Excess Healthcare Costs Research Articles

Healthcare Costs of Secondhand Smoke Exposure at Home for U.S. Children

The purpose of this study is to estimate healthcare utilization and healthcare costs due to secondhand smoke exposure at home for children in the U.S. Using data from the 2000, 2005, and 2010 U.S. National Health Interview Surveys, the authors analyzed the association between secondhand smoke exposure at home and utilization of three types of healthcare services (hospital nights, emergency room visits, and doctor visits) for children aged 3-14 years (N=16,860). A zero-inflated Poisson regression model was used to control for sociodemographic characteristics and the number of months without health insurance. The authors determined excess healthcare utilization attributable to secondhand smoke exposure at home for children and then estimated annual secondhand smoke-attributable healthcare costs as the product of annual excess healthcare utilization and unit costs obtained from the 2014 Medical Expenditures Panel Survey. This study was conducted from 2016 to 2018. The prevalence of secondhand smoke exposure at home for children in 2000, 2005, and 2010 was 25.0%, 12.3%, and 9.1%, respectively. Secondhand smoke exposure at home was positively associated with emergency room visits, but was not significantly associated with nights at the hospital or doctor visits for children. Secondhand smoke exposure at home for children resulted in an excess of 347,156 emergency room visits in 2000, 124,412 visits in 2005, and 101,570 visits in 2010, which amounted to $215.1 million, $77.1 million, and $62.9 million in excess annual healthcare costs (2014 dollars) in 2000, 2005, and 2010, respectively. Although U.S. healthcare costs attributable to secondhand smoke exposure at home for children are declining, interventions to reduce secondhand smoke exposure at home for children are still needed to reduce the economic burden attributable to secondhand smoke exposure.

1270. Are HIV-Related Diagnostics Excessively Ordered? A Pilot Intervention Study to Improve Test Use in the Inpatient Setting

BackgroundExcessive ordering of HIV-related laboratory tests (CD4 counts, HIV RNA levels, and HIV genotypes) may result in increased healthcare costs, unneeded interventions (e.g., response to low CD4 in acute illness), and patient anxiety. Recent data have evaluated methods to reduce excessive testing in outpatients, but there are limited data in the inpatient setting. The purpose of this study was to evaluate if implementation of a pharmacist-driven intervention protocol based on published guidelines improved utilization of HIV-related diagnostics in the inpatient setting.MethodsA pre-interventional study performed on HIV diagnostics usage over a 1-year period, followed by a 3-month post-interventional study at a large academic medical center to evaluate and improve HIV test ordering. Patients were included if ≥18 years old with suspected or documented HIV infection and CD4 count, HIV RNA level, or HIV genotype ordered. A pharmacist-driven intervention was undertaken in which ordered tests were evaluated and canceled if deemed inappropriate per pre-specified criteria based on CDC and DHHS guidelines, and clinicians were provided education on appropriate ordering. Results were tabulated and presented as descriptive statistics, and financial data were calculated based on in-hospital costs.ResultsIn the pre-intervention arm, 87% (296/341) of total tests ordered did not meet criteria for appropriate ordering (160 unneeded CD4 counts, 126 RNA levels, and 10 genotypes). These tests resulted in excessive financial burden of $24,600. Post-intervention, 63% (32/51) of HIV-related tests were canceled netting an initial savings of $2,700. Most common cancelation reason was recent outpatient laboratories readily available. Post-intervention, HIV-related testing decreased over time, likely due to the intervention audit and feedback provided to clinicians.ConclusionA pharmacist-driven intervention reduced the number of unnecessary HIV-associated tests by 63% and offered significant cost savings. These data suggest the importance of evaluating the appropriateness of HIV-related diagnostic testing in the inpatient setting to improve test usage and reduce excessive healthcare costs.Disclosures All authors: No reported disclosures.

The Impact of Healthcare-Associated Methicillin-Resistant Staphylococcus aureus Infections on Postdischarge Health Care Costs and Utilization across Multiple Health Care Systems.

