Greater Healthcare Resource Use Research Articles

Prevalence and burden of chronic cough in France.

Chronic cough is a common condition that is associated with lower health-related quality of life and greater healthcare resource use. There are limited data on the prevalence, population characteristics and burden of chronic cough in France. This was a cross-sectional study based on responses from French adult residents to the 2020 National Health and Wellness Survey. Respondents with chronic cough were compared to 1:3 propensity score-matched controls without chronic cough. The weighted lifetime and 12-month prevalence of chronic cough were estimated as 7.5% and 4.8%, respectively. Respondents with chronic cough reported significantly worse perceived health than matched controls, with lower mean±sd scores of 46.68±9.28 versus 50.42±8.26 on the physical health component and 40.32±9.87 versus 44.32± 9.69 on the mental health component of the Medical Outcomes Study 12-item Short Form Survey Version 2 survey (p<0.001 for both comparisons). Respondents with chronic cough also had higher rates of moderate-to-severe forms of anxiety (24.4% versus 12.4%) and depression (36.4% versus 20.2%); higher rates of multiple forms of sleep disturbance; greater impairment of work productivity (38.2% versus 25.5%) and other activities (41.8% versus 28.2%; p<0.001 for all comparisons). Respondents with chronic cough also had higher rates of all-cause healthcare resource use including emergency room visits, hospitalisation, and overall and specialist healthcare provider visits compared to controls (p<0.001 for all comparisons). Chronic cough is a common condition in France that is associated with lower health-related quality of life and greater healthcare resource utilisation.

Abstract 14644: Healthcare Resource Utilization and Economic Burden Due to Atrial Fibrillation in Patients With Symptomatic Obstructive Hypertrophic Cardiomyopathy: Real-World Analysis of 2016-2021 Claims Data

Introduction: Atrial fibrillation (AF) is common among patients with symptomatic obstructive hypertrophic cardiomyopathy (soHCM), but the impact of AF on healthcare resource use (HCRU) and cost is not well studied. Hypothesis: Comorbid AF increases HCRU and cost among patients with soHCM. Aims: To assess HCRU and charges (per person per year [PPPY], in USD) for patients with vs without comorbid AF. Methods: Symphony medical and pharmacy claims data were assessed from 2016-2021 to identify (by ICD-10 code) adult patients with treatment-naïve soHCM in the United States. We defined symptomatic as fatigue, chest pain, syncope, dyspnea, heart failure, or palpitations within 3 months of index date and comorbid AF as AF within 3 months of index date. Patients entered the cohort once they received their index soHCM pharmacotherapy or soHCM surgery treatment; and were required to be on soHCM pharmacotherapy (beta-blockers, calcium channel blockers, or disopyramide) or to have had a procedure for soHCM (septal reduction therapy, pacemaker, or implantable cardioverter defibrillator). Results: Of 9490 patients with soHCM, 2681 (28.3%) had AF. For patients with vs without AF, median age was 68 years vs 63 years ( p &lt;0.0001), 48.0% vs 42.5% ( p &lt;0.0001) were male, and mean (SD) Charlson Comorbidity Index was 2.4 (2.0) vs 1.5 (1.8). Patients with vs without AF had ~44% more outpatient (OP) visits (14.75 vs 10.22), more urgent care visits (5.95 vs 4.88), and higher charges ($50,936 vs $32,254) PPPY (Table). Total all-cause charges were ~60% higher for those with vs without AF ($70,902 vs $44,035 PPPY) (Table). Conclusions: In this large, US-based cohort of patients with symptomatic oHCM, those with vs without comorbid AF had substantially more OP visits and charges PPPY. Our data show that comorbid AF in patients with soHCM is associated with a significantly greater healthcare resource use and economic burden, emphasizing the need for new treatments to prevent or improve AF.

The burden of ovarian cancer in the USA from 2007 to 2018: evidence from the Medical Expenditure Panel Survey.

