Healthcare Resource Utilization Research Articles

Real-world perioperative treatment patterns and economic burden of recurrence in early-stage HER2-negative breast cancer: a SEER-Medicare study

ABSTRACT Aim This study aimed to describe treatment patterns and quantify the economic impact of recurrence in early-stage human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC). Materials & Methods Medicare beneficiaries with stages I–III HER2-negative BC and lumpectomy or partial/total mastectomy were identified from SEER-Medicare data (2010–2019). Perioperative therapies were reported in the neoadjuvant and adjuvant setting. Locoregional recurrence and distant metastasis were identified using a claims-based algorithm developed with clinical input and consisting of diagnosis-based and treatment-based indicators. All-cause and BC-related healthcare resource utilization (HRU) per-patient-month and monthly healthcare costs were estimated from the recurrence date for patients with recurrence and from an imputed index date for patients without recurrence using frequency matching. HRU and costs were compared between groups stratified by hormone receptor-positive (HR+) or triple negative BC (TNBC) using multivariable regression models. Results Of 28,655 patients, 8.5% experienced recurrence, 90.4% had HR + disease, and 5.6% received neoadjuvant therapy. Relative to patients without recurrence, patients with recurrence had more advanced disease (stage II/III: 73.7% vs. 34.0%) and higher-grade tumors (Grade 3/4: 40.6% vs. 18.0%) at diagnosis. Recurrence in HR+/HER2-negative BC and TNBC was associated with higher rates of all-cause hospitalizations (incidence rate ratio [IRR]: 2.84 and 3.65), emergency department (ED) visits (IRR: 1.75 and 2.00), and outpatient visits (IRR: 1.46 and 1.55; all p < 0.001). Similarly, recurrence was associated with higher rates of BC-related HRU, particularly for ED visits in HR+/HER2-negative BC (IRR: 4.24; p < 0.001) and hospitalizations in TNBC (IRR: 11.71; p < 0.001). Patients with HR+/HER2-negative BC and TNBC recurrence incurred higher monthly all-cause (cost difference [CD]: $3,988 and $4,651) and BC-related healthcare costs (CD: $3,743 and $5,819). Conclusions Our findings highlight the considerable economic burden of recurrence in early-stage HER2-negative BC and underscore the unmet need for optimization of therapies that reduce recurrence in this population.

Gamification and its Potential for Better Engagement in the Management of Heart Failure or Quality of Care Registries: A Viewpoint.

Over the past decade, gamification, an umbrella term that refers to tools that engage and motivate participants through the use of game design elements (e.g., challenges and rewards) in a non-gaming context, has emerged as a promising approach in the management of chronic diseases. Specifically, it has been demonstrated to be effective in the education of both patients as well as healthcare professionals on medication adherence, risk reduction, patient self-care, and rehabilitation. There is some evidence suggesting that gamification might have similar benefits for heart failure (HF) patients and their health care professionals. This is of specific interest since HF is a chronic disease associated with a severely compromised long-term prognosis and subsequent high health care resource utilization. However, more robust research is needed to confirm these findings and determine the optimal method, as well as barriers, to the implementation of gamification in the working process of health care professionals or treatment adherence to patients specifically in the setting of HF. This viewpoint explores the literature concerning HF and gamification and aims to identify its various potentials in the management of HF patients.

Healthcare resource utilization and related cost of non-HIV comorbidity management in people with HIV in a Spanish cohort from 2007-2016

Objective To estimate the cost and healthcare resource utilization (HRU) associated with the prevalence of comorbidities in people living with HIV (PLWH) in a Spanish cohort over ten years. Methods: Cohort study carried out at the HIV outpatient clinic of the University Hospital Virgen del Rocío based on data collected during 2007-2016. PLWH with at least one follow-up visit were included. Comorbidities were determined by examining diagnostic codes in the electronic medical records. Costs were estimated from hospitalizations, emergency and non-HIV visits, laboratory tests for conditions unrelated to HIV infection, HIV antiretroviral therapy, and other non-HIV diagnostic tests. A linear regression was performed with non-ART costs as the dependent variable and patient characteristics (sex, HIV transmission route, age, CD4, comorbidities, and infection duration) as independent variables. Results: The study included 2,798 PLWH; 83% were men with a mean age of 38.6 years. Overall, 52.5% of PLWH had at least one non-HIV comorbidity and 21.2% had ≥3 comorbidities. The most prevalent comorbidities were hepatitis C (25.3%) and hypertension (22.9%). The presence of comorbidities increased the total healthcare cost up to 80% in PLWH with ≥3 comorbidities compared with those without comorbidities (over a 10-year period (115,867.3€vs 64,290.7€, p < 0.001). The number of comorbidities was linked to higher healthcare costs in PLWH in the adjusted model. Conclusion: Comorbidities raised the total healthcare costs for PLWH, with a greater impact on those with multiple comorbidities compared to those with few or none. Both clinical and economic decision-makers must consider and assess the cost of comorbidities when evaluating HIV treatment guidelines or recommendations.

