroundThe Centers for Medicare and Medicaid Services (CMS) links patient-reported outcome measures (PROMs) with hospital reimbursement in some value-based models for total joint arthroplasty (TJA). This study evaluates PROM reporting compliance and resource utilization using protocol-driven electronic collection of outcomes for commercial and CMS alternative payment models (APMs). MethodsWe analyzed a consecutive series of patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2016 and 2019. Compliance rates were obtained for reporting hip disability and osteoarthritis outcome score for joint replacement (HOOS-JR.), knee disability and osteoarthritis outcome score for joint replacement (KOOS-JR.), and 12-item short form survey (SF-12) surveys preoperatively and postoperatively at 6-months, 1 year, and 2- years. Of 43,252 THA and TKA patients, 25,315 (58%) were Medicare-only. Direct supply and staff labor costs for PROM collection were obtained. Chi-square testing compared compliance rates between Medicare-only and all-arthroplasty groups. Time-driven activity-based costing (TDABC) estimated resource utilization for PROM collection. ResultsIn the Medicare-only cohort, preoperative HOOS-JR./KOOS-JR. compliance was 66.6%. Postoperative HOOS-JR./KOOS-JR. compliance was 29.9%, 46.1%, and 27.8% at 6 months, 1 year, and 2 years, respectively. Preoperative SF-12 compliance was 70%. Postoperative SF-12 compliance was 35.9%, 49.6%, and 33.4% at 6 months, 1 year, and 2 years, respectively. Medicare patients had lower PROM compliance than the overall cohort (P < .05) at all time points except preoperative KOOS-JR., HOOS-JR., and SF-12 in TKA patients. The estimated annual cost for PROM collection was $273,682 and the total cost for the entire study period was $986,369. ConclusionDespite extensive experience with APMs and a total expenditure near $1,000,000, our center demonstrated low preoperative and postoperative PROM compliance rates. In order for practices to achieve satisfactory compliance, Comprehensive Care for Joint Replacement (CJR) compensation should be adjusted to reflect the costs associated with collecting these PROMs and CJR target compliance rates should be adjusted to reflect more attainable levels consistent with currently published literature.

ALLERGY-RELATED HEALTHCARE RESOURCE USE AND COSTS IN PATIENTS WITH MULTIPLE VERSUS SINGLE FOOD ALLERGIES

<h3>Introduction</h3> Clinical and economic burden associated with food allergy and allergic diseases is not well characterized, particularly for patients with multiple food allergies (MFA). We explore healthcare resource utilization (HRU) and annual cost estimates of those living with food allergy (FA). <h3>Methods</h3> Patients with ≥1 insurance claim for FA or anaphylactic reaction due to food in 2015-2018, and with continuous enrollment in a health plan ≥12 months before and after the first FA/reaction (index) were identified from the US MarketScan claims databases. Single FA (SFA) cases were defined as those having only 1 documented food allergen (excluding allergy to an unknown food); MFA cases were those with >1 document food allergen. The associations between MFA and 1-year post-index allergy-related HRU and costs were estimated using multivariable regression analysis. <h3>Results</h3> Patients with MFA (N=32,595) and SFA (N=94,802) had mean(SD) age of 11(12) and 20(18) years and were 43% and 52% female. For MFA/SFA cohorts, annual incidences of allergy-related hospitalizations were 2.7%/2.5%, emergency department visits were 16%/11%, and outpatient visits were 80%/54%. After baseline adjustment and compared with SFA, MFA was associated with greater likelihood of: allergy-related hospitalizations (odds ratio [OR][95%CI]: 1.42[1.30,1.55]); emergency department visits (OR[95%CI]: 1.84[1.76,1.91]); outpatient visits (incidence rate ratio: 1.27[1.26,1.28]), p<0.001). In the MFA/SFA cohorts, the estimated 1-year total direct medical costs (95%CI) were $1103 ($1045,$1160)/$760 ($727,$793), respectively. <h3>Conclusion</h3> Allergy-related clinical and economic burden is high in patients with FA, and greater in patients with MFA compared with SFA, highlighting unmet need for treatment and disease management.