Aim: To evaluate the economic and humanistic burden of ovarian cancer in the USA. Methods: Medical Expenditure Panel Survey data (2007-2018) were used to estimate all-cause healthcare resource useand costs for economic burden and examine the activities of daily living and quality-of-life (QoL) measures for humanistic burden between ovarian cancer patients and a non-cancer population. Results: Compared with controls, patients with ovarian cancer had more comorbidities and worse QoL. Their predicted number of annual hospitalizations and office-based visits was significantly higher, as were their estimated annual all-cause total healthcare costs. Total costs were driven by hospitalization costs. Conclusion: The study identified the burden of ovarian cancer and demonstrated that patients with ovarian cancer have greater healthcare resource use, higher costs and worse QoL than the non-cancer population. Future research is needed to develop strategies for managing ovarian cancers and inform decision-making to reduce disease burden.

Adverse Outcomes, Healthcare Resource Utilization, and Costs Associated with Systemic Corticosteroid use Among Adults with Systemic Lupus Erythematosus in the UK.

This analysis was conducted to assess the incidence of adverse clinical outcomes, healthcare resource use (HCRU), and the costs associated with systemic corticosteroid (SCS) use in adults with systemic lupus erythematosus (SLE) in the UK. We identified incident SLE cases using the Clinical Practice Research Datalink GOLD, Hospital Episode Statistics-linked healthcare, and Office for National Statistics mortality databases from January 1, 2005, to June 30, 2019. Adverse clinical outcomes, HCRU, and costs were captured for patients with and without prescribed SCS. Of 715 patients, 301 (42%) had initiated SCS use (mean [standard deviation (SD)] 3.2 [6.0] mg/day) and 414 (58%) had no recorded SCS use post-SLE diagnosis. Cumulative incidence of any adverse clinical outcome over 10-year follow-up was 50% (SCS group) and 22% (non-SCS group), with osteoporosis diagnosis/fracture most frequently reported. SCS exposure in the past 90days was associated with an adjusted hazard ratio of 2.41 (95% confidence interval 1.77-3.26) for any adverse clinical outcome, with increased hazard for osteoporosis diagnosis/fracture (5.26, 3.61-7.65) and myocardial infarction (4.52, 1.16-17.71). Compared to low-dose SCS (< 7.5mg/day), patients on high-dose SCS (≥ 7.5mg/day) had increased hazard for myocardial infarction (14.93, 2.71-82.31), heart failure (9.32, 2.45-35.43), osteoporosis diagnosis/fracture (5.14, 2.82-9.37), and type 2 diabetes (4.02 1.13-14.27). Each additional year of SCS use was associated with increased hazard for any adverse clinical outcome (1.15, 1.05-1.27). HCRU and costs were greater for SCS users than non-SCS users. Among patients with SLE, there is a higher burden of adverse clinical outcomes and greater HCRU in SCS versus non-SCS users.

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

World Federation of Athletic Training and Therapy World Congress 2022 Peer-Reviewed Track Abstracts, May 5–7, 2022, Winnipeg, Manitoba, Canada

Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England.

AimsThe aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England.MethodsThis retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation.ResultsAmong 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001).ConclusionThe cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL.Cite this article: Bone Joint J 2022;104-B(7):811–819.

Progression of chronic pain and associated health-related quality of life and healthcare resource use over 5 years after total knee replacement: evidence from a cohort study

ObjectiveAs part of the STAR Programme, a comprehensive study exploring long-term pain after surgery, we investigated how pain and function, health-related quality of life (HRQL), and healthcare resource use evolved...

Primary vs. Secondary Heart Failure Diagnosis: Differences in Clinical Outcomes, Healthcare Resource Utilization and Cost.

BackgroundThere is scarce information on patients with secondary heart failure diagnosis (sHF). We aimed to compare the characteristics, burden, and outcomes of sHF with those with primary HF diagnosis (pHF).MethodsRetrospective, observational study on patients ≥18 years with emergency department (ED) visits during 2018 with pHF and sHF in ED or hospital (ICD-10-CM) diagnostic codes. Baseline characteristics, 30-day and 1-year mortality, readmission and re-ED visit rates, and costs were compared between sHF and pHF.ResultsOut of the 797 patients discharged home from the ED, 45.5% had sHF, and these presented lower 1-year hospitalization, re-ED visit rates, and costs. In contrast, out of the 2,286 hospitalized patients, 55% had sHF and 45% pHF. Hospitalized sHF patients had significantly (p < 0.01) greater comorbidity, lower use of recommended HF therapies, longer length of stay (10.8 ± 10.1 vs. 9.7 ± 7.9 days), and higher in-hospital and 1-year mortality (32 vs. 25.8%) with no significant differences in readmission rates and lower 1-year re-ED visit rate. Hospitalized sHF patients had higher total costs (€12,262,422 vs. €9,144,952, p < 0.001), mean cost per patient-year (€9,755 ± 13,395 vs. €8,887 ± 12,059), and average daily cost per patient.ConclusionHospitalized sHF patients have a worse initial prognosis, greater use of healthcare resources, and higher costs.

