Health Resource Utilization In Patients Research Articles

Catheter ablation for supraventricular tachycardia and health resource utilization and expenditures: A propensity-matched cohort study

BackgroundFew data are available regarding temporal patterns of health resource utilization (HRU) and expenditures among patients undergoing catheter ablation for paroxysmal supraventricular tachycardia (PSVT). This study aimed to describe expenditures and HRU in patients with PSVT who underwent catheter ablation compared to a matched cohort of patients on medical therapy alone. MethodsUsing a large US administrative database, we identified adult patients (age 18 to 65 years) with a new PSVT diagnosis between 2008 and 2016. Propensity-score matching was used to assemble a PSVT cohort treated with ablation or medical therapy alone (N = 2556). Longitudinal trends in HRU and expenditures in the 3-years preceding and following PSVT diagnosis were compared. ResultsThere were no significant differences in expenditures between groups except within the first year after PSVT diagnosis: $48,004 ablation vs. $17,560 medical therapy (p < 0.001). This difference was driven by procedural expenditures, where the mean cost of catheter ablation was $32,057 ± SD 26,737. In Years 2 and 3 post-ablation, HRU and expenditures decreased to the levels associated with the medical therapy group, although fewer ablation patients required any prescription for beta-blockers, calcium channel blockers, or anti-arrhythmic drugs (32% ablation vs. 42% medical therapy group, p < 0.001). ConclusionCatheter ablation reduces medication burden in PSVT, yet health resource use and expenditures were similar beyond 2 years post-ablation when compared to PSVT patients on medical therapy alone. Additional studies are required to better understand drivers of these sustained health expenditures, and barriers to achieving cost-savings for a potentially curative procedure.

Can Preoperative Laboratory Values Predict Short-term Postoperative Complications and Health Utilization in Patients Undergoing Cranioplasty?

Low hematocrit, low albumin, and high creatinine levels have been associated with postoperative morbidity. The present study intends to analyze the effects of preoperative laboratories on medical complications and postoperative health resource utilization in patients undergoing cranioplasty. Using data from the American College of Surgeons National Surgical Quality Improvement Program, demographic, clinical, and intraoperative characteristics were collected for each patient who had recorded albumin, hematocrit, or creatinine laboratory values within 90 days of the index cranioplasty. Outcomes analyzed were ≥1 medical complication, ≥1 wound complication, unplanned reoperation, 30-day readmission, and extended hospital stay (>30d). Outcomes significant on bivariate analyses were evaluated using multivariate logistic regression. Significant outcomes on multivariate analyses were analyzed using receiver operating characteristic curves and Mann-Whitney U tests. The 3 separate cohorts included 1349 patients with albumin, 2201 patients with hematocrit, and 2182 patients with creatinine levels. Upon multivariate analysis, increases in albumin and hematocrit were independently associated with decreased odds of medical complications and extended length of stay. Increases in creatinine were independently associated with increased odds of medical complications. Discriminative cutoff values were identified for albumin and hematocrit. Preoperative laboratory values were independent predictors of medical complications and health utilization following cranioplasty in this study. Surgical teams can use these findings to optimize preoperative risk stratification.

Treatment Patterns and Health Resource Utilization in Patients With HR+/ HER2- Locally Advanced or Metastatic Breast Cancer in a Real-World Setting in Taiwan

ObjectivesThis study aimed to understand current treatment patterns and healthcare resource utilization (HRU) of women with locally advanced or metastatic breast cancer (advanced breast cancer [ABC]) in Taiwan overall and within the subgroup of patients who were postmenopausal women with no previous systemic therapy in the ABC setting. MethodsA chart review of anonymized data on patient characteristics, treatment patterns, and HRU was conducted via an online physician survey including 118 patient charts from women ≥ 18 years old with hormone receptor positive/human epidermal growth receptor negative ABC, diagnosed between 2015 and 2017. ResultsThe mean age of all patients was 56.6 years (range 29-83). Among the 118 patients, the most common first-line systemic therapy group after diagnosis of ABC was endocrine-based therapy (39.0%) or endocrine therapy (ET) plus chemotherapy (ChT) combinations (38.1%). In the postmenopausal subgroup (n = 56), ET-based therapy was the most common (44.6%). Oncologist visits, at annual rate of 9.20 (95% confidence interval 8.81-9.60), and hospitalizations, at annual rate of 1.08 (95% confidence interval 0.96-1.22), were key drivers of HRU. Of the 118 patients, the 72 with at least one ChT agent in their first-line regimen had an annual hospitalization rate of 1.4 versus 0.45 admissions compared with the 46 patients on first-line ET-based therapy. ConclusionsCurrent treatment patterns suggest an unmet need for new medications that lead to reduction in high rate of ChT use. Results can inform future evaluations of new ABC treatments that estimate the health economic impact of their adoption in Taiwan.