The clinical impact of multiple prevention strategies for respiratory syncytial virus infections in infants and high-risk toddlers in the United States

BackgroundRespiratory syncytial virus (RSV) remains a leading cause of medically-attended acute respiratory infection in infants and children. With multiple preventative interventions under development, accurate estimates of health care resource utilization are essential for policy decision making. MethodsWe developed a literature-based decision-tree model that estimated annual medically-attended RSV (MA-RSV) lower respiratory tract infection (LRTI) and non-LRTI episodes in the US for all infants and for high-risk toddlers. The model accounted for the gestational age and birth-month of infants, and the seasonal variation in RSV incidence. The impact of no prophylaxis, palivizumab, maternal vaccine, and long-acting monoclonal antibody (mAb) interventions was estimated. ResultsWe estimated 1.23 million (range: 0.96 million–1.40 million) annual MA-RSV LRTI/non-LRTI episodes comprised of 1.19 million (range: 0.93 million–1.36 million) emergency department (ED) and outpatient visits, and 39,040 (range: 32,726–45,851) hospitalizations. Outpatient and ED visits were comprised of 586,034 (range: 430,595–718,868) LRTIs and 608,733 (range: 495,705–644,658) non-LRTIs. The long-acting mAb intervention resulted in the greatest number of averted outpatient and ED episodes (310,997 [53%] LRTIs; 284,305 [47%] non-LRTIs) and hospitalizations (21,845 [56%]). Full-term infants constitute the highest proportion of episodes across all interventions. ConclusionsMA-RSV disease is substantial in infants and high-risk toddlers. Long-acting mAbs are most effective at reducing the number of MA-RSV LRTI/non-LRTI episodes, and the only intervention that prevents disease in older infants (≥6 months old).

Repetitive transcranial magnetic stimulation may be a cost-effective alternative to antidepressant therapy after two treatment failures in patients with major depressive disorder

BackgroundThe cost-effectiveness of treatment strategies for patients with Major Depressive Disorder (MDD) who have not responded to two adequate treatments with antidepressants (TRD) are still unclear. The aim of this analysis was to evaluate the cost-effectiveness of add-on repetitive Transcranial Magnetic Stimulation (rTMS) compared with standard treatment.MethodsA Markov-model simulated clinical events over one year from the perspective of healthcare payer. Third- and fourth-line treatment pathways (augmentation, antidepressant switch or combination, and Electro-Convulsive Therapy (ECT)) were defined based on medical practice guidelines. Transition probabilities were derived from a recent meta-analysis and scientific publications. Resource utilization and cost estimates were based on the patient-level database of a large university hospital.ResultsIncremental Quality-Adjusted Life Years (QALYs) and costs were 0.053 and 785 €, respectively, corresponding to an Incremental Cost-Effectiveness Ratio (ICER) of 14,670 € per QALY. The difference in cost between standard treatment and rTMS is explained by the rTMS sessions used in acute (€660) and maintenance (€57/month) treatments, partly offset by lower hospital costs due to higher remission rates in the rTMS arm. Key parameters driving the ICER were incremental utility of remission, unit cost of rTMS treatment and remission rate. At a threshold of €22,243 add-on rTMS is a cost-effective alternative to pharmacotherapy. Evidence on long-term effectiveness is not yet available, so results are estimated for a one-year period.ConclusionNot only does rTMS treatment have beneficial clinical effects compared with drug therapy in TRD, but it also appears to offer good value-for-money, especially in centres with larger numbers of patients where unit costs can be kept low.

EE74 Chronic Rhinosinusitis with Nasal Polyps (CRSwNP): A Cost-of-Illness Study in Brazilian Private Healthcare Settings

To understand the standard of care (SoC) and estimate resource utilization and costs related to chronic rhinosinusitis with nasal polyps (CRSwNP), from the private payer’s perspective in Brazil.