Persistent symptoms, exacerbations and drug side effects despite treatment in myasthenia gravis.

Generalized myasthenia gravis (gMG) is characterized by fluctuating muscle weakness. Exacerbation frequency, adverse events (AEs) related to immunosuppressant therapy and healthcare resource utilization (HCRU) are not well understood. Our study aimed to describe long-term clinical outcomes, drug-related AEs and estimated HCRU in gMG patients. This was a retrospective cohort analysis of clinical data from patients with gMG followed-up over eight consecutive years in a Spanish referral unit. Myasthenia Gravis Foundation of America (MGFA) clinical classification, MGFA post-interventional status (MGFA-PIS), Myasthenia Gravis Activities of Daily Living (MG-ADL) score, exacerbations, MG crises, therapies, AEs reported, specialist consultations and emergency room visits were studied biannually. An estimation of HRCU was made based on these data. Some 220 patients newly diagnosed with gMG were included. Ninety percent were seropositive (84.5% anti-acetylcholine receptor [AChR], 5.9% anti-muscle-specific kinase [MuSK]). Baseline mean MG-ADL score was 5.04 points (SD 3.17), improving to 0.7 points (SD 1.40) after 8 years. Exacerbations were more frequent in years 1-2 (30.1%) but still occurred in years 7-8 (20.2%). Myasthenic crisis frequency remained 1% in years 7-8. Eighty-nine percent achieved MGFA-PIS minimal manifestations or better at 8 years. Fifty-one percent of patients reported at least one AE during the study period, leading to drug withdrawal in approximately 20% of cases. HCRU decreased between years 1-2 to years 7-8 with an estimated cost of MG from 8074.19 € per patient/year to 1679.46 €, respectively. There is a group of MG patients that suffers from persistent symptoms and exacerbations (11%-20%) or MG crises, and drug AEs, which may increase disease burden and impact on the healthcare system.

Accelerated Bacterial Identification with MALDI-TOF MS Leads to Fewer Diagnostic Tests and Cost Savings

Introduction: Rapid microbiology reporting can enhance both clinical and economic outcomes. Material and Methods: This three-year, quasi-experimental study, single-group pretest–posttest study, conducted at a university medical center, aimed to evaluate the clinical and economic impact of rapid microbiological identification reporting using MALDI-TOF MS. A total of 363 consecutive hospitalized patients with bacterial infections were evaluated, comparing a historical control group (CG, n = 183) with an intervention group (IG, n = 180). In the CG, microbiological information (bacterial identification and antibiotic susceptibility) was provided between 18:00 and 22:00 h, while in the IG, bacterial identification was reported between 12:00 and 14:00 h, and antibiotic susceptibility was reported between 18:00 and 22:00 h. Results: The IG demonstrated a significant reduction in the number of patients undergoing Microbiology (p = 0.01), Biochemistry (p = 0.05), C-Reactive Protein (p = 0.02), Radiological Tests (p = 0.05), Computed Tomography Tests (p = 0.04), and Pathology (p = 0.01). However, no statistically significant reduction was observed in economic costs related to microbiological testing (p = 0.76) or antibiotic consumption (p = 0.59). The timely reporting of microbiological identification to clinicians resulted in fewer patients undergoing additional diagnostic tests, ultimately contributing to reduced healthcare resource utilization without adversely affecting clinical outcomes.

Novel Systemic Anticancer Therapy and Healthcare Utilization at the End of Life: A Retrospective Cohort Study.

Novel systemic anticancer therapies (SACT) in the form of targeted and immunotherapies are increasingly replacing traditional chemotherapy. Little is known about the impact of novel SACT on healthcare resource utilization (HCRU) at the end of life. A retrospective review of patients attending a tertiary cancer center in Toronto, Canada, with advanced solid or hematological malignancies who died in 2019. Demographic and cancer data, SACT use, HCRU (emergency room [ER] visits, acute/intensive care unit [ICU] admission, and place of death) were retrieved and compared between those who received SACT in their last 30 days of life and those who did not. Chi-squared tests or Quasi-Poisson regression calculated HCRU expressed as percentages or rate ratios (RR). Univariate and multivariable logistic regression identified factors independently associated with SACT use. Of 443 patients included, 88 (20%) received SACT in the last 30 days of life, with 42 (48%) receiving targeted therapies and 10 (11%) immunotherapy. Factors associated with SACT use included younger age (p = 0.016), breast (p < 0.001), lung (p = 0.047), hematological malignancies (p = 0.002), fewer comorbidities (p = 0.039), and novel SACT (p = 0.006). Receipt of SACT was associated with a higher frequency of ER visits (55% vs. 36% who did not receive SACT, p = 0.001), acute hospitalizations (68% vs. 47%, p < 0.001), ICU admissions (18% vs. 7%, p = 0.003), and death in hospital (45% vs. 30%, p = 0.008). Novel SACT use at the end of life is high and is strongly associated with HCRU. Future studies should explore the impact of advance care planning and palliative care referrals on SACT use.

