Greater Healthcare Resource Utilization Research Articles

The Humanistic and Economic Burden of Migraine in Europe: A Cross-Sectional Survey in Five Countries.

IntroductionPrior studies have estimated the burden of migraine in patients suffering from ≥ 4 monthly headache days (MHDs), but the burden experienced by migraineurs suffering from one to three (1–3) MHDs is unknown. The aim of this study was to examine the incremental burden of migraine in terms of health-related quality of life (HRQoL), impairments to work and daily activities, and healthcare resource utilization (HRU) in five European countries (France, Germany, Italy, Spain, and the UK (EU5]), by comparing migraineurs with ≥ 4 MHDs and migraineurs with 1–3 MHDs.MethodsThe sample for this retrospective cross-sectional study was collected from the 2017 National Health and Wellness Survey (N = 62,000). The Short-Form 12-Item Health Survey Instrument, version-2 physical and mental component summary (PCS and MCS) scores, Short-Form 6-dimensions (SF-6D), EuroQoL 5-dimensions (EQ-5D) and EuroQoL visual analog scale (VAS) scores, impairments to work productivity and daily activities (Work Productivity and Activity Impairment [WPAI] Questionnaire) scores, and HRU were compared between migraineur groups with ≥ 4 MHDs (4–7, intermediate-frequency episodic migraine; 8–14, high-frequency episodic migraine; ≥ 15 chronic migraine) and the migraineur subgroup with 1−3 MHDs (low-frequency episodic migraine) using generalized linear modeling after adjusting for covariates.ResultsData from a total of 62,000 survey respondents were examined, of whom 1323 and 1569 were considered to have 1–3 MHDs and ≥ 4 MHDs (4–7 MHDs [n = 783]; 8–14 MHDs [n = 429]; ≥ 15 MHDs [n = 357]), respectively. The adjusted HRQoL was significantly lower in the 4–7 MHDs (for MCS and SF-6D scores; p < 0.0001) and 8–14 MHDs subgroups (for MCS, SF-6D, EQ-5D, and EuroQoL VAS scores, p < 0.0001; for PCS scores, p = 0.0007) than in the 1–3 MHDs subgroup. Migraineurs with 4–7 and 8–14 MHDs reported higher activity impairment and more frequent visits to healthcare providers (all p < 0.0001) and neurologists (p = 0.0006 and p < 0.0001, respectively) compared to the 1–3 MHDs subgroup. Migraineurs with ≥ 15 MHDs had significantly lower HRQoL and increased WPAI scores and HRU than the 1–3 MHDs subgroup.ConclusionsThis study provides evidence supporting the incremental burden of migraine, characterized by poorer HRQoL and increased WPAI scores and greater HRU, among migraineurs experiencing ≥ 4 MHDs compared with migraineurs experiencing 1–3 MHDs in the EU5.Electronic supplementary materialThe online version of this article (10.1007/s40120-020-00196-2) contains supplementary material, which is available to authorized users.

Temporal trends in healthcare resource utilization and costs following acute myocardial infarction

BackgroundAcute myocardial infarction (AMI) is associated with greater utilization of healthcare resources and financial expenditure.ObjectivesTo evaluate temporal trends in healthcare resource utilization and costs following AMI throughout 2003–2015.MethodsAMI patients who survived the first year following hospitalization in a tertiary medical center (Soroka University Medical Center) throughout 2002–2012 were included and followed until 2015. Length of the in-hospital stay (LOS), emergency department (ED), primary care, outpatient consulting clinic visits and other ambulatory services, and their costs, were evaluated and compared annually over time.ResultsOverall 8047 patients qualified for the current study; mean age 65.0 (SD = 13.6) years, 30.3% women. During follow-up, LOS and the number of primary care visits has decreased significantly. However, ED and consultant visits as well as ambulatory-services utilization has increased. Total costs have decreased throughout this period. Multivariate analysis, adjusted for potential confounders, showed as significant trend of decrease in LOS and ambulatory-services utilization, yet an increase in ED visits with no change in total costs.ConclusionsDespite a decline in utilization of most healthcare services throughout the investigated decade, healthcare expenditure has not changed. Further evaluation of the cost-effectiveness of long-term resource allocation following AMI is warranted. Nevertheless, we believe more intense ambulatory follow-up focusing on secondary prevention and early detection, as well as high-quality outpatient chest pain unit are warranted.

Impact of Sickle Cell Anemia on Inpatient Morbidity After Spinal Fusion.