To measure how much of the postdischarge cost and utilization attributable to methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) occur within the US Department of Veterans Affairs (VA) system and how much occurs outside. Health care encounters from 3 different settings and payment models: (1) within the VA; (2) outside the VA but paid for by the VA (purchased care); and (3) outside the VA and paid for by Medicare. Historical cohort study using data from admissions to VA hospitals between 2007 and 2012. We assessed the impact of a positive MRSA test result on costs and utilization during the 365days following discharge using inverse probability of treatment weights to balance covariates. Among a cohort of 152,687 hospitalized Veterans, a positive MRSA test result was associated with an overall increase of 6.6 (95 percent CI: 5.7-7.5) inpatient days and $9,237 (95 percent CI: $8,211-$10,262) during the postdischarge period. VA inpatient admissions, Medicare reimbursements, and purchased care payments accounted for 60.6 percent, 22.5 percent, and 16.9 percent of these inpatient costs. While most of the excess postdischarge health care costs associated with MRSA HAIs occurred in the VA, non-VA costs make up an important subset of the overall burden.

Epidemiology and Immune Pathogenesis of Viral Sepsis

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. Sepsis can be caused by a broad range of pathogens; however, bacterial infections represent the majority of sepsis cases. Up to 42% of sepsis presentations are culture negative, suggesting a non-bacterial cause. Despite this, diagnosis of viral sepsis remains very rare. Almost any virus can cause sepsis in vulnerable patients (e.g., neonates, infants, and other immunosuppressed groups). The prevalence of viral sepsis is not known, nor is there enough information to make an accurate estimate. The initial standard of care for all cases of sepsis, even those that are subsequently proven to be culture negative, is the immediate use of broad-spectrum antibiotics. In the absence of definite diagnostic criteria for viral sepsis, or at least to exclude bacterial sepsis, this inevitably leads to unnecessary antimicrobial use, with associated consequences for antimicrobial resistance, effects on the host microbiome and excess healthcare costs. It is important to understand non-bacterial causes of sepsis so that inappropriate treatment can be minimised, and appropriate treatments can be developed to improve outcomes. In this review, we summarise what is known about viral sepsis, its most common causes, and how the immune responses to severe viral infections can contribute to sepsis. We also discuss strategies to improve our understanding of viral sepsis, and ways we can integrate this new information into effective treatment.

A Multi-Fidelity Rollout Algorithm for Dynamic Resource Allocation in Population Disease Management.

Dynamic resource allocation for prevention, screening, and treatment interventions in population disease management has received much attention in recent years due to excessive healthcare costs. In this paper, our goal is to design a model and an efficient algorithm to optimize sequential intervention policies under resource constraints to improve population health outcomes. We consider a discrete-time finite-horizon budget allocation problem with disease progression within a closed birth-cohort population. To address the computational challenges associated with large-state and multiple-period dynamic decision-making problems, we propose a low-fidelity approximation that preserves the population dynamics under a stationary policy. To improve the healthcare interventions in terms of population health outcomes, we then embed the low-fidelity approximation into a high-fidelity optimization model to efficiently identify a good non-stationary sequential intervention policy. Our approach is illustrated by a numerical example of screening and treatment policy implementation for chronic hepatitis C virus (HCV) infection over a budget planning period. We numerically compare our Multi-Fidelity Rollout Algorithm (MF-RA) to a grid search approach and demonstrate the similarity of sequential policy trends and closeness of overall health outcomes measured by quality-adjusted life-years (QALYs) and the total number of individuals that undergo screening and treatment for different annual budgets and birth-cohorts. We also show how our approach scales well to problems with high dimensionality due to many decision periods by studying time to elimination of HCV.