Frailty is Associated with Increased Complication, Readmission, and Hospitalization Costs Following Primary Total Shoulder Arthroplasty

Frailty is an age-related state of multi-system decline that has been associated with negative outcomes after surgery. Numerous methods have been utilized to quantify frailty and predict postoperative outcomes with variable results. The purpose of this study is to determine if the Hospital Frailty Risk Score (HFRS) is an independent predictor of postoperative complications and increased healthcare costs following elective primary total shoulder arthroplasty (TSA). The Nationwide Readmissions Database was queried to select patients undergoing elective primary TSA from 2016-2020. HFRS was calculated for each patient and patients with scores of five or greater were considered frail. Demographic characteristics, preoperative comorbidities, postoperative complications, and healthcare resource utilization metrics were compared between frail and non-frail patients using bivariate analysis. Binary logistic regression was used to determine if HFRS was independently predictive of adverse postoperative outcomes. There were 44,118 frail patients and 210,032 control patients undergoing TSA included in this study. After logistic regression analysis, HFRS was shown to be independently predictive of any complication (p<0.001), readmission (p<0.001), and mortality (p<0.001) within 180 days of elective primary TSA. HFRS was predictive of periprosthetic fracture (p<0.001), acute respiratory distress syndrome (p<0.001), acute renal failure (p<0.001), cellulitis (p<0.001), pneumonia (p<0.001), sepsis (p<0.001), transfusion (p<0.001), and urinary tract infection (p<0.001). Frail patients had higher resource utilization than control patients, including a higher mean total cost of hospitalization ($20,991 vs. $18,869; p<0.001) and a longer mean hospital LOS (3.1 vs. 1.4 days; p<0.001). Frail patients were more likely to be discharged to a facility (p<0.001) or with home healthcare (p<0.001). Frailty is independently associated with increased postoperative complications and healthcare utilization after elective primary TSA, and this study demonstrates the utility of HFRS as an adjunct for preoperative risk stratification and patient optimization prior to elective primary TSA. Frail patients had higher postoperative complications and healthcare costs after primary elective TSA compared to non-frail patients. The HFRS is easily calculated from routinely collected patient data and thus can help orthopedic surgeons and healthcare systems identify high-risk patients without significant burden to current provider workflows.

Healthcare resource utilization and costs among treatment-naïve people with HIV in state Medicaids: analysis of multi-tablet vs. single-tablet antiretroviral regimen initiators with and without concurrent mental health disorders

BACKGROUND Research is needed to understand the impact of mental health disorders (MHD) on healthcare resource utilization (HCRU) and costs among people with human immunodeficiency virus (PWH). OBJECTIVES Examine the HCRU and cost burden among treatment-naïve PWH with and without MHD initiating single tablet antiretroviral regimens (STRs) and multi-tablet regimens (MTRs). METHODS A retrospective database analysis of US Medicaid population from Anlitiks’ All Payor Claims database between 01/01/16 to 06/30/23 was conducted. Treatment-naïve MTR-initiators vs STR-initiators (the index was the first prescription fill claim date) with ≥ 12-months pre- and post-index continuous enrollment and no pre-index HIV-2 diagnosis among PWH/MHD and PWH/no-MHD during 01/01/17-06/30/22 were selected. Demographics, clinical characteristics, HCRU and costs between MTR-initiators vs STR-initiators among PWH/MHD and PWH/no-MHD were described using Chi-square tests and Wilcoxon rank-sum or t-tests for categorical and continuous variables, as appropriate. HCRU and costs were examined using multivariable logistic and gamma-log link regression models, controlling for potential confounders. RESULTS MTR-initiators (PWH/MHD: n = 7,874, PWH/no-MHD: n = 3,612) vs. STR-initiators (PWH/MHD: 46,024, PWH/no-MHD: 23,452) were significantly younger (PWH/MHD: 43.6 vs. 47.2 years; PWH/no-MHD: 39.2 vs. 43.3 years) and more likely to be female (PWH/MHD: 46.4% vs. 35.7%; PWH/no-MHD: 42.3% vs 29.7%) in both groups (all p-values < 0.05). MTR-initiators vs. STR-initiators had significantly higher rates of inpatient (IP) hospitalizations (PWH/MHD: 28.9% vs. 27.1%; PWH/no-MHD:13.9% vs. 11.9%) and emergency department (ED) visits (PWH/MHD: 53.3% vs. 49.2%; PWH/no-MHD: 35.2% vs. 31.8%) among both those with and without MHD (all p-values < 0.05). MTR-initiators vs. STR-initiators also had significantly higher adjusted all-cause medical costs (PWH/MHD: $60,228 vs $40,634; PWH/no-MHD: $33,623 vs. $17,996) (all p-values < 0.05). CONCLUSIONS Among PWH/MHD and PWH/no-MHD, MTR-initiators experienced significantly higher HCRU, and 1.5 times greater costs compared to STR-initiators. In both MTR and STR-initiator groups, PWH/MHD cohort consistently demonstrated a greater HCRU and cost burden than PWH/no-MHD.