Results of treatment with alemtuzumab in a Spanish cohort of patients with multiple sclerosis in the real world: The RealMS study.

Alemtuzumab (ALZ) is a humanized monoclonal antibody approved for the treatment of patients with highly active relapsing-remitting multiple sclerosis (RRMS) administered in two annual courses. The objective of this study was to describe the effectiveness and safety data of ALZ and to report the health resource utilization in patients receiving this treatment. In this retrospective, non-interventional study, information was retrieved from patients' medical charts at one center in Spain. Included patients were ≥18 years old, and ALZ treatment was initiated between 1 March 2015 and 31 March 2019, according to routine clinical practice and local labeling. Of 123 patients, 78% were women. The mean (standard deviation, SD) age of patients at diagnosis was 40.3 (9.1) years, and the mean time since diagnosis was 13.8 (7.3) years. Patients were previously treated with a median (interquartile range; IQR) number of two (2.0-3.0) disease-modifying treatments (DMTs). Patients were treated with ALZ for a mean (SD) of 29.7 (13.8) months. ALZ reduced the annualized relapse rate (ARR) (1.5 before vs. 0.05 after; p < 0.001) and improved the median EDSS (4.63 before vs. 4.00 after; p < 0.001). Most (90.2%) patients were relapse-free while receiving ALZ. The mean number of gadolinium-enhancing [Gd+] T1 lesions was reduced (1.7 before vs. 0.1 after; p < 0.001), and the mean number of T2 hyperintense lesions was maintained (35.7 before vs. 35.4 after; p = 0.392). A total of 27 (21.9%) patients reported 29 autoimmune diseases: hyperthyroidism (12), hypothyroidism (11), idiopathic thrombocytopenic purpura (ITP) (3), alopecia areata (1), chronic urticaria (1), and vitiligo (1). The mean number of health resources (outpatient visits, emergency room visits, hospital admissions, and tests performed in the hospital) used while patients were treated with ALZ progressively decreased from year 1 to year 4, except for a slight increase at year 2 of outpatient visits. The ReaLMS study provides real-world evidence that ALZ can promote clinical and magnetic resonance imaging disease remission, as well as disability improvement in patients with MS, despite several prior DMT failures. The ALZ safety profile was consistent with data available from clinical trials and other real-world studies. Healthcare resource use was reduced throughout the treatment period.

Real world evidence study on treatment patterns and health resource utilization in patients with HR+/HER2- locally advanced or metastatic breast cancer in Korea

Objective To understand current treatment patterns and health care resource utilization (HRU) of women with locally advanced or metastatic breast cancer (advanced breast cancer; ABC) in Korea overall and within patients who had progressed with prior endocrine therapy (as first-line treatment for metastatic disease) and patients with no prior systemic treatment (for advanced disease). Methods A chart review was conducted in 109 patients (women ≥ 18 years old with HR+/HER2- ABC diagnosed between 2015 and 2017) from 11 hospitals. Anonymized data on patient characteristics, treatment patterns and HRU was abstracted. Results Mean (range) age of all patients was 57.5 (40–81) years. Overall, the most common first-, second- and third-line systemic therapy after diagnosis of ABC were letrozole ± palbociclib (51%), endocrine therapy (ET)±everolimus (42%) or chemotherapy (ChT) (39%), and ChT (68%), respectively. In patients progressed with ET (n = 33) and those with no prior systemic treatment (n = 52), the most common first-line treatments were letrozole (82%) and letrozole + palbociclib (42%), respectively. The percentage of patients with at least one grade 3 or higher adverse event during first-line therapy was 93.1% vs 39.2% in patients on a ChT based regimen (N = 29) vs. ET (N = 74). Overall, oncologist visits, at an annual rate of 9.27 (95% CI: 8.87, 9.69) visits per month, and hospitalizations, with an annual rate of 0.44 (95% CI: 0.36, 0.54), and mean (SD) length of stay of 14.3 (10.32) days, were the key drivers of HRU. Conclusions These findings on real world HRU reflected clinical guidelines and severity of ABC. Results can inform future evaluations of new ABC treatments that estimate the health economic impact of their adoption in Korea.