A retrospective study. To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery. Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown. Hospitalizations for elective spinal fusion surgery between the years of 2001-2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia. From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27-12.71; P<0.001], respiratory complications (OR=2.36; CI, 1.63-3.42; P<0.001), wound complications (OR=3.84; CI, 2.72-5.44; P<0.001), and overall inpatient complications (OR=2.58; CI, 2.05-3.25; P<0.001). Sickle cell anemia patients also have significantly longer length of stay (7.0 vs. 3.8 d; P<0.001) and higher inpatient costs ($20,794 vs. $17,608 P<0.05). Sickle cell anemia is associated with increased risk of perioperative complications and greater health care resource utilization. Sickle cell anemia patients undergoing spinal fusion surgeries should be counseled on these increased risks. Moreover, current strategies for perioperative management of sickle cell anemia patients undergoing spinal fusion surgery need to be improved.

Healthcare resource utilisation for critical care survivors in Wales: a population-based data linkage study

IntroductionMore patients are surviving critical illness, with a growing understanding that transition to survivorship needs to be managed in primary care. In Wales, however, survivors' comprehensive healthcare resource utilisation (HRU) has not been studied in detail.&#x0D; AimTo investigate the levels and predictors of HRU of critical illness survivors in Wales.&#x0D; MethodsWe used the SAIL Databank to identify survivors and characterise their HRU. We fitted Poisson models for HRU during one year after intensive care unit (ICU) stay, adjusted for follow-up length within that year, HRU in the previous year, modified Charlson Comorbidity Index (CCI), age group, and gender.&#x0D; ResultsWe identified 56,722 patients. The median age was 66 years (IQR=52-76), 46.3% were female, and 39.0% had high comorbidity (CCI≥10). More patients lived in the more deprived areas. Patients had medians of 29 (0-51) visits to general practitioners (GP), 5 (2-10) outpatient visits, 17 (5-63) days for length of hospital stay (LOS), and a mean of 0.89 emergency department (ED) attendances. Older patients had more GP visits (incidence rate ratio, IRRs, ranged from 1.1 to 1.2) and outpatient visits (1.1), greater LOS (1.2 to 1.7), but fewer ED visits (0.72 to 0.65). Higher CCI was associated with greater HRU (GP [1.19, 1.20], ED [1.34, 1.42], outpatient [1.50, 1.52], LOS [1.24, 1.6]). Higher socioeconomic deprivation was associated with more ED visits (IRR=1.2 [1.17, 1.25] between the most and the least deprived areas).&#x0D; ConclusionCritical care survivors use significant primary healthcare resources following their ICU stay. Predictors of long-term mortality [1] also influence HRU. The fewer ED visits in the older patients needs further evaluation.&#x0D; 1. Szakmany T et al. Crit Care Med. 2019 Jan;47(1):15–22.

Seizure frequency, healthcare resource utilisation and mortality in childhood epilepsy: a retrospective cohort study using the THIN database

ObjectiveTo understand the association of seizure frequency with healthcare resource utilisation (HCRU) and mortality in UK children with epilepsy (CWE).DesignRetrospective cohort study.SettingRoutinely collected data in primary care from The Health...

Healthcare resource utilization, expenditures, and productivity in patients with asthma with and without allergies

Objective: To compare healthcare resource utilization (HCRU), healthcare expenditures, and work productivity and activity impairment within a general asthma population with persistent asthma and evidence of allergy (PA-EA) and persistent asthma with no evidence of allergy (PA-NEA).Methods: We conducted a retrospective analysis of survey responses and claims from the Observational Study of Asthma Control and Outcomes (OSACO) study. Eligible patients with persistent asthma aged ≥12 years were sent four surveys over 15 months. Regression models were used to assess the association between: (1) PA-EA (defined as a positive response to a survey question about hay fever/seasonal allergies AND ≥1 diagnostic code for atopic conditions) and HCRU and expenditures; and (2) PA-EA and Work Productivity and Activity Impairment (WPAI)-Asthma questionnaire scores (vs. PA-NEA).Results: Adjusted data showed that, vs. PA-NEA (n = 312), patients with PA-EA (n = 971) incurred 1.34-times more all-cause prescriptions (95% confidence interval [CI], 1.20–1.48), $132.79 higher prescription costs (95% CI, $22.03–243.56), and $926.11 higher all-cause total healthcare costs (95% CI, $279.67–1572.54), per 4-month period. Patients with PA-EA were 4.1% less productive while working (95% CI, 3.75–4.48%) and experienced a 6.5% reduction in all activities (95% CI, 6.11–6.88%) vs. those with PA-NEA.Conclusions: Patients with PA-EA had greater HCRU, healthcare expenditures, and lower productivity compared with those patients with PA-NEA. These results highlight the burden of atopy in patients with persistent asthma and underscore the importance of allergic endotype identification for more vigilant disease management.