Clinical epidemiology of infectious disease among patients with chronic kidney disease

Infectious disease is recognized as an important complication among patients with end-stage renal disease, contributing to excess morbidity and health care costs. However, recent epidemiological studies have revealed that even mild to moderate stages of chronic kidney disease (CKD) substantially increase risk of infection. Regarding underlying mechanisms, evidence suggests various aspects of altered immune response in patients with CKD including impaired function of T cells, B cells and neutrophil. Multiple conditions surrounding CKD, such as older age, diabetes, and cardiovascular disease are important contributors in the increased susceptibility to infection in this population. In addition, several mechanisms impairing immune function have been hypothesized including accumulated uremic toxins, increased oxidative stress, endothelial dysfunction, low-grade inflammation, and mineral and bone disorders. In terms of prevention strategies, influenza and pneumococcal vaccines are most feasible and important. Nevertheless, the extent of vaccine utilization in CKD has not been well documented. In addition, antibody response to vaccination may be reduced in CKD patients, and thus a vaccine delivery strategy (e.g., dose and frequency) may need to be optimized among patients with CKD. Through this review, we demonstrate that infection is a major but underrecognized complication of CKD. As CKD is recognized as a serious public health issue, dedicated research is needed to better characterize the burden of infectious disease associated with CKD, understand the pathophysiology of infection in patients with CKD, and develop effective strategies to prevent infection and its sequela in this high risk population.

Delayed discharge does not decrease the cost of readmission after pulmonary lobectomy

Readmission after pulmonary lobectomy has become a potentially avoidable source of excess health care costs. Initiatives that focus on expedited discharge after lobectomy may decrease costs, but a criticism of this approach is that expedited discharge may be associated with more frequent and more expensive readmissions. We explored whether patients are at greater risk for costly readmission after expedited discharge. The Nationwide Readmission Database was queried for cases of lobectomy for lung cancer between 2010 and 2014. Patients 65 years of age and older were categorized into three groups: patients discharged between hospital day 1 and 3 (expedited), between hospital days 4 and 7 (routine), or discharge after day 8 (late). Risk-adjusted 90-day readmission rates and hospital costs for readmission were compared among groups. A total of 104,905 patients underwent lobectomy for lung cancer during the study period. There were 18,652 (17.8%) expedited discharges, 54,551 (52.0%) routine discharges, and 31,702 (30.2%) late discharges. Compared with the expedited group, patients in the routine discharge group had a 3.2% greater risk-adjusted readmission rate (P < .0001), and patients in the late discharge group had 12.7% greater risk-adjusted readmission rate (P < .0001). After adjustment, expedited discharge was associated with a $4,066 decrease in index hospital costs compared with routine discharge, and a $19,233 decrease compared with late discharges (both P < .0001) but was not associated with costlier readmission (routine mean -$24 ± standard error $153, P = .87; late mean +$2,528 ± standard error $178; P < .0001). Expedited discharge after lobectomy is associated with a greater risk-adjusted readmission rate and greater index hospital costs over routine and late discharge, with no increased costs for readmission. These data demonstrate that prolonged hospital duration of stay does not decrease the risk of 90-day readmission after lobectomy, providing support for protocols that expedite patient discharge and decrease overall health care utilization.

2261 - Estimating the Health Benefits of a Proposed Regional Transportation Plan

The population of the Greater Toronto-Hamilton Area (GTHA) is projected to grow from 6.2 million people in 2001 to 9.6 million in 2031. Existing commute times are the country's highest with annual costs of congestion to reach $15 billion. A proposed 25-year, $50 billion Regional Transportation Plan (RTP) would build a regional rapid transit network, expand active transportation (AT), and build communities that are AT- and transit-supportive. Medical Officers of Health of GTHA communities issued a call to action for government investment based on the estimated health-related benefits of implementing the RTP. To calculate increases in transport physical activity, the RTP's projected increase in public transit use was combined with conservative estimates of increases in AT to work and school by adults (5%), as well as a substitution of 5% of local vehicle trips ≤7 km with AT. The associated number of prevented deaths and incident cases of diabetes were calculated using the Health Economic Assessment Tool and the Diabetes Population Risk Tool, respectively. Data inputs included regional travel data from transportation and census surveys, crude mortality rates, and literature-based walking estimates with transit use. Adjustments were included for the duration of the academic year and seasons. A value of a statistical life (VSL) was $6.5 million and the lifetime excess medical costs of a diabetes case of $24,500. Previous Toronto-based estimates for annual premature deaths and hospitalizations attributed to traffic-related emissions were extrapolated to the GTHA based on population. Full implementation of the RTP would prevent 338 deaths per year in the current population with a VSL-based cost of $2.2 billion. The number of projected prevented deaths due to increased physical activity (184) and reduced vehicle emissions (154) were similar. The annual number of prevented cases of diabetes due to an increase in physical activity was 1,061 with a projected lifetime excess healthcare costs of almost $26 million. The projected health impacts of the RTP are substantial, yet conservative since they consider only mortality and diabetes incidence. The results provided an additional health-based argument for government investment, as well as signaled public health's interest in building healthier communities. In addition to initial media coverage, the report has been repeatedly cited at local, provincial and national levels. While impossible to directly attribute causality, subsequent government policies have included strengthening the accountability for integrated land use and transportation planning, as well as substantial investment in the RTP.