The impact of symptom severity on the humanistic and economic burden of inflammatory bowel disease: a real-world data linkage study

Objective Few studies have examined the association between inflammatory bowel disease (IBD) severity, and humanistic, and economic burden. We addressed this gap using a unique real-world data source that links self-reported patient data from the US National Health and Wellness Survey (NHWS) to claims data. Methods This cross-sectional study linked the 2015–2018 US NHWS data with medical, and pharmacy claims. Patients (≥18 years) who self-reported a physician diagnosis of IBD (ulcerative colitis [UC], or Crohn’s disease [CD]) in the NHWS, and had a medical or pharmacy claim indicating a possible diagnosis of IBD were included. Disease symptom severity was defined by a weighted symptom score and main outcomes include health-related quality of life (HRQoL), work productivity (WPAI), healthcare resource use (HRU), and associated costs. Results Overall, 687 patients with IBD were included, of which 347 were identified with UC and 340 with CD. Validation analysis showed that 94.7% of UC and 88.7% of patients with CD who self-reported diagnosis of CD or UC in NHWS had evidence of diagnosis and/or treatment patterns in claims. Patients with both UC and CD with moderate or severe symptoms had significantly lower HRQoL, increased work productivity loss, greater HRU, and associated costs compared with patients with mild symptoms. Conclusions Patients with moderate/severe UC or CD experience substantial humanistic, and economic burden compared with patients with mild UC or CD. These factors should be considered within treatment goals for patients in order to provide holistic care beyond the treatment of objective markers or disease severity and symptoms alone.

Cost and healthcare utilization of methicillin-resistant Staphylococcus aureus bacteremia estimated from linked antimicrobial resistance surveillance and hospital claims data in Japan.

To compare the incremental costs and healthcare utilization of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia with those of methicillin-susceptible S. aureus (MSSA) bacteremia. Retrospective cohort study using data from April 2014 to March 2015. Antimicrobial resistance surveillance and hospital claims data from 16 Japanese hospitals. The study included 73 patients with S. aureus bacteremia: 23 with MRSA and 50 with MSSA. MRSA bacteremia was identified using blood cultures and drug-susceptibility tests. MRSA- and MSSA-related medical practices were evaluated. The costs were calculated and compared. All the medical costs were classified into empirical and definitive therapy periods and expressed in Japanese yen (JPY, 1 USD = 106 JPY). Additionally, costs at aggressive and passive bacterial test-performing facilities were compared. No significant differences existed in MRSA-related resource use per patient episode between MRSA and MSSA bacteremia during empirical therapy. However, during definitive therapy, in MRSA bacteremia compared with MSSA bacteremia, this difference was higher. The average MRSA-related costs of empirical therapy for MRSA and MSSA were 13,380 and 9,140 JPY (126 and 86 USD) per patient, and for definitive therapy, they were 69,810 and 29,510 JPY (659 and 278 USD) per patient, respectively. No significant differences were noted. Conversely, the average examination costs during definitive therapy differed significantly: 9,740 vs 3,850 JPY (92 vs 36 USD), respectively (P = .0294). Furthermore, the incremental costs in aggressive facilities were lower for the definitive therapy period than those in passive facilities. In the definitive therapy period, MRSA bacteremia had higher incremental costs and greater use of healthcare resources. In addition, the incremental costs in aggressive facilities were lower than those in passive facilities.