Resource utilization in mental illness – evaluation of an instrument for measuring direct costs of treatment for patients with severe mental illness (SMI)

Purpose Serious mental illnesses (SMIs) exert a considerable financial burden on health-care systems. In this study, the resource utilization in mental illness (RUMI) tool was developed and employed to evaluate resource utilization in patients with SMI. Materials and methods Data from 107 patients with SMI treated in four psychiatric outpatient clinics in Sweden were collected. The relationships between costs for physical and psychiatric care, social services, and the justice system, to self-reported health and quality of life, educational level, Global Assessment of Functioning (GAF), the Clinical Global Impressions scale score (CGI), and body mass index (BMI) were studied. Results Sixteen out of 107 patients accounted for 74% of the total costs. The mean and median cost for 6 months included in the survey for social services, family and social welfare and healthcare, psychiatric and physical treatment interventions, mean 8349 EUR, median 2599 EUR per patient (currency value for 2021). Education and psychosocial function (GAF) were both negatively correlated with costs for the social services (education, r=–0.207, p < 0.014; GAF, r=–0.258, p < 0.001). CGI was correlated with costs for physical and psychiatric healthcare (r = 0.161, p < 0.027), social services support (r = 0.245, p = 0.002) and total cost (r = 0.198, p = 0.007). BMI correlated with costs for psychiatric and physical health settings interventions (r = 0.155, p < 0.019) and for somatic and psychiatric medicines (r = 0.154, p < 0.019). Conclusion The RUMI scale was acceptable and enabled estimation of resource utilization in a comparable manner across different care settings. Such comparable data have potential to provide a basis for budgeting and resource allocation.

EPID-05. A novel, clinically-relevant classification of pediatric CNS tumors for cancer registries using a clustering analysis

Abstract To accurately evaluate the burden of pediatric central nervous system (CNS) tumors, estimate resources for cancer control, and monitor outcomes, a classification system that segregates tumors into clinically relevant groups is essential. The current classification of CNS tumors included in the third revision of the International Childhood Cancer Classification does not identify key clinical groups, such as low- and high-grade gliomas. To address this need, a novel classification was embarked upon using ICD-O-3 codes, CBTRUS grouping, incidence, survival, and treatment modalities as inputs. For each ICD-O-3 code with &amp;gt;50 new cases/year in CBTRUS from 2000 to 2016, 2 clinicians reached consensus defining the efficacy of three treatment modalities: surgical resection, radiotherapy, and chemotherapy. Then, patient level 5-year overall survival (OS) times were simulated based on total incidence and 5-year OS for each code. Subsequently, 5 factors were included as potential classifiers: tumor behavior, CBTRUS sub-group, and efficacy of the three treatment modalities. A “survival tree” was developed by using partitioning. Starting with the patient cohort (root), univariate cox proportional hazards model was used to identify statistically significant (P &amp;lt; 0.05) factors. The factors with the largest hazard ratio were selected manually to create child nodes. Within each child node, the partitioning process was repeated on remaining factors until no statistically significant factor remained. This clustering yielded 4 main groups (low-, intermediate-, high-, and very high-risk tumors) and 11 subgroups, including “embryonal tumors” and “low-risk glial and glioneuronal tumors”. Further validation of the classification will be sought through a structured consensus process using multidisciplinary experts. This systematic method to develop a classification for pediatric CNS tumors will allow for more relevant estimations of outcomes and better estimation of resource utilization. Furthermore, this strategy could be replicated for other disease groups.