2261 - Estimating the Health Benefits of a Proposed Regional Transportation Plan

Highest Scoring Abstract: Practitioner Background The population of the Greater Toronto-Hamilton Area (GTHA) is projected to grow from 6.2 million people in 2001 to 9.6 million in 2031. Existing commute times are the country's highest with annual costs of congestion to reach $15 billion. A proposed 25-year, $50 billion Regional Transportation Plan (RTP) would build a regional rapid transit network, expand active transportation (AT), and build communities that are AT- and transit-supportive. Medical Officers of Health of GTHA communities issued a call to action for government investment based on the estimated health-related benefits of implementing the RTP. Methods To calculate increases in transport physical activity, the RTP's projected increase in public transit use was combined with conservative estimates of increases in AT to work and school by adults (5%), as well as a substitution of 5% of local vehicle trips ≤7 km with AT. The associated number of prevented deaths and incident cases of diabetes were calculated using the Health Economic Assessment Tool and the Diabetes Population Risk Tool, respectively. Data inputs included regional travel data from transportation and census surveys, crude mortality rates, and literature-based walking estimates with transit use. Adjustments were included for the duration of the academic year and seasons. A value of a statistical life (VSL) was $6.5 million and the lifetime excess medical costs of a diabetes case of $24,500. Previous Toronto-based estimates for annual premature deaths and hospitalizations attributed to traffic-related emissions were extrapolated to the GTHA based on population. Results Full implementation of the RTP would prevent 338 deaths per year in the current population with a VSL-based cost of $2.2 billion. The number of projected prevented deaths due to increased physical activity (184) and reduced vehicle emissions (154) were similar. The annual number of prevented cases of diabetes due to an increase in physical activity was 1,061 with a projected lifetime excess healthcare costs of almost $26 million. Conclusions The projected health impacts of the RTP are substantial, yet conservative since they consider only mortality and diabetes incidence. The results provided an additional health-based argument for government investment, as well as signalled public health's interest in building healthier communities. In addition to initial media coverage, the report has been repeatedly cited at local, provincial and national levels. While impossible to directly attribute causality, subsequent government policies have included strengthening the accountability for integrated land use and transportation planning, as well as substantial investment in the RTP.

Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study.

Objectives: Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. Methods: A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population (n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. Results: IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. Conclusions: IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.

Assessment of inappropriate antibiotic prescribing among a large cohort of general dentists in the United States

BackgroundThe purpose of this study was to assess dental antibiotic prescribing trends over time, to quantify the number and types of antibiotics dentists prescribe inappropriately, and to estimate the excess health care costs of inappropriate antibiotic prescribing with the use of a large cohort of general dentists in the United States. MethodsWe used a quasi-Poisson regression model to analyze antibiotic prescriptions trends by general dentists between January 1, 2013, and December 31, 2015, with the use of data from Express Scripts Holding Company, a large pharmacy benefits manager. We evaluated antibiotic duration and appropriateness for general dentists. Appropriateness was evaluated by reviewing the antibiotic prescribed and the duration of the prescription. ResultsOverall, the number and rate of antibiotic prescriptions prescribed by general dentists remained stable in our cohort. During the 3-year study period, approximately 14% of antibiotic prescriptions were deemed inappropriate, based on the antibiotic prescribed, antibiotic treatment duration, or both indicators. The quasi-Poisson regression model, which adjusted for number of beneficiaries covered, revealed a small but statistically significant decrease in the monthly rate of inappropriate antibiotic prescriptions by 0.32% (95% confidence interval, 0.14% to 0.50%; P = .001). ConclusionsOverall antibiotic prescribing practices among general dentists in this cohort remained stable over time. The rate of inappropriate antibiotic prescriptions by general dentists decreased slightly over time. Practical ImplicationsFrom these authors’ definition of appropriate antibiotic prescription choice and duration, inappropriate antibiotic prescriptions are common (14% of all antibiotic prescriptions) among general dentists. Further analyses with the use of chart review, administrative data sets, or other approaches are needed to better evaluate antibiotic prescribing practices among dentists.