Real-world applicability and impact of early rhythm control for European patients with atrial fibrillation: a report from the ESC-EHRA EORP-AF Long-Term General Registry

BackgroundUse of rate/rhythm control is essential to control symptoms in patients with atrial fibrillation (AF). Recently, the EAST-AFNET 4 trial described how early rhythm control strategy was associated with a lower risk of adverse clinical outcomes.ObjectivesThe aim was to evaluate the real-world applicability and impact of an early rhythm control strategy in patients with AF.MethodsUse of an early rhythm control strategy was assessed in a European cohort of AF patients derived from the EHRA-ESC EORP-AF General Long-Term Registry. Early rhythm control was defined as use of antiarrhythmic drugs or cardioversion/catheter ablation. The primary outcome included cardiovascular death, stroke, acute coronary syndrome, and worsening of heart failure. Quality of life and health-care resource usage were also assessed as outcomes.ResultsAmong the 10,707 patients evaluated for eligibility to EAST-AFNET 4, a total of 3774 (34.0%) were included. Early rhythm control was associated with better quality of life, but with greater use of health-care resources. During follow-up, the primary outcome occurred less often in early rhythm control patients than in those with no rhythm control (13.6% vs. 18.5%, p < 0.001). In the multivariate adjusted Cox regression model, no significant difference was found between no rhythm control and early rhythm control, for the primary outcome. No difference in the primary outcome between early rhythm control and ‘no rhythm control patients’ adherent to Atrial fibrillation Better Care (ABC) pathway’ was evident (p = 0.753)ConclusionsUse of an early rhythm control strategy was associated with a lower rate of major adverse events, but this difference was non-significant on multivariate analysis, being mediated by differences in baseline characteristics and clinical risk profile. Early rhythm control was associated with a higher use of health-care resources and risk of hospital admission, despite showing better quality of life.Graphic abstract

Burden of Pneumonia Among Hospitalized Patients with Influenza: Real-World Evidence from a US Managed Care Population

IntroductionPneumonia is among the most prevalent complications of influenza. The purpose of this study is to quantify the burden of pneumonia among hospitalized patients with influenza.MethodsReal-world retrospective data from 01JAN2014-30JUN2019 (study period) were obtained from Optum’s de-identified Clinformatics® Data Mart Database (2007–2020) for patients who had ≥ 1 diagnosis for influenza during the identification period and ≥ 1 all-cause inpatient visit within 1 day of diagnosis. Cases had ≥ 1 diagnosis claim for an influenza-related pneumonia within the 30 days after the initial influenza diagnosis date. Controls had no evidence of influenza-related pneumonia in the 30 days following the initial influenza diagnosis. Final 1:1 matching was determined using propensity score matching (PSM). Statistical significance between the cohorts was tested.ResultsAfter PSM, there were 4878 hospitalized patients with influenza in each of the case and control groups. During the index hospitalization, cases vs. controls had longer length of stay [Mean (standard deviation): 6.5 (8.3) vs. 1.9 (3.7)], greater intensive care unit (ICU) use (38.4 vs. 16.8%), and greater mechanical ventilation use (invasive: 11.4 vs. 2.3%; non-invasive: 6.8 vs. 2.6%) (all p < 0.001). Cases also had higher readmission rates than controls (12.3 vs. 3.5% within 30 days; 20.0 vs. 6.1% within 90 days; p < 0.001 for both). Post-index date direct all-cause healthcare costs were higher for cases than for controls (median total cost: $18,428 vs. $621 for 30 days; $21,774 vs. $3312 for 90 days; $25,960 vs. $8699 for 6 months; $35,875 vs. $21,619 for 1 year; all p < 0.001).ConclusionsPneumonia as a complication of influenza increases risk of mortality and leads to greater healthcare resource use and direct medical costs among patients hospitalized with influenza. These effects are seen early during the index hospitalization and within the first 30 days after diagnosis, but their impact continues throughout a year of follow-up.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41030-021-00169-2.

A Direct Rapid Phenotypic Antimicrobial Susceptibility Test Enables Early Selection of Optimal Antibiotics to Treat Bacteremia in COVID-19 Patients.