Use of inpatient systemic chemotherapy and/or radiotherapy and related predictive factors, healthcare resource utilization, and direct hospitalization costs for metastatic urothelial cancer: findings from a real-world retrospective observational study derived from the national hospital discharge claims database in Italy

BackgroundRecent real-world studies revealed high proportions of patients with metastatic urothelial cancer (mUC) do not receive any systemic therapy. This study describes the demographics, clinical characteristics, treatment rate and related predictive factors, healthcare resource utilization, and direct medical costs of patients with mUC receiving systemic therapy (or not) in the inpatient setting in Italy.MethodsThis retrospective observational study used the national hospital discharge database (Scheda di Dimissione Ospedaliera) to describe incident adult (≥ 18 years) patients with a first hospitalization for mUC (index) from 2017-2018, identified by a combination of ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), medical procedure, and diagnosis-related group codes. A model was fitted to identify factors associated with receiving inpatient chemotherapy and/or radiotherapy.ResultsOf 3674 patients with mUC identified, 1014 (27.6%) were treated with inpatient chemotherapy and/or radiotherapy and 2660 (72.4%) were not treated. The median age at index was 71 and 78 years for treated and untreated patients, and the mean (SD) Charlson Comorbidity Index (CCI) score was 0.3 (0.8) and 0.6 (1.1), respectively. Primary tumor location was the bladder in 87.2% of patients. Cardiovascular disease and renal function impairment were more prevalent in untreated (22.6% and 13.2%) vs treated (16.7% and 7.8%) patients. Older age (odds ratio [p-value]) (0.94 [< 0.001]), female sex (0.82 [0.035]), and higher CCI score (0.82 [< 0.001]) were all associated with a lower likelihood of receiving inpatient systemic treatment. The first year was the costliest: estimated national projected costs during the 36-month follow-up from first hospitalization for mUC were €34.3 million (95% CI, €30.3-€60.0 million) and €31.8 million (95% CI, €28.1-€56.0 million) when estimated after 1 year.ConclusionsOur findings indicate a low rate of inpatient systemic therapy for patients with mUC in Italy (driven by older age, female sex, and high comorbidity burden), with a large economic burden despite a high nontreatment rate. Although this study provides a partial capture of the treatment pathway in Italy, the results are consistent with other European studies with similar designs and highlight the need to better identify the reasons for not administering inpatient systemic chemotherapy and/or radiotherapy.

Healthcare utilization and costs following molecular diagnostic testing among patients with vaginitis.