Treatment Patterns and Health Resource Utilization in Patients With Hepatocellular Carcinoma After Failure of Sorafenib in Real-World Setting in Taiwan

ObjectivesThis study aimed to characterize current treatment patterns and healthcare resource utilization (HRU) observed among patients with hepatocellular carcinoma (HCC) after the failure of sorafenib in real-world setting in Taiwan. MethodsA chart review was conducted in 130 patients; the inclusion criteria were patients with HCC who were aged 20 years or older and had received systemic therapy or best supportive care after failure of first-line systemic treatment with sorafenib between 2016 and 2018. Anonymized data on patient characteristics, treatment pathways, and survival were abstracted. ResultsThe mean age of patients was 61.7 years (range 27-84); of these 130 patients, 103 (79%) were male, 81 (62%) had high alpha-fetoprotein (AFP) levels (≥400 ng/mL), and 96 (78.0%) were deceased at the time of data abstraction. After sorafenib therapy, 60 patients (46%) received systemic therapy, including nivolumab monotherapy (42%) and chemotherapy (25%). Oncologist visits at a semiannual per-patient rate of 3.7 (95% confidence interval [CI] 3.4-4.0) and hospitalizations at rate of 1.1 (95% CI 1.0-1.3) were the key contributors to HRU. Semiannual per-patient hospitalization rate was 1.3 (95% CI 1.1-1.5) in the high-AFP group. Median survival from discontinuation of sorafenib was 6.9 months (95% CI 5.9-9.0). ConclusionsThis real-world evidence research on treatment patterns reflected substantial HRU consistent with the severity of HCC, particularly in the high-AFP group. Findings highlighted continuing high mortality in HCC, underlying a need for new treatments that can lengthen survival. Results can inform future evaluations of new HCC treatments that estimate the health economic impact of their adoption in Taiwan.

Real-World Treatment Patterns and Health-Resource Utilization in Patients with Hepatocellular Carcinoma (HCC) Following Failure of Sorafenib: A Retrospective Chart Review of 127 Patients in South Korea.

BackgroundEuropean, US, Asian and Korean treatment guidelines all recommend sorafenib as first-line systemic therapy in patients with hepatocellular carcinoma (HCC). However, due to the emergence of several new treatments, post-sorafenib treatment patterns in real-world clinical practice are less well understood.ObjectiveThis study aimed to characterize current treatment patterns and healthcare resource utilization (HRU) in patients with HCC following the failure of first-line sorafenib in a real-world setting in Korea.Patients and methodsA chart review was conducted in 127 HCC patients who received systemic therapy or best supportive care following failure of first-line systemic treatment with sorafenib (2016–2018). Anonymized data on patient characteristics, treatment patterns, and survival were abstracted by 37 physicians in Korea.ResultsThe mean (range) age of patients was 60 (37–79) years; 63 patients had low alpha-fetoprotein (AFP < 400 ng/mL), 64 patients had high alpha-fetoprotein (AFP ≥ 400 ng/mL). Post-sorafenib, 64 (50%) patients had systemic therapy. Regorafenib, used by 54 (84%) patients in second-line, and nivolumab monotherapy, by ten (56%) patients in third-line, were the most common therapies. Hepatologist visits and hospitalizations, at an average rate of 6.89 (95% CI 6.37–7.45) and 2.24 (95% CI 1.95–2.57) per patient-year, respectively, were the key contributors of HRU. The median overall survival (95% CI) from discontinuation of sorafenib was 13.0 (9.8–20.7), 6.5 (5.0–9.5) and 9.5 (6.7–12.3) months in the low AFP, high AFP and overall group, respectively.ConclusionThis real-world evidence research on treatment patterns reflected current clinical guidelines and highlighted fast progressing nature and continuing high mortality in HCC, especially among the high AFP group, underlying a need for new treatments that can lengthen survival. Results from this real-world chart review, together with existing clinical trial data, can inform future evaluations of new HCC treatments that estimate their health economic impact in Korea.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-021-00286-z.