Health Care Utilization and Economic Burden in Patients with Central Precocious Puberty: An Assessment of the Commercially Insured and Medicaid Populations.

Central precocious puberty (CPP), early onset of puberty caused by the premature activation of the hypothalamic-pituitary-gonadal axis, is a rare disease affecting children of both sexes. There is limited evidence that quantifies the economic burden of CPP. To characterize the health care resource utilization (HRU) and costs among patients with CPP who were treated with gonadotropinreleasing hormone (GnRH) agonists, for those insured commercially and with Medicaid. Eligible CPP patients for this retrospective cohort analysis were aged ≤ 12 years; were diagnosed between January 1, 2010, and September 30, 2014; and had at least 1 prescription for an FDA-approved GnRH agonist: leuprolide or histrelin (first prescription = index date). CPP patients had to be continuously enrolled in the MarketScan Commercial or Medicaid Database for at least 12 months before and after the index date. Control patients were randomly selected from all eligible non-CPP patients and N:1 matched on demographic characteristics with up to 20 controls per case. Clinical comorbidities, HRU, and costs were compared between study cohorts. Health care costs were examined via multivariable analysis to adjust for baseline differences between patients and controls. Treatment patterns among CPP patients were also characterized. There were 1,236 CPP patients and 24,206 controls with commercial insurance and 673 CPP patients and 11,965 controls with Medicaid insurance who met the inclusion criteria. Across payers, the mean age of CPP patients ranged from 7.6 years (Medicaid) to 8.5 (commercial), and 80%-87% were female. The mean observed duration (SD) of treatment with any approved GnRH agonist was 1.51 (0.98) years for commercial patients and 1.22 (1.04) for Medicaid patients. The mean age of discontinuation among patients who ceased GnRH agonist treatment ranged from 8.7 to 9.6 years. In the first year post-index, CPP patients had a greater number of unique diagnosis codes, unique medications, and comorbid conditions than controls. They also had significantly higher all-cause and diseasemonitoring related HRU. After adjusting for baseline characteristics, CPP patients with Medicaid insurance spent 6.42 times more ($16,768 [$31,460] vs. $2,610 [$4,897]), and patients with commercial insurance spent 12.25 times more ($19,940 [$20,132] vs. $1,628 [$1,645]) on health care in the year following treatment initiation than matched controls. Patients with CPP have substantially more comorbidities and greater HRU and costs than their non-CPP peers. All funding for this study was provided by AbbVie, which participated in analysis and interpretation of data, drafting, reviewing, and approving the publication. All authors contributed to the development of the publication and maintained control over the final content. Soliman and Grubb are employed by AbbVie and hold stock in AbbVie. Bonafede and Nelson are employed by IBM Watson Health, which received funding from AbbVie to conduct this study. Klein is a paid consultant of AbbVie but was not compensated for any work on development of this manuscript for publication. Portions of this work were presented at Pediatric Academic Societies (PAS) 2018 Meeting, May 5-8, 2018, in Toronto, Canada, as a poster presentation titled "Examination of Economic Burden Among Commercially Insured Patients with Central Precocious Puberty (CPP)."

P026 The association between corticosteroid exposure and long-term clinical and economic outcomes among patients diagnosed with ulcerative colitis