Aim: Vaginitis and other vaginal discharge syndromes lead to high healthcare utilization. Molecular tests like syndromic multiplex real-time (RT) polymerase chain reaction (PCR)-based tests are highly sensitive and specific at diagnosing the infectious causes of vaginitis. This study compared the healthcare resource utilization (HCRU) and direct all-cause healthcare costs among patients with vaginitis in the US receiving next-day syndromic multiplex RT-PCR tests with those receiving other PCR tests or no diagnostic test of interest. Patients & methods: This retrospective study utilized claims data from IQVIA PharMetrics® Plus database to identify adult patients with a diagnosis for vaginitis (first claim=index) from January 2021 to April 2023, with 6months of continuous enrollment prior to (baseline) and after index (follow-up). Pairwise comparisons were conducted between RT-PCR and 1:1 propensity matched Other PCR and No Test subcohorts for all-cause HCRU and costs during follow-up. Results: Each of the RT-PCR, Other PCR and No Test subcohorts included 1946 matched patients. Mean(SD) follow-up total cost was significantly lower for the RT-PCR than the No Test subcohort ($5607[$15,122] vs $6680[$20,751], p=0.0023). Mean(SD) overall outpatient and other medical service costs were lower for RT-PCR versus Other PCR (outpatient: $2964[$9666] vs $3174[$7113], p=0.0110; other medical: $1961[$9244] vs $2099[$6475], p=0.0002) and No Test subcohorts (outpatient: $2964 [$9666] vs $4067[$12,341], p<0.0001; other medical: $1961[$9244] vs $2973[$11,685]; p<0.0001). A lower proportion had any outpatient service HCRU in RT-PCR versus Other PCR subcohort (92.6% vs 94.2%, p=0.0349). A lower proportion had any other medical service claim in RT-PCR versus Other PCR (78.3% vs 83.2%, p<0.0001) and No Test subcohorts (78.3% vs 83.0%, p=0.0001). Physician office, emergency room (ER), prescription use and costs were similar between the subcohorts. Conclusion: The use of syndromic multiplex RT-PCR diagnostics with next day test results in patients with vaginitis was associated with lower outpatient costs and total healthcare costs than those in the no test cohort over 6months. These findings indicate that use of syndromic multiplex RT-PCR diagnostics may contribute to improved patient management compared with clinical diagnosis alone.

INVESTIGATION OF GEOSPATIAL DISPARITIES IN CHRONIC PANCREATITIS OUTCOMES.

Chronic pancreatitis (CP) is a fibro-inflammatory disorder characterized by abdominal pain and exocrine and endocrine pancreatic insufficiency resulting in significant morbidity. This study evaluates the impact of geospatial parameters, assessed using the Social Vulnerability Index (SVI), a tool comprising sixteen social attributes, on CP outcomes, including opioid use. We conducted a retrospective analysis of CP patients with available addresses followed at our pancreas center. We reviewed demographics, clinical variables including number of CP flares, local complications, pancreatic function, and healthcare-resource utilization (HRU) including imaging, endoscopic procedures, and surgeries, and outpatient opioid prescriptions measured in morphine milligram equivalents (MME). Regression analysis was performed to assess the association between outcomes and SVI [divided into 4 quartiles (I-IV; IV being most vulnerable]. Among 324 CP patients followed over 8 years, we noted trends of higher dependence on governmental insurance or no insurance among patients in higher SVI quartiles (III/IV vs. I/II) but no differences in demographics, comorbidities, or etiology of CP. In patients residing in more vulnerable SVI quartiles, we noted significantly higher frequency of hospitalizations for CP flares and lower daily MME. Rates of exocrine and endocrine pancreatic dysfunction and HRU were similar across all SVI quartiles. Despite multidisciplinary guideline-based care, residence in the most vulnerable neighborhoods may be associated with less opioid use and more frequent CP flares, suggesting possible inadequate pain control in these patients. These findings should guide prospective investigation of the impact of geospatial social determinants of health in CP and efforts to mitigate the above disparities.

Peak left atrial longitudinal strain and incident atrial fibrillation in the general population: a systematic review and meta-analysis

Background Atrial fibrillation (AF) is the commonest supraventricular arrhythmia in adults. Timely AF diagnosis seems to ameliorate patients prognosis. Purpose To investigate the association between peak left atrial longitudinal strain (PALS) and new onset AF in the general population. Objectives We searched major electronic databases for articles assessing the relationship between PALS and incident AF. Results Eight studies (11,145 patients) were analysed. Lower levels of PALS were significantly associated with higher risk of incident AF (HR: 0.95; 95%CI: 0.92–0.97, I 2: 83%). According to the diagnostic accuracy meta-analysis, PALS <33.4% presents 64% (95%CI: 46–79%) sensitivity and 69% (95%CI: 63–75%) specificity. Conclusions In a relatively healthy population, lower levels of PALS were significantly associated with incident AF. The overall diagnostic accuracy was moderate. Lower levels of PALS seem to justify an opportunistic – rather than a systematic-screening approach. These findings could allow more efficient utilisation of healthcare resources.