Disease burden of knee osteoarthritis patients with a joint replacement compared to matched controls: a population-based analysis of a Dutch medical claims database.

On a population level, the incidence of knee prostheses (KPs) has increased, but excess health care costs per patient, compared to matched controls without a KP, in the years surrounding these procedures and their determinants are largely unknown. We therefore aimed to provide estimates of age- and sex-specific incidence of KPs, revision KPs, and prosthesis complications in patients with knee osteoarthritis (OA) and to determine excess health care costs in the years surrounding surgery compared with matched controls. All KPs in OA patients in the Achmea Health Database were identified as well as up to four controls. Incidence rates of KPs, revisions, and complications from 2006 to 2013 were determined. Annual health care cost and excess costs (over matched controls) preceding, during, and after surgery were calculated and their determinants were evaluated. The increased incidence of KPs, revisions, and complications was strongest in younger age categories and men. The average costs per patient were relatively stable between 2006 and 2012. KP patient's annual health care costs increased towards the year of surgery. After surgery, costs decreased, but remained higher as compared to costs prior to surgery. High post-surgery costs were mainly associated with subsequent revisions or additional KPs, but costs were also higher in females, lower age categories, and lower social economic status. These results underscore the increasing burden and medical need associated with end-stage OA, especially in younger age categories. Improvement of guidelines tailored to individual patient groups aimed at avoiding complications and revisions is required to counteract this increasing burden.

Opioid Abuse: A Detailed Examination of Cost Drivers over a 24-Month Follow-up Period.

Previous work has documented the considerable economic burden associated with opioid abuse, dependence, and overdose/poisoning (hereafter, "abuse"). Recent analyses have provided insights into the trajectory and drivers of the excess costs of abuse both before and after diagnosis, showing the important role of other substance abuse, mental health issues, and painful conditions. To build on the recently published study by Kirson et al. (2017) and extend its findings by (a) evaluating the trajectory of excess costs of abuse for an additional year after an incident abuse diagnosis and (b) exploring the diagnosis-level drivers of excess costs over time in greater detail. Using administrative medical and pharmacy claims, which included payment amounts, for beneficiaries covered by large self-insured companies throughout the United States, abusers were matched to controls using the same methods as in Kirson et al. Excess health care costs were assessed over a 24-month follow-up period, which comprised the 6 months before the initial abuse diagnosis and the 18 months after. Drivers of excess costs were then evaluated by diagnosis (grouped at the 3-digit ICD-9-CM level). This study analyzed 9,345 matched pairs of abusers and non-abusers. Similar to the previous study, mean per-patient excess health care costs were found to rise considerably leading up to and shortly after the incident diagnosis of abuse, reaching $15,764 over the first half of the follow-up period. Over the newly extended follow-up period (months 6 to 18 after diagnosis), excess costs remained elevated ($7,346) and did not return to baseline levels. Over time, an increasing share of excess costs was observed for outpatient services and prescription drug use, relative to acute care settings. A detailed examination of cost drivers suggested elevated costs in several clinical categories (e.g., gastrointestinal, respiratory conditions) beyond those previously identified. This research finds that the excess medical costs of abuse extend for at least 1 more year than previously documented, reflecting the need for considerable follow-up care over time. The identification of several other clinical categories with elevated excess costs suggests important areas for future research into the interaction of opioid abuse with the management of other conditions. This study was funded by Purdue Pharma. Howard was an employee of Purdue Pharma at the time that this study was conducted. Kirson, Scarpati, Jia, and Wen are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Study concept and design were contributed by Kirson, Scarpati, and Howard, along with Jia and Wen. Jia and Wen took the lead in data collection, with assistance from Scarpati and Kirson. Data interpretation was performed by Scarpati, Kirson, and Howard, with assistance from Jia and Wen. The manuscript was written and revised by Scarpati, Kirson, and Howard.