BACKGROUND: Despite their long-term risks, corticosteroids are often used in the management of ulcerative colitis (UC) to help patients achieve and maintain disease remission. The aim of this study was to describe the frequency of high-level corticosteroid exposure and the association between this exposure and both clinical and economic outcomes. METHODS: This retrospective analysis used the IQVIA Real-World Data Adjudicated Claims—US database from January 1, 2006 to June 30, 2017. Patients aged ≥18 years with ≥2 medical claims for UC (ICD9:556.* or ICD10 K51.*) who initiated their first UC therapy (considered the “index” date) between July 1, 2006 and June 30, 2013 and had continuous enrollment 6 months prior to (pre-index) and 4 years after (post-index) this therapy were included. The first 3 years of the post-index window was the corticosteroid exposure observation period; the fourth (and last) year was the outcomes assessment period. Patients were categorized into one of 2 corticosteroid use cohorts: “frequent” (&gt;30 days of continuous corticosteroid exposure in at least 2 of the 3 observation years) versus “infrequent” (all others). Cohorts were compared with respect to the incidence of clinical outcomes (known disease and corticosteroid-related sequelae including infections, osteoporosis etc.), healthcare resource utilization, and costs in the outcomes assessment period. Analyses included chi-square tests and 2-sample t tests. RESULTS: A total of 22,841 patients with UC were included (53.1% female; mean age = 45.2 years [SD = 11.5]). Among them, 4,098 (17.9%) patients met criteria for frequent corticosteroid use. Compared with patients in the infrequent cohort, patients in the frequent cohort were significantly more likely to be younger (28.0% vs 22.7% were 18–39 years), male (48.9% vs 46.5%), and had greater total pre-index costs ($17,294 vs $8,257) (all P &lt; 0.05). Patients in the frequent cohort were significantly more likely to develop gastrointestinal conditions (e.g., ulcers, gastrointestinal bleeding; 87.5% vs 74.0%), infections (e.g., herpes zoster; 53.5% vs 44.3%), musculoskeletal conditions (e.g., osteoporosis; 59.7% vs 51.5%), and dermatologic conditions (e.g., acne, abdominal striae; 34.9% vs 29.8%) (all P &lt; 0.05) during the subsequent outcomes assessment period compared with patients in the infrequent cohort. Patients in the frequent cohort were also more likely to experience a future emergency room visit (24.8% vs 17.9%), an inpatient hospitalization (16.9% vs 8.2%), longer average length of hospital stays (5.9 vs 5.4 days), and higher costs (pharmacy: $17,243 vs $7,939; outpatient: $9,998 vs $6,363; inpatient: $7,299 vs $2,769) compared with patients in the infrequent cohort (all P &lt; 0.05). CONCLUSION(S): Frequent corticosteroid exposure was common among patients with UC and subsequently associated with an increased likelihood of adverse clinical outcomes and greater healthcare resource utilization, and costs.

Mild traumatic brain injury in the United States: demographics, brain imaging procedures, health-care utilization and costs

ABSTRACTObjective: To characterize mild traumatic brain injury (mTBI) patients in the USA, describing location of diagnosis, timing, and modality of imaging procedures, health-care resource utilization (HRU) and costs in the 12-month period post-diagnosis.Research Design: Retrospective claims analysisMethods: Anonymized data from the OptumHealth Care Solutions claims database (2006–2016). The index date was the first date with an mTBI diagnosis. HRU and costs (2016 USD) were assessed in the 12-month post-index period.Results: A total of 80,004 patients with mTBI were included: 60% were under 26 years and 54% were male. Mild TBI was most frequently diagnosed in an emergency department (ED) for all age groups, except patients aged 11–17 years, for whom the outpatient setting was the most frequent place of diagnosis. Almost half (47%) received brain imaging on the index date, with 98% of which receiving computed tomography. Mean follow-up health-care costs were $13,564 (SD = $41,071), primarily from inpatient ($4,675, SD = $29,982) and non-ED outpatient/physician office visits ($4,207, SD = $12,697). Older patients had greater HRU and higher health-care costs.Conclusions: The findings of this claims-based study show substantial HRU and costs associated with mTBI diagnosis during a 12-month follow-up period.

Healthcare utilization, medical costs and mortality associated with malnutrition in patients with chronic obstructive pulmonary disease: a matched cohort study

Objective: Although disease-related malnutrition has prognostic implications for patients with chronic obstructive pulmonary disease (COPD), its health-economic impact and clinical burdens are uncertain. We conducted a population-level study to investigate these questions.Methods: We excerpted data relevant to malnutrition, prolonged mechanical ventilation and medications from claims by 1,197,098 patients which were consistent with COPD and registered by the Taiwan National Health Insurance Administration between 2009 and 2013. These patients were separated into cohorts with or without respiratory failure requiring long-term mechanical ventilation, and each cohort was divided to compare cases who developed malnutrition after their first diagnosis consistent with COPD, versus non-malnourished propensity-score matched controls.Results: The prevalence of malnutrition was 3.8% overall (10,259/287,000 non-ventilator-dependent; 1198/15,829 ventilator-dependent). Propensity-score matched non-ventilator-dependent patients who became malnourished (N = 10,242) had comparatively more hospitalizations, emergency room and outpatient visits, longer hospitalization (all p < .01), and higher mortality (HR = 2.26, 95% CI 2.18–2.34) than non-malnourished controls (N = 40,968). Malnourished ventilator-dependent patients (N = 1197) had higher rates of hospitalization, emergency room and outpatient visits, but shorter hospitalization (all p < .001) and lower mortality (HR = 0.85, 95% CI 0.80–0.93) than matched non-malnourished controls (N = 4788). Total medical expenditure on malnourished non-ventilator-dependent COPD patients was 75% higher than controls (p < .001), whereas malnourished ventilator-dependent patients had total costs 7% lower than controls (p < .001).Conclusions: Malnourishment among COPD patients who were not dependent on mechanical ventilation was associated with greater healthcare resource utilization and higher aggregate medical costs.