1682. Health Resource Utilization in Patients with Complicated Urinary Tract Infections (cUTI) and Antibiotic Resistance or Treatment Failure: A Retrospective Database Analysis

BackgroundIn the United States, urinary tract infections (UTIs) are predominately treated in the outpatient setting. Resistance to gram-negative bacteria has substantially increased in recent years, however, and many common oral treatment options continue to lose efficacy. As a result, patients may receive multiple courses of antibiotics at various outpatient settings and may ultimately require hospitalization. Here, we quantify health resource utilization and rate of hospitalization in patients with complicated UTI (cUTI).MethodsA retrospective study was performed in partnership with Komodo Health, Inc., using aggregate data from the Komodo Healthcare Map™ for cUTI-related events. Inclusion criteria: (1) 2+ UTI-related encounters within 35 days, beginning in 2017-2018, (2) clinical/coding features indicative of treatment failure or antibiotic resistance, or treatment with carbapenem or piperacillin/tazobactam.. Location of service, number of cUTI-related healthcare encounters, and rate of hospitalization following service location were quantified.Results1,889,216 cUTI patients with antibiotic resistance or treatment failure were identified; 1,545,559 were included in the site of care analysis. These patients incurred 8,694,236 cUTI-related healthcare encounters in 2017-2018. In 2017, among 1,105,459 patients, there were 385,981 cUTI-related inpatient hospitalizations, 798,574 emergency department (ED) visits, 285,985 long-term care (LTC) stays, 147,291 home health (HH) visits, and 2,534,083 other outpatient (OP) encounters. For patients with an ED visit, the mean number of visits was 1.67/patient; mean number of LTC, HH, and OP visits were 1.67, 3.07, and 2.97/patient, respectively. Of those who were hospitalized, 38% of patients were hospitalized following an ED encounter; hospitalization rates following LTC, HH, and OP visits were 30%, 43%, and 24%, respectively. The 30-day cUTI-related rehospitalization rate for inpatients was 12%. 2018 data was similar.ConclusioncUTI is associated with substantial health resource utilization, the majority of which occurs in the outpatient setting.DisclosuresKatherine Sulham, MPH, Spero Therapeutics (Independent Contractor) Jennifer Reese, PharmD, Spero Therapeutics (Employee)

Effect of Originator Infliximab Treatment on Disease-Related Hospitalizations, Work Productivity and Activity Impairment, and Health Resource Utilization in Patients with Crohn’s Disease in a Real-Life Setting: Results of a Prospective Multicenter Study in Germany

Introduction: Infliximab (IFX) therapy is efficacious for inducing and maintaining symptomatic remission in patients with Crohn’s disease (CD), but whether this benefit results in reduced hospitalization rates and therefore may improve patients’ quality of life in an economically sensible way is conflicting so far. Methods: We conducted a noninterventional, multicenter, open-label, prospective study to evaluate the effect of originator IFX treatment on patient-reported outcomes and disease-related hospitalizations in adult CD patients in Germany treated for the first time with IFX according to label. Results: Two hundred and ninety-four patients were included in the study. We observed a statistically significant reduction in the number of CD-related hospitalizations from the year before baseline (mean 1.00 per patient, SD ± 0.93) to the mean value of the 1st (0.62, SD ± 0.95) and 2nd year (0.32, SD ± 0.75) of the observation period (p < 0.0001). After 3 months of IFX therapy, work productivity and activity increased by an average of 12.6 and 17.1%, respectively. Patient’s clinical outcome was markedly improved as the total CD activity index (CDAI) sum score continuously decreased from baseline to month 24 and the mean score of the total inflammatory bowel disease questionnaire (IBDQ) changed substantially from 141 at baseline to 172 after 24 months of IFX treatment. Additionally, the number of work incapacity days declined. Recently, no new safety issues of IFX have been identified. Conclusion: In this large, prospective, multicenter study on disease-related hospitalization rates, work productivity, capacity for daily activities, and HRQoL in patients with CD, IFX significantly reduces their hospitalization rates and improves work productivity, daily activity, and quality of life over 24 months.