Direct evidence of central nervous system axonal damage in patients with postoperative delirium: A preliminary study of pNF-H as a promising serum biomarker

IntroductionApproximately 50–80% patients experience postoperative delirium, an acute cognitive dysfunction associated with prolonged hospitalization, increased mortality, excess healthcare costs, and persistent cognitive impairment. Elucidation of the mechanism of delirium and associated diagnostic and therapeutic measures are urgently required. Here we investigated the role of phosphorylated neurofilament heavy subunit (pNF-H), a major structural protein in axons, as a predictive maker of postoperative delirium. Material and methodsTwenty-three patients who underwent surgery for abdominal cancer were screened for postoperative delirium, and they were assessed for its severity using the memorial delirium assessment scale (MDAS) at and 48h after delirium onset. Serum pNF-H levels were also measured at both time points. The patients were divided into two groups according to the presence or absence of pNF-H. Clinical variables were compared between groups using the Mann–Whitney U test, and the relationship between pNF-H levels and delirium severity was analyzed using the exponential curve fitting. ResultsFifteen of the 23 (65.2%) patients tested positive for pNF-H, and these patients exhibited significantly higher MDAS scores compared with the pNF-H-negative patients only at the onset of delirium. Although the MDAS score significantly improved over time in the positive group, pNF-H positivity persisted. There was a correlation between the maximum pNF-H level and maximum MDAS score (R2=0.31, p=0.013). ConclusionsMore severe postoperative delirium was directly related to higher serum pNF-H levels, suggesting the potential application of pNF-H as a quantitative biomarker of neural damage in postoperative delirium.

Association of Rates of Obesity with Voting Patterns in the 2016 Presidential Election

Excess health care costs for treatment of noncommunicable diseases caused by obesity are now $200 billion/year. In addition, obesity reduces workforce productivity, and increases risks for disability and accidents. The executive branch of government can potentially influence obesity through many mechanisms, including policies for health care, feeding assistance programs, dietary guidelines, industry subsidies or tax breaks for weight management programs, farm subsidies for different types of agricultural products, diet‐physical activity policies for government employees and the military, and funding for obesity research. Despite this powerful connection between national administrations and the likely ability of the U.S. to manage its obesity epidemic, little is known about the relationship between obesity and voting patterns. We examined the association of rates of obesity with voting patterns in the 2016 presidential election to explore the political ramifications of this challenging disease.Data on rates of obesity across states and Washington D.C. were drawn from CDC data. Voting patterns in the 2016 election, the percent of the population in different racial/ethnic categories, and median income were taken from public records. There was a strong positive association between rate of obesity and percent of votes received by the Republican presidential candidate (Spearman's correlation coefficient=0.755, P&lt;0.001), and a negative association of rate of obesity with percent of votes received by the Democrat presidential (Spearman's correlation coefficient=0.553, P&lt;0.001). In regression models adding median income and percent ethnic minorities as covariates, percent of votes received by the Republican candidate remained a strong and highly significant predictor of percent obesity.The underlying reasons for the robust association of obesity and republican voting, independent of income and ethnic minority populations, are not known. However, regional food consumption patterns, eating habits and lifestyle are likely to important, given the dominant role of these factors in the development and maintenance of obesity, as well as rates of educational attainment and rural versus urban environments.These results confirm and extend associations of republication voting and rates of obesity documented in previous elections. Reducing health care costs and increasing employment were common agenda items during the 2016 presidential election. Even a 5–10% weight loss reduces health care costs and employee absenteeism within two years. By using a combination of executive actions and increased research funding, obesity reduction is likely to provide a quick return on investment that supports multiple political priorities.