Patients with Psychiatric Disorders Require Greater Health-Care Resources after Injury

The objective of this study was to assess whether patients with comorbid psychiatric conditions admitted after traumatic injury require greater health-care resource utilization. The trauma registry of a Level 1 trauma center was used to identify all adult trauma patients presenting from 2012 to 2015. Patients with psychiatric needs, identified as having either an ICD-9 code corresponding to a psychiatric disorder or requiring inpatient psychiatric consultation, were compared with controls, using propensity score matching. Patients with psychiatric disorders were more than three times more likely to present with penetrating injuries (odds ratio [OR] 3.5, P < 0.005). They had longer length of hospital stay (median 5 [IQR 2.5-11] vs. three days [IQR 1-7], P < 0.01), were approximately 70 per cent more likely to require ICU-level care (OR 1.68, P = 0.08), and were 80 per cent less likely to be discharged home (OR 0.18, P < 0.005). Trauma patients with psychiatric illness or need consume greater health-care resources.

Retrospective assessment of patient characteristics and healthcare costs prior to a diagnosis of Alzheimer\u2019s disease in an administrative claims database

BackgroundThe objective of this study was to examine patient characteristics and health care resource utilization (HCRU) in the 36 months prior to a confirmatory diagnosis of Alzheimer’s disease (AD) compared to a matched cohort without dementia during the same time interval.MethodsPatients newly diagnosed with AD (with ≥2 claims) were identified between January 1, 2013 to September 31, 2015, and the date of the second claim for AD was defined as the index date. Patients were enrolled for at least 36 months prior to index date. The AD cohort was matched to a cohort with no AD or dementia codes (1:3) on age, gender, race/ethnicity, and enrollment duration prior to the index date. Descriptive analyses were used to summarize patient characteristics, HCRU, and healthcare costs prior to the confirmatory AD diagnosis. The classification and regression tree analysis and logistic regression were used to identify factors associated with the AD diagnosis.ResultsThe AD cohort (N = 16,494) had significantly higher comorbidity indices and greater odds of comorbid mental and behavioral diagnoses, including mild cognitive impairment, mood and anxiety disorders, behavioral disturbances, and cerebrovascular disease, heart disease, urinary tract infections, and pneumonia than the matched non-AD or dementia cohort (N = 49,482). During the six-month period before the confirmatory AD diagnosis, AD medication use and diagnosis of mild cognitive impairment, Parkinson’s disease, or mood disorder were the strongest predictors of a subsequent confirmatory diagnosis of AD. Greater HCRU and healthcare costs were observed for the AD cohort primarily during the six-month period before the confirmatory AD diagnosis.ConclusionThe results of this study demonstrated a higher comorbidity burden and higher costs for patients prior to a diagnosis of AD in comparison to the matched cohort. Several comorbidities were associated with a subsequent diagnosis of AD.

Impact of antiepileptic-drug treatment burden on health-care-resource utilization and costs.