Hospitalization due to pneumococcal disease in the Unified Health System in Brazil: A retrospective analysis of administrative data

IntroductionCommunity-Acquired Pneumonia (CAP) caused by pneumococcus and Invasive Pneumococcal Disease (IPD) pose a substantial economic burden on health systems. The objective of the present study is to explore hospitalization costs of pneumococcal disease in the public health system in Brazil, the Unified Health System. MethodsRetrospective analysis of administrative data on hospitalized cases of pneumococcal disease from January 2019 to July 2023. Hospitalization cases recorded with ICD-10 codes of CAP due to S. pneumoniae and IPD were retrieved from DATASUS, the inpatient information system of the Unified Health System in Brazil. Costs were converted to US dollars by Using Purchasing Power Parity (USD-PPP). Absolute number of hospitalizations, costs of hospitalizations and healthcare resource utilization were presented descriptively. The annual cost estimate was calculated. Differences in costs by type of clinical presentation and age group were assessed. Factors associated with higher costs were explored by multiple linear regression models. ResultsA total of 22,498 hospitalization episodes were analyzed. Total cost of hospitalizations was USD-PPP 13,958,959 (BRL 34,659,578) with an annual mean estimate of USD-PPP 3,045,591 (BRL 7,562,090). Cost per hospitalization episode was significantly higher for meningitis, followed by septicemia, CAP and arthritis, with median values ranging from USD-PPP 190.93 to 615.14 (BRL 476.20 to 1529.02). (Kruskal-Wallis χ2 = 6473, df = 3, p-value < 0.0001). Costs were significantly higher among individuals aged 60-years and older. (Kruskal-Wallis test; χ2 = 773.53; df = 2, p-value < 0.0001). There were differences in age at hospitalization, length of stay, and ICU utilization among types of clinical presentations. ConclusionsOur findings reveal the economic burden associated with pneumococcal disease in the Unified Health System in Brazil. Hospitalization costs were higher for cases of meningitis and among individuals aged 60-years and above.

Treatment persistence, adherence and healthcare resource utilisation for iGlarLixi versus basal-bolus insulin or premixed insulin in older adult ethnic minorities with type 2 diabetes: SoliEthnicity study.

Most type 2 diabetes (T2D) studies have predominantly enrolled White people aged <65 years. This retrospective study evaluated outcomes for iGlarLixi (fixed-ratio combination [FRC] of insulin glargine 100 U/mL and lixisenatide) versus basal-bolus or premixed insulin in African American, Asian and Hispanic adults with T2D aged ≥65 years. Medicare claims data were assessed from beneficiaries receiving basal insulin who newly initiated iGlarLixi, basal-bolus insulin, or premixed insulin between 7/1/2019 and 12/30/2021. Groups were propensity score matched at baseline and followed for up to 12 months. Endpoints (primary: treatment persistence; secondary: treatment adherence, hypoglycaemia event rates, healthcare resource utilisation) were assessed using multivariable regression. Treatment persistence was higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (26.9%, 7.6%, 18.9%; adjusted p < 0.0001) and numerically higher in all ethnic subgroups. Treatment adherence was numerically higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (28.0%, 8.0%, 19.0%) and in all subgroups. Hypoglycaemia event rates were numerically lower for iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population (2.5, 3.8, 7.5/100 person-years' follow-up) and in all subgroups except Asians receiving basal-bolus insulin. All-cause and diabetes-related hospitalisation and emergency department visit event rates were lower with iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population, and in all subgroups except for hospitalisations in Hispanics. FRC therapies such as iGlarLixi represent an appropriate treatment option when intensifying basal insulin therapy in ethnic minority older adults with T2D.

Impact of Integrated Pharmacist-Nurse-Radiology-Dietitian Teams on Polypharmacy Patient Outcomes: A Comprehensive Analysis

Polypharmacy, defined as the concurrent use of five or more medications, is a significant challenge in modern healthcare. It affects 10-20% of community-dwelling adults and 40-50% of people aged 65 years and older. This study presents a comprehensive assessment of the impact of integrated healthcare teams comprising pharmacists, nurses, radiologists, and dietitians on polypharmacy patient outcomes. The results indicated significant improvements across multiple domains: medication appropriateness scores increased by 65%, adverse drug events decreased by 45%, and hospital readmission rates decreased by 40%. Each professional contributed something unique: pharmacists reduced inappropriate medications through comprehensive medication reviews by 65%; hospital readmissions were reduced by nurses, who applied quality-enhanced care coordination for the best interest of the patient by 35%; radiologists increased treatment accuracy by 40%, providing advanced diagnostic support; and dietitians decreased drug-nutrient interaction complications by 55%. Economic analysis revealed substantial cost savings of approximately $2,500 per patient annually, and a 35% reduction in emergency department utilization. Patient-centered outcomes demonstrated a 55% increase in health-related quality of life and 60% improvement in medication adherence. Implementation barriers, resource constraints, and limitations in the reimbursement structure exist, but evidence strongly supports the effectiveness of such integrated healthcare teams in polypharmacy patient management. The study concluded that such collaborative care models are vital for better patient outcomes and healthcare resource utilization in an evolving practice around advanced medication management.