Abdominal obesity and healthcare costs related to hypertension and diabetes in older adults

ABSTRACT Objective: To analyze the association between excess abdominal fat and healthcare costs related to hypertension and diabetes Mellitus in older adults. Methods: These cross-sectional analyses are part of the Health, Wellbeing and Aging Study conducted in São Paulo, Brazil, with 806 older adults with self-reported hypertension and diabetes Mellitus. The study included the annual costs with medicines, hospital admissions, and outpatient services for hypertension and diabetes Mellitus control. Excess abdominal fat was diagnosed based on waist circumference. Level of physical activity, age, and gender were considered covariates. The sample was divided into two groups according to waist circumference. Multiple logistic regression analyzed the associations between annual costs and waist circumference. Results: The cost of services and hospitalizations (R$551.05; 95%CI=418.27-683.83) and total costs (R$817.77; 95%CI=669.21-966.33) were higher in the excess abdominal fat group. Older adults with high waist circumference had higher odds of increasing annual costs due to medicines (OR=2.6; 95%CI=1.13-3.77), regardless of gender, age, and level of physical activity. Conclusion: Healthcare costs for treating hypertension and diabetes Mellitus in older adults are higher in the presence of excess abdominal fat.

Abstract 049: Smart Rx

Introduction: Chronic cardiac conditions, such as heart failure (HF) and atrial fibrillation (AF), have complex pathophysiology that can often pose challenges when treating comorbid conditions, especially with respect to drug-disease interactions. Although much is known scientifically about these interactions, integrating such evidence into clinical practice with the intent of avoiding negative health outcomes and avoiding excess healthcare costs has proved challenging. Here, we present: (1) a novel software platform that enables real-time assessment of incidence of drug-disease interactions among patients with CHF taking medications for other comorbid indications in a large cohort; and (2) development of a natural language processing (NLP)-driven software platform for performing such quality improvement assessments through automated searches of the electronic health record (EHR) of patients with any cardiac disease. Methods and Results: An NLP-driven search tool (Figure 1A) was developed based upon the Queriable Patient Inference Dossier (QPID) created by the Laboratory of Computer Science at the Massachusetts General Hospital (MGH) that incorporates an automated assessment of chronic cardiac diseases and of medications that have been identified as absolutely or relatively contraindicated in patients with specific cardiac diseases. The tool, which can be customized to assess for medications or other factors important in cardiovascular care, was used to perform an automated cross-sectional study of medications prescribed to 2,500 patients with CHF currently under care at the MGH. All records were manually reviewed by two independent observers, with a Cohen’s κ of greater than 0.8. Nearly 60% of patients were prescribed agents in the past three months that are known to cause major or moderate adverse events, with three drugs (citalopram, doxazosin and ibuprofen), accounting for over 80% of the contraindicated agents (Figure 1B). Conclusion: Use of prescription drugs known to cause major or moderate adverse events among patients with HF is quite common. An automated software platform for rapid real-time assessment of drug disease interactions can help identify gaps in care and help improve the quality of care among patients with cardiovascular disease and multiple comorbidities.

The Economic Burden of Opioid Abuse: Updated Findings.