PCN107 Real World Chart Review of Treatment Patterns and Health Resource Utilization in Patients with Hepatocellular Carcinoma (HCC) Following Failure of Sorafenib in Korea

PCN107 Real World Chart Review of Treatment Patterns and Health Resource Utilization in Patients with Hepatocellular Carcinoma (HCC) Following Failure of Sorafenib in Korea

PCN104 Treatment Patterns and Health Resource Utilization in Patients with HR+/HER2- Locally Advanced or Metastatic Breast Cancer in Real World Setting in Taiwan

PCN104 Treatment Patterns and Health Resource Utilization in Patients with HR+/HER2- Locally Advanced or Metastatic Breast Cancer in Real World Setting in Taiwan

PCN106 Treatment Patterns and Health Resource Utilization in Patients with Hepatocellular Cancer (HCC) Following Failure of Sorafenib in Real World Setting in Taiwan

PCN106 Treatment Patterns and Health Resource Utilization in Patients with Hepatocellular Cancer (HCC) Following Failure of Sorafenib in Real World Setting in Taiwan

Gender disparities in health resource utilization in patients with relapsing-remitting multiple sclerosis: a prospective longitudinal real-world study with more than 2000 patients.

Background:For the case of multiple sclerosis, research on gender differences from a health economics perspective has not received much attention. However, cost-of-illness analyses can provide valuable information about the diverse impact of the disease and thus help decision-makers to allocate scarce resources. The aim of this study was to describe healthcare resource use and associated societal costs from a gender perspective. In particular, we aimed to identify how resource utilization potentially differs in certain cost components between men and women.Methods:Clinical and economic data were extracted from two prospective, multicentre, non-interventional, observational studies in Germany. Information on health resource use was obtained from all patients on a quarterly basis using a validated questionnaire.Cost analyses were conducted from the societal perspective including all direct (healthcare-related) and indirect (work-related) costs, regardless of who bears them. Gender-related differences were analysed by a multivariable generalized linear model with a negative binomial distribution and log link function due to the right-skewed distribution pattern of cost data. In addition, costs for men and women were descriptively analysed within subgroups of two-year disease activity.Results:In total, 2095 patients (women-to-men ratio of 2.7:1) presented a mean age of 41.85 years and a median Expanded Disability Status Scale of 2 (interquartile range 1–3.5) (p > 0.30 for gender-related differences). Women and men did not statistically differ in total quarterly costs (€2329 ± €2570 versus €2361 ± €2612). For both, costs were higher with advancing disease severity and indirect costs were the main societal cost driver. Regarding healthcare-related resources, women incurred higher costs for ambulant consultations [incidence rate ratio (IRR) 1.16, confidence interval (CI) 1.04–1.31], complementary medicine (IRR 2.41, CI 1.14–5.06), medical consumables (IRR 2.53, CI 1.69–3.79) and informal care (IRR 2.79, CI 1.56–5.01). Among indirect costs, we found higher costs for men for presenteeism (IRR 0.62; CI 0.53–0.72) and higher costs for women for disability pension (IRR 1.62; CI 1.23–2.13).Conclusions:Multiple sclerosis poses a significant economic burden on patients, families and society. While the total economic burden did not differ between male and female patients, we found gender differences in specific cost items that are similar to those in the wider non-MS population.

Gender Disparities in Health Resource Utilization in Patients with Atherosclerotic Cardiovascular Disease: A Retrospective Cross-Sectional Study.