BackgroundCo-infection with bacteria and severe acute respiratory syndrome coronavirus 2 may result in greater use of healthcare resources and a poor prognosis. Therefore, early selection and use of optimal antibiotics are essential. The direct rapid antibiotic susceptibility test (dRAST) can detect antibiotic resistance within 6 h of a Gram smear result. This study aimed to assess the effectiveness of dRAST for improving early selection of appropriate antibiotics for coronavirus disease 2019 (COVID-19) patients with bacteremia.Materials and MethodsThis retrospective study included 96 blood culture-positive COVID-19 patients. Bacterial isolates and antimicrobial resistance profiles of each case were evaluated. Cases were divided into two groups based on whether they underwent conventional antibiotic susceptibility test (AST) or dRAST. The time to optimal targeted treatment for the two groups was investigated and compared. In addition, we examined the proportion of cases for which appropriate antibiotics were selected and broad spectrum antibiotics were administered at 72 h from blood sample collection.ResultsThe mean time to optimal targeted antibiotic treatment was shorter for the dRAST group [55.7; standard deviation (SD), 28.7 vs. 92.3; SD, 51.1 h; P = 0.041]. The proportion of cases receiving optimal targeted antibiotics 72 h after blood collection for culture was higher [6/10 (60.0%) vs. 10/25 (40.0%)] and the percentage receiving broad spectrum antibiotics at 72 h was lower [6/10 (60.0%) vs. 19/25 (76.0%)] in the dRAST group than in the conventional AST group. In terms of microbiology profile, the contamination rate was high (35.5%) and multidrug-resistant strains were common (63.2%) in COVID-19 patients with bacteremia.ConclusionApplication of dRAST for selection of antibiotics to treat bacteremia in COVID-19 patients may enable earlier and optimal treatment. The high incidence of contamination and resistant organisms in blood cultures from COVID-19 patients suggest that dRAST may speed up appropriate targeted treatment.

Relieving ICU Pressures and Reducing Mortality in COVID-19: A Framework for Early Intervention

Delayed presentation of COVID-19 pneumonia leads to higher mortality and greater use of healthcare resources. Early identification of progressive COVID-19 cases saves lives, reduces the pressure on healthcare services, and facilitates the easing of social restrictions. To improve the earlier detection of COVID-19 pneumonia in the community we provide a narrative review of current evidence examining the clinical parameters associated with disease progression. We explore the symptoms that may suggest COVID-19 progression; the timing of deterioration; the utility of basic observations; the value of post-exertion oxygen saturations, and the use of CRP to monitor disease progression. We go on to provide recommendations for monitoring the COVID-19 patient in the community and discuss thresholds for further assessment.

PRS20 Rates of COPD Diagnosis and Health Outcomes in at Risk Populations: An Insight to the Diagnosis of COPD

Chronic obstructive pulmonary disease (COPD) is a global health concern and is a major cause of chronic morbidity and mortality worldwide. However, identifying patients has proved challenging, resulting in widespread under-diagnosis of the condition. In this study, we examined the rates of COPD at risk population (undiagnosed) and the impact on their health outcomes compared to non-COPD population. Respondents to the 2019 National Health and Wellness Survey in US and Japan and 2020 survey in Taiwan and South Korea were classified into three groups: ‘COPD Diagnosed’, ‘COPD Risk (undiagnosed)’, and ‘Control (unaffected)’, based on their self-reported diagnosis and Lung Function Questionnaire (LFQ) score. The proportion of at risk but undiagnosed COPD patients were descriptively analysed for each country. Health-related quality of life (HRQoL), work productivity and activity impairment (WPAI), and healthcare resource use (HRU) were compared in undiagnosed at-risk patients vs. respondents without COPD using bivariate analyses for each country. In Japan, South Korea, Taiwan and US, 25.32%, 29.28%, 22.72% and 25.58% of respondents were classified as of at risk for COPD (LFQ sum score of 18 or lower) but did not report receiving a diagnosis. Relative to controls, respondents who were at-risk of COPD (undiagnosed) had statistically significantly worse HRQoL, higher impairment in work productivity and daily activity, and greater healthcare resource use (p<0.001). Specifically, there were clinically meaningful differences (3 points difference) in terms of the physical component score between the two groups in all countries (Japan: 49.88 vs. 53.02; Korea: 46.55 vs. 51.28; Taiwan: 46.69 vs. 52.40; US: 45.07 vs. 52.88). There is a huge undiagnosed COPD at risk population across the countries including Japan, South Korea, Taiwan and US, and their health outcomes such as HRQoL, work productivity and healthcare resource utilization were significantly worse than the non-COPD population.