BackgroundComplex titration requirements and dosing of antiepileptic drugs (AEDs) may pose a significant treatment burden for patients with epilepsy. This study evaluated health-care-resource utilization (HCRU) rates and costs by treatment burden, defined as number of daily pills and dosing frequency, among managed-care enrollees with epilepsy who initiated AED monotherapy.MethodsThis retrospective longitudinal study examined administrative HC-claim data in patients aged ≥18 years with two or more pharmacy claims for an AED and two or more medical claims for epilepsy or afebrile convulsion. The number of daily AED pills was estimated at index as the total number of pills dispensed divided by the days supplied, and categorized as more than zero/one, one/two, two/three, and more than three per day. AED-dosing frequency was measured at index and categorized as one, two, three, or four times daily. Postindex 12-month all-cause and epilepsy-related HCRU and costs were estimated using multivariable Poisson regression models and generalized linear models, respectively.ResultsUnadjusted total all-cause and epilepsy-related costs at 12 months postindex averaged US$26,015 per person and US$5,557 per person (2017 values), respectively. Adjusted all-cause and epilepsy-related costs were US$25,918 per person and US$5,602 per person, respectively. A pill burden of more than three a day was associated with a 6.7% increase in total annual HC costs compared with one pill/day. Patients receiving one/two, two/three, and more than three pills per day had 13.3%, 23.9%, and 38.3% higher epilepsy-related costs, respectively, than those receiving one pill per day (P<0.0001). Increase in dosing frequency was associated with greater total HCRU and higher costs, but only patients with twice-daily dosing had significantly higher epilepsy-related costs.ConclusionFindings from this study suggest that increased treatment burden is associated with greater HCRU and higher overall and epilepsy-related costs. Reducing treatment burden via selection of AED therapy with reduced pill numbers and dosing frequency should be considered to improve health and economic outcomes.

Treatment patterns in diabetic macular edema in Taiwan: a retrospective chart review.

ObjectivesTo characterize diabetic macular edema (DME) treatment patterns in Taiwan and examine their impact on health care resource utilization and visual and anatomic outcomes.MethodsRetrospective, observational cohort study of longitudinal data from medical records of five hospital ophthalmology clinics. Patients with type 2 diabetes and DME who received ≥1 laser treatment or pharmacotherapy (intravitreal/subtenon corticosteroids and/or intravitreal anti-vascular endothelial growth factor [VEGF] agents) between January 2012 and December 2013 (index period) and attended ≥1 follow-up visit after the first treatment during that period were identified (prevalent population, N=431). In addition, a subset that received no anti-VEGFs before 2012 (anti-VEGF-naïve population, N=77) was analyzed. Outcome measures were change in DME treatment distribution between January 2009 and December 2014 and health care resource utilization over up to 3 years from the first DME treatment received in the index period (prevalent population), mean number of anti-VEGF injections and change from baseline in visual acuity and central macular thickness over 12 months (anti-VEGF-naïve population).ResultsBetween 2009 and 2014, laser treatment use declined, overall use of anti-VEGFs increased, and bevacizumab use decreased proportionately as ranibizumab use increased. Patients receiving corticosteroids and anti-VEGFs in the first 6 months post-index had greater health care resource utilization than those treated with laser, corticosteroids, or anti-VEGF alone (P<0.0001, cross-cohort comparison). Among anti-VEGF-naïve patients, 69% received one to four anti-VEGF injections in the first year post-index. Overall, visual acuity improvement from baseline was minimal at 1 year (0.4 letters, observed data; 0.1 letters, last observation carried forward), and modest central macular thickness reduction (28 µm [last observation carried forward]) was detected.ConclusionIn Taiwanese clinics, DME treatment patterns have shifted from use of laser to anti-VEGFs (with higher health care resource utilization); however, few patients receive anti-VEGF injections at the frequency reported in landmark trials, consistent with poorer visual outcomes. Effective alternative treatments with lower treatment burden should be considered.

PND93 - THE IMPACT OF MYASTHENIA GRAVIS (MG) ON HEALTHCARE RESOURCE UTILIZATION: EMPIRICAL EVIDENCE FROM A US REGISTRY SAMPLE

Myasthenia gravis (MG) is a debilitating disease that can substantially impact patients' daily activities, particularly among the subset of patients whose disease is refractory to conventional therapies. These patients live with the burden of a chronic impaired state and also experience a greater frequency of severe clinical events. How this increased burden impacts healthcare resource utilization is not known. Therefore, the objective of this analysis was to compare resource utilization between patients with and without refractory MG. The study population was derived from the enrollment survey of the MG Patient Registry (http://www.mgregistry.org/). Patients between 18-65 years of age were studied between July 2013-February 2018 and were required to have an MG diagnosis for at least 2 years prior to survey completion. Patient-reported information, including treatment type, treatment duration and MG-ADL scores, were used to classify patients as having either refractory or non-refractory MG. Healthcare resource use was compared between refractory and non-refractory patients using t-tests and Chi-square tests. This analysis included 76 refractory and 749 non-refractory patients. At enrollment, refractory patients were significantly more likely (in the prior 6 months) than non-refractory patients to have had at least one exacerbation (67.1% vs. 50.2%, p=0.01), five or more clinical exacerbations (13.2% vs. 6.9%, p=0.02), at least one emergency room (ER) visit (43.4% vs. 26.7%, p<0.01), four or more ER visits (7.9% vs. 2.9%, p<0.01), and at least one overnight hospitalization (32.9% vs. 20.3%, p=0.03). Refractory patients were also significantly more likely to have ever been in an intensive care unit (61.8% vs. 32.4% p<0.01) and to have ever needed a feeding tube (21.1% vs. 9.0%, p<0.01). Refractory patients have distinctly different clinical needs and this added burden is correlated with greater healthcare resource utilization.