IntroductionGender disparities in access to healthcare have been documented, including disparities in access to care for cardiovascular diseases (CVDs). Disparities in access to cardiologists could disadvantage some patients to the newer lipid-lowering proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) antibodies, as utilization management criteria for PCSK9is often require step therapy with statins and/or ezetimibe and prescription by a cardiologist. To assess whether these utilization management criteria disproportionally limit access to patients with certain characteristics, we assessed the use of cardiologist care and receipt of statin and/or ezetimibe prescriptions from a cardiologist by gender and other patient demographic and clinical characteristics.MethodsThis cross-sectional study used administrative claims data from Inovalon’s Medical Outcomes Research for Effectiveness and Economics Registry (MORE2 Registry®) for patients enrolled in commercial and Medicare Advantage healthcare plans from January 1, 2014, through December 31, 2014. Provider data from the registry were linked to individual demographic and administrative claims data. Logistic regression models were used to assess characteristics associated with outpatient visits to a cardiologist and receipt of a prescription for statin and/or ezetimibe from a cardiologist.ResultsData from 39,322 patients in commercial plans and 261,898 patients with Medicare Advantage were analyzed. Female gender (vs male) was associated with a significantly lower likelihood of visiting a cardiologist for patients in commercial plans (odds ratio [OR] 0.85; 95% confidence limit [CL] 0.81–0.88) and in Medicare Advantage plans (OR 0.82; 95% CL 0.81–0.83). Female gender was also associated with a lower likelihood of receiving a statin and/or ezetimibe prescription from a cardiologist for patients in commercial plans (OR 0.69; 95% CL 0.65–0.74) and in Medicare Advantage plans (OR 0.78; 95% CL 0.76–0.79).ConclusionsCompared with men, women were less likely to visit a cardiologist and less likely to receive a prescription for a statin and/or ezetimibe from a cardiologist.FundingAmgen Inc.

Healthcare resource use and attributable cost of Clostridium difficile infection: a micro-costing analysis comparing first and recurrent episodes.

Accurate and sufficiently detailed data on the economic burden of Clostridium difficile infection (CDI) are lacking. We performed a micro-costing study to determine the health resource utilization of patients with a first episode of CDI (fCDI) and those with a recurrent episode of CDI (rCDI). Forty-five adult and paediatric inpatients with rCDI were matched by age, sex and date of diagnosis with control patients with fCDI. Total length of hospital stay, length of stay in the ICU and several cost parameters differentiated into fixed and variable components were measured and compared across both groups. The mean total length of stay for rCDI patients was 33 days (95% CI 19-46) compared with 17 days (95% CI 12-21) for fCDI patients; P = 0.0259. ICU length of stay was also longer for rCDI patients than for fCDI patients (mean 2.5 versus 0.7 days). Mean total variable costs for fCDI and rCDI were £2382 (95% CI 1750-3014) and £4683 (95% CI 3051-6311), respectively; P = 0.009. Mean fixed costs for fCDI and rCDI were £10 328 (95% CI 7555-13 101) and £26 438 (95% CI 16 135-36 742), respectively; P = 0.003. Mean total costs for fCDI and rCDI were £12 710 (95% CI 9652-15 769) and £31 121 (95% CI 19 792-42 447), respectively; P < 0.002. The healthcare resource use and financial burden attributable to CDI is significant. Most excess cost is driven by additional length of hospital stay. These costs may have been underestimated in previous studies that have not accounted for several difficult-to-measure parameters or have used averaged tariff-based estimates.