Resource use and costs in patients with poorly controlled type 2 diabetes mellitus and obesity in routine clinical practice in Spain

Objective To compare healthcare resource use (HRU) and annual costs in type 2 diabetes mellitus (T2DM) patients with poor glycaemic control and obesity versus good glycaemic control without obesity. Methods Observational retrospective study based on the analysis of electronic medical records from the BIG-PAC database, with one year of follow-up. T2DM patients aged ≥30 years who requested medical care during 2013 were included. Annual HRU and costs per patient were compared between a reference group (HbA1c ≥ 8%, BMI ≥30 kg/m2, receiving ≥2 oral antidiabetic drugs [OADs]) and a control group (HbA1c < 7% and BMI <30 kg/m2). Direct and indirect costs (lost productivity) were analysed. Cost comparisons across groups were made using the analysis of covariance (ANCOVA) for each cost component, with age, sex, time from diagnosis, Charlson comorbidity index, OAD number and sex by group interaction as covariates. Results During the follow-up, patients in the reference group (N = 2709) had a greater HRU than those in the control group (N = 5266), especially in the number of primary care (PC) visits (11.8 vs. 9.8; 95%CI: 11.5–12.1 vs. 9.6–10.0) and days of hospitalization (1.1 vs 0.6; 95%CI: 1.0–1.2 vs. 0.5–0.7). The main components of the total cost were hospital admissions (24.5%), productivity losses (16.3%), complementary tests (14.4%), PC visits (14.2%) and medication (13.6%) in the reference group and medication (19.6%), hospital admissions (18.7%) and PC visits (18.2%) in the control group. The corrected mean annual cost per patient was higher in the reference than in the control group: €1804 vs. €1309; p < .001. Conclusions Poor glycaemic control and obesity in T2DM patients were associated with increased HRU and costs in routine clinical practice.

Incidence, Risk Factors, and Outcomes of Pouchitis and Pouch-Related Complications in Patients With Ulcerative Colitis

Acute pouchitis is the most common non-surgical complication after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). We used validated case-finding definitions for pouchitis to search administrative claims data and determine the incidence of pouchitis in the first 2 years after IPAA. We identified all patients who underwent proctocolectomy with IPAA for UC in the IQVIA Legacy PharMetrics Adjudicated Claims Database, from January 1, 2007 through June 1, 2016. The primary outcome was the development of pouchitis within 2 years after IPAA. Secondary outcomes included isolated acute vs recurrent pouchitis, immunosuppressive therapy, further surgery, and admission to the hospital. Among 594 patients, the cumulative incidence of pouchitis within 2 years of IPAA was 48% (95% CI, 44%-52%). The cumulative incidence of isolated acute pouchitis was 29% (95% CI, 26%-33%). Compared to patients with isolated acute pouchitis, patients who received a diagnosis of recurrent pouchitis (cumulative incidence, 19%: 95% CI, 16%-22%) demonstrated increased outpatient visits, emergency department visits, and inpatient admissions (all P < .001). Patients who developed pouchitis were more likely to have a history of primary sclerosing cholangitis (adjusted odds ratio [aOR], 3.94; 95% CI, 1.05-14.8) and anti-tumor necrosis factor alpha therapy prior to colectomy (aOR 1.63; 95% CI, 1.09-2.45). Among patients with pouchitis, the cumulative frequency of new immunosuppressive therapy was 40% (95% CI, 35%-46%) and the cumulative incidence of pouch excision was 1.0% (95% CI, 0.4%-3.0%). The cumulative incidence of a new diagnosis of Crohn's disease after IPAA for UC was 9.0% (95% CI, 7.2%-11%). In a geographically diverse population, 48% of patients with UC developed pouchitis within the first 2 years after IPAA. Patients with pouchitis had greater use of healthcare resources, indicating a significant burden of disease.