Ceftazidime–avibactam for the Treatment of Intra-abdominal Sepsis and Urosepsis: A Retrospective Hospital-based Study in India

Abstract Background: In India, microbial susceptibility to antibiotics has been gradually decreasing, thus making treatment of multidrug-resistant bacterial infections challenging. We aimed to assess the effectiveness of ceftazidime–avibactam in patients with intra-abdominal sepsis or urosepsis. Methods: This hospital-based, single-center retrospective study was conducted between April 2020 and March 2022 using data from inpatient records. Outcomes included inpatient mortality, clinical success/failure, and microbiological cure/failure measured on day 14/end of treatment, length of hospitalization and intensive care unit (ICU) admission, treatment and infection characteristics, recurrence within 30 days, and healthcare resource utilization. Descriptive statistics were used for data analysis. Results: Data from 46 patients (mean age = 65.2 ± 14.5 years, 73.9% male) were included. Ceftazidime–avibactam treatment was initiated within 5 days of hospitalization in 51.2% of patients. The median (range) duration of treatment was 8 (1, 20) days, and the average daily dose was 4.6 g. Inpatient and 30-day all-cause mortality rates were 41.5% and 17.1%, respectively. We observed clinical success, defined a priori, by day 14 in 58.5% of patients and microbiological cure in 61.3%. Most patients (97.0%) did not have recurrent infections. The median (range) length of hospitalization and ICU admission was 15.5 (3, 63) days and 11 (2, 63) days, respectively. Most patients (85.7%) utilized various healthcare resources during hospitalization. Conclusion: Among patients with available data, most showed clinical success (58.5%) and microbiological cure (61.3%) within 14 days of treatment initiation with ceftazidime–avibactam, with nearly no recurrence of infection, indicating treatment effectiveness in patients with intra-abdominal sepsis or urosepsis in an Indian hospital setting.

Clinical and economic outcomes with rivaroxaban versus warfarin in patients with nonvalvular atrial fibrillation and obstructive sleep apnea: retrospective analysis of US healthcare claims.

Atrial fibrillation (AF) and obstructive sleep apnea (OSA) are often comorbid and associated with increased risk of cardiovascular events such as stroke. We evaluated the effectiveness, safety, healthcare resource utilization, and costs of rivaroxaban versus warfarin in patients with nonvalvular AF (NVAF) and comorbid OSA. We used the IQVIA PharMetrics® Plus adjudicated claims database to evaluate patients with NVAF, OSA, and moderate-to-severe stroke risk who initiated rivaroxaban or warfarin between November 2011 and December 2022. We adjusted for potential confounders with propensity score overlap weighting. Primary endpoints were evaluated based on intent-to-treat (ITT) and on-treatment follow-up to compare stroke or systemic embolism risk, major bleeding risk, all-cause healthcare resource utilization (inpatient hospitalizations, emergency department visits, outpatient visits, and pharmacy fills), and costs (per patient per year [PPPY]) by treatment cohort. In total, 14,765 patients were included (9133 received rivaroxaban; 5632 received warfarin). Rivaroxaban significantly reduced stroke or systemic embolism versus warfarin by 26% (ITT-hazard ratio, 0.74 [95% CI 0.60-0.91]; P = 0.004) and 30% (on-treatment-hazard ratio, 0.70 [95% CI 0.55-0.89]; P = 0.004). Major bleeding was not significantly different between rivaroxaban and warfarin in either analysis. All-cause healthcare resource utilization was significantly reduced with rivaroxaban versus warfarin, leading to significantly reduced PPPY costs. Among patients with NVAF and OSA, rivaroxaban was associated with a significant reduction in stroke or systemic embolism risk versus warfarin with no difference in major bleeding. Rivaroxaban significantly reduced healthcare resource utilization and costs compared with warfarin, providing support for the use of rivaroxaban in this population.

Characteristics of patients hospitalized for falls: electronic health records analysis

Abstract Aim Falls are common adverse events, often leading to hospitalization with adverse effects on the physiological and psychological health of patients. Although risk factors for falls are well examined, it is difficult to identify fallers through their electronical health records (EHR). This study investigates whether EHR contain characteristics that indicate a fall before hospitalization. Subject and methods We evaluated 500 EHR of patients hospitalized through the Department of Emergency Medicine of Jena University Hospital. We considered electronically available characteristics including free texts and ICD-10-GM codes. Inpatients with and without a fall event previous to their hospitalization were compared for significant differences in EHR characteristics. Therefore, we applied the Mann–Whitney U test and the exact Fisher test, respectively, with a two-sided significance level of 0.05 and without correction for multiple testing. Results It was possible to identify significant differences between fallers and non-fallers by gender (66.3% women), age (median: 84 years), living situation prior to hospital admission (20.5% from nursing home, 41.1% living alone) and type of discharge. Besides other risk factors, ICD-10-GM codes included injuries, especially fractures and superficial injuries, but also cognitive deficits, incontinence, and physical limitations were more prevalent with fallers than non-fallers. Conclusion This study identified characteristics that can support identification of fall patients through EHR. Such information should be tested in other hospitals and is expected to enhance patient safety and utilization of healthcare resources.