Costs of Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients with Acute Lymphoblastic Leukemia (ALL) - an Analysis of German Claims Data

Allogeneic hematopoietic stem cell transplantation (HSCT) is a possible treatment option for pediatric patients with acute lymphoblastic leukemia (ALL). Typical patient groups eligible for HSCT are high-risk patients, refractory patients or patients with a relapse after initial chemotherapy treatment. Despite constituting a potentially curative treatment for pediatric ALL patients, HSCT is a complicated procedure that requires extensive medical care and can result in life-threatening complications. Furthermore, HSCTs are associated with significant costs, not only related to the procedure itself but also to follow-up medical care. The aim of this study is to provide estimates of health care expenditures for pediatric patients with ALL undergoing allogeneic HSCT in Germany. Costs are considered from the perspective of the German statutory health insurance (i.e. from a payers' perspective).In a retrospective observational study based on German claims data, health care expenses for allogeneic HSCTs in pediatric ALL patients were investigated. As a data source, we used the German Health Risk Institute (HRI) database - a representative database including approximately 7 million patient journeys over a continuous observation period of 6 years. The study population comprised pediatric patients (< 18 years) with an HSCT procedure between January 1, 2010 and June 30, 2014 and a diagnosis of ALL (ICD-10 code: C91.0*) in the same hospital case as the HSCT. Costs were analyzed for a time interval reaching from 2 quarters prior to the HSCT to 8 quarters after the HSCT (the analysis was done in quarters because outpatient diagnoses in German claims data are documented on a quarterly basis). The following health care costs were considered in the analysis: (1) costs for prescription medication, (2) outpatient treatment costs, (3) inpatient treatment costs, (4) costs for remedies and technical aids (e.g. physiological or occupational therapy). Other expenses such as costs for over-the-counter medication, patient transport or costs associated with the stem cell donor were not included in the analysis. In addition, we analyzed the health resource utilization of patients (hospitalization days, outpatient visits).A total of 1,687 individuals with an HSCT procedure in the identification period (January 1, 2010 to June 30, 2014) were identified. Of these, 30 pediatric patients (12 female) with a diagnosis of ALL were included in the final study population. Mean age at the time of the HSCT was 9.3 years (SD: 5.3). Mortality in the 4 (8) quarters following the HSCT procedure was 10.0 % (13.3 %). The average number of hospitalization days per patient in the time period from 2 quarters before the HSCT to 8 quarters after the HSCT was 291.5 (SD: 166.78) with an average of 45.5 days (SD: 42.4) for emergency hospitalizations. A mean of 43.2 outpatient visits (SD: 22.1) was observed in this time period.Average total costs per patient from 2 quarters before the HSCT to 8 quarters after the HSCT were € 290,125 (SD: 110,381) ranging from € 149,933 to € 597,774 €. The largest proportion of these costs were incurred in the hospital sector, followed by costs for medication and ambulatory treatment (see Table 1). Total costs per patient were highest in the index quarter with the HSCT procedure (€ 133,585). However, substantial costs were also observed in the quarters before and after the HSCT with costs gradually decreasing in the quarters following the HSCT procedure (see Figure 1).Our results provide first estimates for HSCT treatment costs in pediatric ALL patients for different health care sectors from the perspective of the German statutory health insurance. [Display omitted] [Display omitted] DisclosuresLehne:Elsevier: Employment. Hickstein:Elsevier: Employment; Health Risk Institute: Employment. Salimullah:Novartis Pharma AG: Employment. Su:Biogen: Employment, Equity Ownership; Novartis Pharmaceuticals Corporation: Employment. Prieur:Elsevier: Employment. Thomas:Novartis Pharmaceuticals Corporation: Employment.

Factors Associated with Repeated Health Resource Utilization in Patients with Diverticulitis

Conservative management trends in diverticulitis may lead to increased hospitalizations secondary to repeated attacks. The study aimed to characterize trends in management and risk-assess patients with diverticulitis that required multiple admissions to identify high utilizers. A total of 265,724 patients with diverticulitis were identified from 1995 to 2014 from the New York SPARCS database. Patients with ≥2 hospital admissions were stratified across demographics, comorbidities, insurance status, and surgical intervention. In total, 42,850 patients had ≥2 hospital admissions. Risk factors for ≥2 admissions included younger age, White race, obesity, hypertension, pulmonary disease, hypothyroidism, rheumatoid arthritis, and depression. Fifty-two percent of these patients went on to have surgery. The percentage of elective cases increased from 59 to 70 %, while emergent cases conversely decreased from 41 to 30 %. One in five patients admitted with diverticulitis required two or more admissions. Numerous patient factors were correlated with increased risk of readmission. These factors may be used to guide treatment decisions and help reduce economic burden in frequent utilizers. Trends in surgery rates for these patients could reflect improved treatment options and/or changing clinical practice patterns.