Opioid pain relievers can be highly effective in providing relief for patients suffering from pain. At the same time, prescription opioid abuse, dependence, overdose, and poisoning (hereinafter "abuse") have become a national public health concern. Opioid abuse is also costly: previous estimates of the annual excess costs of opioid abuse to payers range from approximately $10,000 to $20,000 per patient. To (a) provide a comprehensive, current estimate of the economic burden of opioid abuse to commercial payers and (b) explore the drivers of these excess costs of abuse. Administrative claims from beneficiaries covered by large self-insured companies throughout the United States were used to identify patients diagnosed with opioid abuse, dependence, and overdose/poisoning ("abuse") between 2012 and 2015. Sample selection criteria identified patients most likely to be misusing opioids. Abusers and nonabuser controls were matched using propensity scores. Excess health care costs were assessed over the 18-month study period. Drivers of excess costs were then evaluated by place of service and medical condition (identified as 3-digit ICD-9-CM groupings). 9,342 matched abuser/nonabuser pairs were analyzed. Relative to nonabusers, abusers had significantly higher annual health care resource utilization, leading to $14,810 in per-patient incremental annual health care costs. Excess costs began accumulating 5 months before the formal, incident diagnosis of abuse, driven by alcohol and nonopioid substance abuse. Major drivers of excess costs of abuse included opioid and other substance abuse disorders, mental health conditions, and painful conditions. Many patients had diagnoses for other substance abuse that predated their opioid abuse diagnoses. Opioid abuse imposes a substantial economic burden on payers and often occurs in the context of other substance abuse. Poly-substance abuse often precedes the diagnosis of opioid abuse. This study was funded by Purdue Pharma. Mayne is an employee of Purdue Pharma. Kirson, Scarpati, and Birnbaum are employees of Analysis Group, which received funding from Purdue Pharma to conduct this study. Enloe and Dincer were employees of Analysis Group at the time this research was conducted. Study concept and design were contributed by Kirson, Birnbaum, Mayne, and Scarpati, along with Enloe and Dincer. Enloe and Dincer took the lead in data collection, along with Birnbaum and assisted by Kirson and Scarpati. Data interpretation was performed by all the authors. The manuscript was written and revised by Kirson and Scarpati, along with Mayne and Birnbaum.

The effect of childhood adversity on 4-year outcome in individuals at ultra high risk for psychosis in the Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial

Childhood adversity is associated with a range of mental disorders, functional impairment and higher health care costs in adulthood. In this study we evaluated if childhood adversity was predictive of adverse clinical and functional outcomes and health care costs in a sample of patients at ultra-high risk (UHR) for developing a psychosis. Structural Equation Modeling was used to examine the effect of childhood adversity on depression, anxiety, transition to psychosis and overall functioning at 4-year follow-up. In addition, we evaluated economic costs of childhood adversity in terms of health care use and productivity loss. Data pertain to 105 UHR participants of the Dutch Early Detection and Intervention Evaluation (EDIE-NL). Physical abuse was associated with higher depression rates (b=0.381, p=0.012) and lower social functional outcome (b=−0.219, p=0.017) at 4-year follow-up. In addition, emotional neglect was negatively associated with social functioning (b=−0.313, p=0.018). We did not find evidence that childhood adversity was associated with transition to psychosis, but the experience of childhood adversity was associated with excess health care costs at follow-up. The data indicate long-term negative effects of childhood adversity on depression, social functioning and health care costs at follow-up in a sample of UHR patients.

Epidemiology of Hemoglobinopathies in the Huzhou Region, Zhejiang Province, Southeast China

The aim of the present study was to report the frequency of thalassemia traits and other hemoglobinopathies in Huzhou City, Zhejiang Province, People’s Republic of China (PRC), and for the future management of hemoglobinopathies. A total of 8578 pregnant women in the Huzhou region was analyzed for thalassemia traits and other hemoglobinopathies from July 1 2012 to November 30 2015. Complete blood count (CBC), and hemoglobin (Hb) variant analyses were performed with automatic counters and capillary electrophoresis (CE). High resolution melting (HRM) analysis was applied for genetic diagnosis of thalassemia. The prevalence of patients with the α-thalassemia (α-thal) trait was 1.01% (87/8578). β-Thalassemia (β-thal) was carried by 112 women with a frequency of 1.3%. The carrier rate of thalassemia genes in the studied samples was nearly 2.32%. We excluded those without iron studies, with 159 cases as our sample, a total of 63/159 cases (39.6%) also had iron deficiencies. Moreover, Hb E (HBB: c.79G > A), and Hb D-Punjab (HBB: c.364G > C) were the most common Hb variants after thalassemia trait with frequencies of 0.16 and 0.06%, respectively. Only two Hb S (HBB: c.20A > T) carriers were detected in 20 months of screening time. Hb A1c results could be confidently reported on all cases except the Hb D-Punjab and Hb E variants. This study provided a detailed prevalence and molecular characterization of thalassemia in the Huzhou region, and will contribute toward the development of prevention strategies and reducing excessive health care costs in this area, allowing better management of hemoglobinopathies.