The economic and humanistic burden of patients in receipt of current available therapies for nAMD.

To determine the economic and humanistic burden of neovascular age-related macular degeneration (nAMD) in a cohort of patients treated with anti-VEGF in Europe and the US. 79 respondents from the EU and 63 from the US with a self-reported diagnosis of nAMD and in current receipt of treatment, as reported in an international, general population survey, were compared with non-nAMD controls. Anti-VEGF-treated nAMD patients in the EU had a greater utilization of healthcare resources, poorer quality of life and greater overall activity impairment versus non-nAMD controls. In the US cohort, treated nAMD patients had significantly greater resource utilization for ophthalmologist visits only. The burden of care associated with nAMD on EU and US healthcare systems, and on patients who are in receipt of nAMD therapy, is significant and likely to be unsustainable.

Frailty and Greater Health Care Resource Utilization Following Major Urologic Oncology Surgery

BackgroundIn the setting of value-based care, it is critical to improve our understanding of surgical risk and greater health care resource utilization (HRU) as it relates to frailty. ObjectiveTo evaluate the impact of frailty on HRU and surgical morbidity in urologic oncology surgery using the five-item frailty index. Design, setting, and participantsA retrospective cohort study was conducted using subjects from the 2012–2016 American College of Surgeons National Surgical Quality Improvement Program who underwent radical cystectomy or minimally invasive or open radical prostatectomy, radical nephrectomy, or partial nephrectomy. Outcome measurements and statistical analysisMultivariable logistic regression was performed to determine the association between frailty index and any increase in HRU, which was defined as prolonged length of stay greater than the 75th percentile, discharge to continued care, or unplanned readmission within 30 d. Results and limitationsIn the overall cohort of 92 999 subjects and within each surgery type, increasing frailty score was associated with significant stepwise increases in HRU. Logistic regression adjusting for patient demographics revealed statistically significant odds ratios of 1.2 (95% confidence interval [CI] 1.2–1.3; p<0.001), 1.5 (95% CI 1.4–1.6; p<0.001), and 2.0 (95% CI 1.8–2.1; p<0.001) at frailty indices of 1, 2, and ≥3, respectively, for increased HRU relative to no frailty. In subanalyses, each categorical increase in frailty index was independently associated with prolonged length of stay, more discharges to continued care, and unplanned readmission. Increasing frailty score was associated with increasing rates of any complication and serious complications within each surgery type. The analysis is limited by the retrospective design and available data within a large hospital-based database. ConclusionsFrailty in major urologic oncology surgery is associated with greater HRU and surgical morbidity. Patient summaryWe assessed the impact of frailty on greater health care resource utilization and complications after major urologic cancer surgery in a large US population. With each increase in a frailty score, there was an increase in the likelihood of having complications, prolonged hospital stay, more discharges to continued care, and unplanned readmissions within 30 d.

Healthcare resource utilization, costs of care, and treatment of mycosis fungoides cutaneous T-cell lymphoma patterns in a large managed care population: a retrospective US claims-based analysis

Purpose: To evaluate health care utilization, treatment patterns and costs among patients with mycosis fungoides-cutaneous T-cell lymphoma (MF-CTCL).Methods: This retrospective cohort study queried the HealthCore Integrated Research Database to identify patients ≥18 years with ≥2 diagnoses of MF-CTCL (ICD-9-CM code 202.1x, 202.2x) between 07 January 2006 and 07 January 2013. Index date was defined as first MF-CTCL diagnosis. Patients were continuously enrolled ≥6 months before and ≥12 months after index date. Severe MF-CTCL was identified via systemic therapy use postindex. Generalized linear model (GLM) was used to estimate the relationship between MF-CTCL severity and healthcare costs controlling for selected factors.Results: A total of 1981 MF-CTCL patients were evaluated: 493 (24.9%) severe and 1488 (75.1%) with mild to moderate disease. GLM analysis indicated severe MF-CTCL patients incurred higher all-cause healthcare total costs compared to patients with mild-to-moderate MF-CTCL (coefficient estimate: 4.19, p < .0001). About 51% of patients did not receive any MF-CTCL-specific treatment within 60 days after MF-CTCL diagnosis.Conclusions: MF-CTCL severity was associated with greater healthcare resource utilization and costs. These findings suggest that about half of MF-CTCL patients do not receive MF-CTCL-specific treatment within 60 days following initial diagnosis. Future studies are needed to understand reasons for delayed treatment initiation.