Effect of clinically significant thresholds of eosinophil elevation on health care resource use in asthma

BackgroundBlood eosinophil counts correlate with exacerbations, but there is a lack of consensus on a clinically relevant definition of eosinophil count elevation. ObjectiveTo analyze health care resource use among patients with elevated blood eosinophil counts defined at 150 cells/μL or greater and 300 cells/μL or greater. MethodsData on patients who received a diagnosis of asthma between 2007 and 2016 were extracted from EMRClaims + database. Patients were defined as having elevated eosinophil counts if any test result during 3 months before follow-up found blood eosinophil count of 150 cells/μL or more or 300 cells/μL or more. Hospitalizations, emergency department visits, outpatient visits, and associated costs were compared. With logistic regression, likelihood of hospitalization was assessed in the presence of eosinophil elevation. ResultsAmong 3687 patients who met the study criteria, 1152 received a test within 3 months before the follow-up period, of whom 644 (56%) had elevated eosinophil counts of 150 cells/μL or greater and 322 (29%) had eosinophil counts of 300 cells/μL or greater. Overall, the mean (SD) number of hospitalizations for patients with elevated eosinophil counts vs the comparator was significantly greater (0.29 [0.92] vs 0.17 [0.57], P < .001 at ≥150 cells/μL and 0.30 [0.95] vs 0.18 [0.61] at ≥300 cells/μL, P = .001). The total mean cost was significantly greater for patients with elevated eosinophil counts (at ≥150 cells/μL: $10,262 vs $7149, P < .001 and at ≥300 cells/μL: $9966 vs $7468, P = .003). ConclusionPatients with asthma incurred greater health care resource use when their blood eosinophil counts were elevated at 150 cells/μL or greater and 300 cells/μL or greater as measured within 3 months of follow-up.

Cost-effectiveness of fine-needle aspiration cytology (FNAC) and watchful observation for incidental thyroid nodules.

A trial-based comparison of the use of resources, costs and health utility outcomes of fine-needle aspiration cytology (FNAC), and watchful observation for incidental small (< 2cm) thyroid nodules was performed using data from the randomized controlled trial (RCT). Using data from 314 patients, healthcare-related use of resources, costs, health utility, and quality-adjusted life years (QALYs) were estimated at 12months after first presentation of incidental thyroid nodule(s) on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for FNAC versus watchful management at 12months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data. FNAC management was associated with greater use of healthcare resources and mean direct healthcare costs per patient (US$542.47 vs US$411.55). Lower mean 12-month QALYs per patient in FNAC was observed in comparison to watchful observation (0.752 versus 0.758). The probability that FNAC management was cost-effective compared with watchful management at a willingness-to-pay threshold of US50,000 per QALY gained was 26.5%. Based on 12-month data from RCT, watchful observation appeared cost-saving compared to FNAC in patients with incidental thyroid nodules that have a low-suspicion sonographic pattern and measure between 1.0 and 2.0cm from healthcare provider perspective. CLINICALTRIALS. NCT02398721.

Health resource utilization of labor induction versus expectant management

Although induction of labor of low-risk nulliparous women at 39 weeks reduces the risk of cesarean delivery compared with expectant management, concern regarding more frequent use of labor induction remains, given that this intervention historically has been thought to incur greater resource utilization. The objective of the study was to determine whether planned elective labor induction at 39 weeks among low-risk nulliparous women, compared with expectant management, was associated with differences in health care resource utilization from the time of randomization through 8 weeks postpartum. This is a planned secondary analysis of a multicenter randomized trial in which low-risk nulliparous women were assigned to induction of labor at 39 weeks or expectant management. We assessed resource utilization after randomization in 3 time periods: antepartum, delivery admission, and discharge through 8 weeks postpartum. Of 6096 women with data available, those in the induction of labor group (n= 3059) were significantly less likely in the antepartum period after randomization to have at least 1 ambulatory visit for routine prenatal care (32.4% vs 68.4%), unanticipated care (0.5% vs 2.6%), or urgent care (16.2% vs 44.3%), or at least 1 antepartum hospitalization (0.8% vs 2.2%, P < .001 for all). They also had fewer tests (eg, sonograms, blood tests) and treatments (eg, antibiotics, intravenous hydration) prior to delivery. During the delivery admission, women in the induction of labor group spent a longer time in labor and delivery (median, 0.83 vs 0.57 days), but both women (P= .002) and their neonates (P < .001) had shorter postpartum stays. Women and neonates in both groups had similar frequencies of postpartum urgent care and hospital readmissions (P > .05 for all). Women randomized to induction of labor had longer durations in labor and delivery but significantly fewer antepartum visits, tests, and treatments and shorter maternal and neonatal hospital durations after delivery. These results demonstrate that the health outcome advantages associated with induction of labor are gained without incurring uniformly greater health care resource use.