0550 Health-Economic Implications of Defined Improvements in Restless Leg Syndrome Severity: A Model-Based Exploratory Analysis based on Prior Publication Data

Abstract Introduction Restless leg syndrome (RLS) is a debilitating condition associated with reduced health-related quality of life (HRQoL) and increased resource utilization. Our objective was to provide model-based estimates of quality-adjusted life year (QALY) gain and reduction in healthcare utilization that might be expected for changes in symptom severity. Methods We identified two health-economic studies which reported severity-specific quality-of-life and resource utilization. Happe et al. 2009 reported HRQoL using EQ-5D measurements stratified by International Restless Legs Scale (IRLS) severity (n=519, 63.6% female, 64.2 years) and Durgin et al. 2015 reported healthcare utilization stratified by RLS severity (no/mild/moderate/severe RLS) (n=2,392, 56.9% female, 56.0 years). We fitted regression models to support IRLS-specific estimates of EQ-5D and healthcare resource utilization. These models (polynomial for EQ-5D, linear for resource utilization) were applied to calculate QALY gain, and events avoided for ER visits, hospitalizations, and healthcare provider (HCP) visits over 5 years for IRLS improvement of 1-10 points, from a baseline of 30, 25, and 20. Results At five years, a 1, 3, 5, 7, and 10-point IRLS reduction corresponded to a QALY gain of 0.09, 0.25, 0.40, 0.52, and 0.69 for a baseline of 30, 0.07, 0.19, 0.29, 0.37, and 0.47 for a baseline of 25, and 0.04, 0.12, 0.18, 0.22, and 0.26 for a baseline of 20. The events avoided over 5 years with an IRLS reduction of 1, 3, 5, 7, and 10 points respectively were 1.12, 3.37, 5.62, 7.87, and 11.25 HCP visits, 0.09, 0.26, 0.43, 0.61, and 0.87 ER visits, and 0.04, 0.11, 0.18, 0.26, and 0.36 hospitalizations. Conclusion This exploratory analysis based on two health-economic studies confirms the substantial quality-of-life and healthcare cost burden associated with RLS. The data provide guidance on the magnitude of potential quality-of-life improvement and cost reduction that might be associated with defined improvement in RLS severity. Further investigation may be warranted for the factors that link change in IRLS and healthcare resource utilization, such as sleep deficits or cardiovascular risks. Support (If Any) Funding was provided by Noctrix Health

DRX in NR Unlicensed for B5G Wireless: Modeling and Analysis

The proliferation in the demand of high data rate and improved performance has urged wireless vendors to think of extending 5G New Radio (NR) in unlicensed bands. The unlicensed band is mainly used by Wi-Fi and Wi-Gig resulting in the reduced probability of channel availability. The User Equipment (UE) has to remain active and wait for the availability of unlicensed channel. This process escalates the energy expense of battery-constrained mobile devices. Discontinuous Reception (DRX) introduced in 3GPP can also be used in NR-Unlicensed (NR-U) to reduce UEs energy consumption. This article introduces a DRX mechanism over NR-U networks for both Standalone (SA) and Non-Standalone (NSA) deployment modes. We have used two different flavors, Beam-Search and Beam-Aware, to model DRX mechanism. Hence, the proposed DRX mechanisms are: Standalone DRX with Beam-Search (SBS-DRX), Standalone DRX with Beam-Aware (SBA-DRX), Non-Standalone DRX with Beam-Search (NBS-DRX), and Non-Standalone DRX with Beam-Aware (NBA-DRX). Semi-Markov based modeling is used to show the estimation of power-saving, average delay, and resource utilization. The power-saving achieved with SBA-DRX is 21.13% and 24.84% higher than 5G NR DRX for both Trace 1 and Trace 2, respectively. Moreover, delay achieved with NBA-DRX is 19.16% less than NBS-DRX with 18% less resource utilization.