Costs associated with nonalcoholic steatohepatitis disease progression in Medicare patients: a retrospective cohort study.

Aim: Non-alcoholic steatohepatitis (NASH), or metabolic dysfunction-associated steatohepatitis (MASH), is a severe form of non-alcoholic fatty liver disease (NAFLD) or metabolic dysfunction-associated liver disease (MASLD), that may progress to advanced liver disease. Costs associated with progression are not well characterized. This study sought to quantify costs and healthcare resource utilization (HRU) associated with NASH progression. Methods: Patients were included if diagnosed with NASH (ICD-10: K75.81) in 100% Medicare claims data (2015-2021) who were ≥66years at index (diagnosis), continuously enrolled in Parts A, B and D for ≥12months prior to and 6months following index (unless death) and who had no evidence of other causes of liver disease. Patient-time was categorized into five severity states: non-cirrhotic NASH, compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC) and liver transplant (LT). Annualized HRU and costs were calculated during the study periods overall and stratified by occurrence and timing of progression. Results: In 14,806 unique patients (n=12,990 non-cirrhotic NASH; 1899 CC; 997 DCC; 209 HCC; 140 LT), mean age and follow-up were 72.2 and 2.8years, respectively. Average annualized costs increased from baseline following diagnosis, generally scaling with severity: $16,231 to $27,044; $25,122 to $57,705; $40,613 to $181,036; $36,549 to $165,121 and $35,626 to $108,918 in NASH; CC; DCC; HCC; and LT; respectively. Non-cirrhotic NASH and CC patients with progression had higher follow-up spending (1.6x for NASH; 1.7x for CC) than non-progressors (both p<0.001), 2.8 and 6.1-times higher odds of an inpatient stay and 2.6 and 3.6-times higher odds to be in the top 20% of spenders, respectively, relative to non-progressors (both p<0.001). Patients progressing within a year had costs 1.4, 1.6, 1.7 and 2.2-times more than year 2, 3, 4 and 5 progressors' costs, respectively, for non-cirrhotic NASH and 1.3, 1.8, 2.0 and 2.2-times more than year 2, 3, 4 and 5 progressors' costs, respectively, for CC. Conclusion: NASH progression is associated with high costs that increase in more severe disease states. Slower progression is associated with lower costs, suggesting a potential benefit of therapies that may delay or prevent progression.

Implementation of a lisocabtagene maraleucel chimeric antigen receptor T-cell therapy outpatient monitoring program: Multicenter nursing/advanced practice provider perspectives

ObjectivesLisocabtagene maraleucel (liso-cel; Breyanzi), an autologous chimeric antigen receptor T-cell therapy, has demonstrated efficacy and safety in relapsed/refractory large B-cell lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, and mantle cell lymphoma. Outpatient monitoring after liso-cel administration has shown lower health care resource utilization and cost and high patient satisfaction. However, outpatient monitoring programs require well-designed processes with collaborations from multiple stakeholders across several facilities. The study objective is to provide learnings and key considerations from nurses and advanced practice providers (APP) with experience setting up and managing liso-cel outpatient monitoring programs. Data sourceAuthor experience gathered from 3 institutions at 2 workshops. ResultsIn the reviewed programs, patients are discharged on the same day after liso-cel infusion and observation. They are required to remain within a short distance of the facility for ≥4 weeks with admission to treatment facilities upon experiencing adverse events (AE). Nurses/APPs report several key features of successful programs: flexibility to carry out essential roles/functions based on institution's resources and staff structure, a phased or hybrid (hospital/clinic) approach to program launch, a core team to run and guide the program, robust training for staff, options to tailor AE monitoring based on institution guidelines, and coordinated transitions between multiple stakeholders and facilities. ConclusionsNurses/APPs are critical contributors to liso-cel outpatient monitoring programs. Success in providing appropriate, complex individualized care in these programs can be achieved by using a multistakeholder approach with appropriate staff and patient/caregiver training and careful coordination across multiple functions and facilities. Implications for nursing practiceThe learnings and resources presented may provide insight to considerations around the development of a cell therapy outpatient monitoring program. However, the information provided here should be taken together with other relevant resources and guidelines and should be adapted to align with the institution's own guidelines.