Health-Related Quality of Life and Health Resource Utilization in Patients with Primary Immunodeficiency Disease Prior to and Following 12Months of Immunoglobulin G Treatment.

PurposeHealth-related quality of life (HRQOL) has not been examined in patients with predominant antibody deficiency both pre- and post-immunoglobulin G (IgG) treatment initiation. HRQOL and health resource utilization (HRU) were assessed in newly diagnosed patients with primary immunodeficiency disease (PIDD) pre- and 12 months post-IgG treatment initiation.MethodsAdults (age ≥18 years) completed the 36-item Short Form Health Survey, version 2; pediatric patients (PP)/caregivers completed the Pediatric Quality of Life Inventory (PedsQL). Scores were compared with normative data from the US general population (GP) and patients with other chronic conditions (OCC).ResultsSeventeen adult patients (APs), 8 PPs, and 8 caregivers completed baseline assessments. APs had significantly lower baseline mean physical component summary scores versus GP (37.4 vs 50.5, p < 0.01) adults with chronic back pain (44.1, p < 0.05) or cancer (44.4, p < 0.05) and lower mental component summary scores versus GP (41.6 vs 49.2, p < 0.05). PPs had lower PedsQL total (63.1 vs 82.7), physical summary (64.5 vs 84.5), and psychosocial summary (62.5 vs 81.7) scores versus GP. Post-IgG treatment, 14 APs, 6 PPs, and 8 caregivers completed assessments. Hospital admissions (0.2 versus 1.8, p < 0.01), serious infections (3.3 versus 10.9, p < 0.01) and antibiotic prescriptions (3.0 versus 7.1; p < 0.01) decreased significantly overall. While APs reported significant improvement in role-physical (p = 0.01), general health (p < 0.01), and social functioning (p = 0.02) and caregivers in vitality (p < 0.01), PPs did not.ConclusionsPre-IgG treatment, patients with PIDD experienced diminished HRQOL versus GP and patients with OCC; post-treatment, HRU decreased and certain HRQOL aspects improved for APs and caregivers.

582 Factors Associated With Repeated Health Resource Utilization in Patients With Diverticulitis

582 Factors Associated With Repeated Health Resource Utilization in Patients With Diverticulitis

Health Resource Utilization in Patients with Advanced Non-Small Cell Lung Cancer Receiving Chemotherapy in China.

Chemotherapy is the preferred treatment regimen for advanced lung cancer patients. This study investigated the health resources utilized by and medical expenses of patients with non-small cell lung cancer (NSCLC) as well as the influence of various chemotherapy regimens on the final medical costs in China. The aim of this study was to provide physicians with a reference to use as the basis for their choice of treatment. Data were collected from the Shanghai Chest Hospital's medical charts and billing database. The collected patient information included the baseline characteristics, medical history, chemotherapy regimens, and medical costs, which were used to estimate the health resources utilized by patients and the cost of treatment. This study included 328 patients, and the average total medical cost was $US14,165. This cost included drugs, which accounted for as much as 78.91% of the total cost, and chemotherapy drugs, which accounted for 51.58% of total drug expenses. The most frequently utilized chemotherapy drug was carboplatin, and the most expensive chemotherapy drug was erlotinib. In drug combinations, gemcitabine was utilized most frequently, the combination of gemcitabine and paclitaxel was the most expensive, and cisplatin was the least expensive drug. Epidermal growth factor receptor-positive patients were treated with targeted drug therapy (icotinib, erlotinib, and gefitinib). The use of recombinant human endostatin was often combined with a vinorelbine plus cisplatin regimen. Traditional Chinese medicines were the most frequently utilized non-chemotherapy drugs, and these drugs were also the most expensive. The final cost significantly depended on the specific chemotherapy regimen; thus, the rationale and cost of the chemotherapy regimen and adjuvant chemotherapy should be considered in patients with advanced NSCLC.