A Retrospective Cohort Study of Patients with Type 2 Diabetes in China: Associations of Hypoglycemia with Health Care Resource Utilization and Associated Costs.

IntroductionThis study aimed to examine the associations of hypoglycemia with health care resource utilization (HCRU) and health care costs among patients with type 2 diabetes mellitus (T2DM) in China.MethodsThis retrospective cohort study was conducted with 23,680 T2DM patients >18 years old who visited the Second Affiliated Hospital of Nanchang University between 1 January 2011 and 31 December 2015. Univariate descriptive statistics were used to relate the HCRU and associated costs to patient characteristics, and regression analysis was used to examine the association between hypoglycemia and HCRU, controlling for other confounding factors.ResultsIn the T2DM patients with or without insulin treatment, when compared with nonhypoglycemic patients, hypoglycemia was associated with more medical visits (all T2DM patients 19.48 vs. 10.46, insulin users 23.45 vs. 14.12) and higher diabetes-related medical costs (all T2DM patients ¥5187.54 vs. ¥3525.00, insulin users ¥6948.84 vs. ¥3401.15) and medication costs (T2DM patients ¥1349.40 vs. ¥641.92, insulin users: ¥1363.87 vs. ¥853.96). Controlling for age, gender, and Charlson comorbidity index (CCI) score, hypoglycemia and insulin intake were associated with greater health care resource utilization. As compared to nonhypoglycemic patients, hypoglycemic T2DM patients and those on insulin therapy performed more outpatient visits (proportions of hypoglycemic vs nonhypoglycemic T2DM patients performing 3+ visits: 72.69% vs. 65.49%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy performing 3+ visits: 78.26% vs. 71.73%) and were hospitalized more often (proportions of hypoglycemic vs nonhypoglycemic T2DM patients with 3+ admissions 75.90% vs. 50.24%; proportions of hypoglycemic vs nonhypoglycemic patients on insulin therapy with 3+ admissions: 83.19% vs. 58.51%).ConclusionHypoglycemia in diabetes patients was associated with increased healthcare resource utilization and health-related expenditure, especially for patients on insulin treatment. Insulin treatment regimens should be more individualized and account for hypoglycemia risk.

The cost of cardiovascular-disease-related death in patients with type 2 diabetes mellitus

Objectives: To assess the magnitude of difference in all-cause healthcare resource utilization (HCRU) and costs between patients with type 2 diabetes mellitus (T2DM) who died from a cardiovascular disease (CVD)-related cause in the year preceding death vs. those who did not die during this same period.Methods: A large US administrative claims database was used to identify patients with T2DM who died of a CVD-related cause from July 2012 to April 2015. These patients were matched 1:1 to patients with T2DM who did not die, using direct matching methods. HCRU and costs were assessed in each of the four quarters (Q4: 12–10 months; Q3: 9–7 months; Q2: 6–4 months; and Q1: 3–0 months) prior to death and compared between patient cohorts using paired t-tests and McNemar’s tests.Results: A final matched cohort of 7648 patients who died and 7648 patients who did not die were identified. A significantly higher proportion of patients who died utilized inpatient services vs. those who did not die (Q4: 12.6% vs. 4.6%, p < .001; Q3: 14.6% vs. 4.6%, p < .001; Q2: 17.6% vs. 5.5%, p < .001; and Q1: 65.0% vs. 10.1%, p < .001). In addition, patients who died incurred significantly higher all-cause costs (Q4: $8882 vs. $3970, p < .001; Q3: $10,462 vs. $3661, p < .001; Q2: $12,564 vs. $4169, p < .001; and Q1: $36,076 vs. $6319, p < .001).Conclusions: T2DM patients with a CVD-related death had significantly greater HCRU and costs in the year including and preceding death compared to those who did not die.