Design Optimization for Low-Complexity FPGA Implementation of Symbol-Level Multiuser Precoding

This paper proposes and validates a low-complexity FPGA design for symbol-level precoding (SLP) in multiuser multiple-input single-output (MISO) downlink communication systems. In the optimal case, the symbol-level precoded transmit signal is obtained as the solution to an optimization problem tailored for a given set of users’ data symbols. This symbol-by-symbol design, however, imposes excessive computational complexity on the system. To alleviate this issue, we aim to reduce the per-symbol complexity of the SLP scheme by developing an approximate yet computationally-efficient closed-form solution. The proposed solution allows us to achieve a high symbol throughput in real-time implementations. To develop the FPGA design, we express the proposed solution in an algorithmic way and translate it to hardware description language (HDL). We then optimize the processing to accelerate the performance and generate the corresponding intellectual property (IP) core. We provide the synthesis report for the generated IP core, including performance and resource utilization estimates and interface descriptions. To validate our design, we simulate an uncoded transmission over a downlink multiuser channel using the LabVIEW software, where the SLP IP core is implemented as a clock-driven logic (CDL) unit. Our simulation results show that a throughput of 100 Mega symbols per second per user can be achieved via the proposed SLP design. We further use the MATLAB software to produce numerical results for the conventional zero-forcing (ZF) and the optimal SLP techniques as benchmarks for comparison. Thereby, it is shown that the proposed FPGA implementation of SLP offers an improvement of up to 50 percent in power efficiency compared to the ZF precoding. Remarkably, it enjoys the same per-symbol complexity order as that of the ZF technique. We also evaluate the loss of the real-time SLP design, introduced by the algebraic approximations and arithmetic inaccuracies, with respect to the optimal scheme.

A Cartesian Genetic Programming Based Parallel Neuroevolutionary Model for Cloud Server’s CPU Usage Prediction

Cloud computing use is exponentially increasing with the advent of industrial revolution 4.0 technologies such as the Internet of Things, artificial intelligence, and digital transformations. These technologies require cloud data centers to process massive volumes of workloads. As a result, the data centers consume gigantic amounts of electrical energy, and a large portion of data center electrical energy comes from fossil fuels. It causes greenhouse gas emissions and thus ensuing in global warming. An adaptive resource utilization mechanism of cloud data center resources is vital to get by with this huge problem. The adaptive system will estimate the resource utilization and then adjust the resources accordingly. Cloud resource utilization estimation is a two-fold challenging task. First, the cloud workloads are sundry, and second, clients’ requests are uneven. In the literature, several machine learning models have estimated cloud resources, of which artificial neural networks (ANNs) have shown better performance. Conventional ANNs have a fixed topology and allow only to train their weights either by back-propagation or neuroevolution such as a genetic algorithm. In this paper, we propose Cartesian genetic programming (CGP) neural network (CGPNN). The CGPNN enhances the performance of conventional ANN by allowing training of both its parameters and topology, and it uses a built-in sliding window. We have trained CGPNN with parallel neuroevolution that searches for global optimum through numerous directions. The resource utilization traces of the Bitbrains data center is used for validation of the proposed CGPNN and compared results with machine learning models from the literature on the same data set. The proposed method has outstripped the machine learning models from the literature and resulted in 97% prediction accuracy.

Fueling Clinical and Translational Research in Appalachia: Informatics Platform Approach.

BackgroundThe Appalachian population is distinct, not just culturally and geographically but also in its health care needs, facing the most health care disparities in the United States. To meet these unique demands, Appalachian medical centers need an arsenal of analytics and data science tools with the foundation of a centralized data warehouse to transform health care data into actionable clinical interventions. However, this is an especially challenging task given the fragmented state of medical data within Appalachia and the need for integration of other types of data such as environmental, social, and economic with medical data.ObjectiveThis paper aims to present the structure and process of the development of an integrated platform at a midlevel Appalachian academic medical center along with its initial uses.MethodsThe Appalachian Informatics Platform was developed by the Appalachian Clinical and Translational Science Institute’s Division of Clinical Informatics and consists of 4 major components: a centralized clinical data warehouse, modeling (statistical and machine learning), visualization, and model evaluation. Data from different clinical systems, billing systems, and state- or national-level data sets were integrated into a centralized data warehouse. The platform supports research efforts by enabling curation and analysis of data using the different components, as appropriate.ResultsThe Appalachian Informatics Platform is functional and has supported several research efforts since its implementation for a variety of purposes, such as increasing knowledge of the pathophysiology of diseases, risk identification, risk prediction, and health care resource utilization research and estimation of the economic impact of diseases.ConclusionsThe platform provides an inexpensive yet seamless way to translate clinical and translational research ideas into clinical applications for regions similar to Appalachia that have limited resources and a largely rural population.

PND70 EVALUATING THE IMPORTANCE OF DRUG ADMINISTRATION AND MONITORING COSTS IN ECONOMIC EVALUATION FOR MANAGEMENT OF MULTIPLE SCLEROSIS IN THE UNITED KINGDOM

Estimation of healthcare resource utilization (HCRU) cost, like drug administration and drug monitoring costs, is a crucial part of an economic evaluation and slight variation can substantially impact the decision of the economic analysis. With more countries adopting economic evaluations as part of their Health Technology Assessment (HTA) submissions, identifying country specific HCRU costs has become an important process. The precise estimation of these costs through comprehensive methodology is essential for optimal decision making. The objective of this study was to estimate and assess drug administration and drug monitoring costs across different disease modifying therapies for the management of Multiple Sclerosis (MS) in the United Kingdom (UK). A Microsoft Excel® based HCRU cost calculator was developed for different multiple sclerosis drugs. The HCRU requirements were extracted from the Summary of Product Characteristics and Food and Drug Administration. The HCRU cost data was extracted from the National Health Service costs and Personal Social Service Research Unit. All HCRU requirements were interpreted to estimate annual cost in the real-world scenario. The annual administration cost per patient was estimated to be highest for natalizumab followed by alemtuzumab and ocrelizumab. The annual monitoring cost per patient was estimated to be highest for natalizumab followed by dimethyl fumarate and alemtuzumab. Overall, highest annual HCRU cost per patient was associated with natalizumab followed by alemtuzumab and ocrelizumab. The careful assessment of HCRU requirements in addition to drug cost should be assessed in order to have pragmatic economic evaluation in MS management. The HCRU cost calculator methodology could be useful to study real-world effectiveness & utilization patterns across different therapy areas, globally.

Fall/Fracture-Related Healthcare Costs and Their Association with Cumulative Anticholinergic Burden in People with Overactive Bladder.

BackgroundFalls/fractures are major causes of morbidity and mortality among older adults and the resulting health consequences generate a substantial economic burden. Risk factors are numerous and include overactive bladder (OAB) and anticholinergic use.ObjectivesWe aimed to estimate the impact of falls/fractures on all-cause healthcare resource utilization and costs, according to levels of cumulative anticholinergic burden, among individuals with OAB.MethodsAmong a US cohort of adults with OAB (identified based on medical claims for OAB or OAB-specific medications), the frequency of resource utilization (outpatients visits, medication use, and hospitalizations) was examined according to level of anticholinergic burden. Anticholinergic burden was assessed cumulatively using a published measure, and categorized as no, low, medium, or high. Resource utilization prior to and after a fall/fracture was compared. Generalized linear models were used to examine overall and incremental changes in healthcare resource utilization and costs by fall/fracture status, and annual costs were predicted according to age, sex, fall/fracture status, and level of anticholinergic burden.ResultsThe mean age of the OAB cohort (n = 154,432) was 56 years, 68% were female, and baseline mean anticholinergic burden was 266.7 (i.e. a medium level of burden); a fall/fracture was experienced by 9.9% of the cohort. All estimates of resource utilization were higher among those with higher levels of anticholinergic burden, regardless of fall/fracture status, and higher for all levels of anticholinergic burden after a fall/fracture. Among those with a fall/fracture, the highest predicted annual costs were observed among those aged 66–75 years with high anticholinergic burden (US$22,408 for males, US$22,752 for females).ConclusionsFalls/fractures were associated with higher costs, which increased with increasing anticholinergic burden.Electronic supplementary materialThe online version of this article (10.1007/s41669-020-00215-w) contains supplementary material, which is available to authorized users.