Patient Healthcare Costs Research Articles

Health-Care Utilisation and Costs of Transition from Paliperidone Palmitate 1-Monthly to 3-Monthly Treatment for Schizophrenia: A Real-World, Retrospective, 24-Month Mirror-Image Study.

Poor adherence to antipsychotics in patients with schizophrenia is a leading cause of relapse and functional deterioration. Long-acting injectable paliperidone may reduce relapse risks, health-care utilisation, and health-care costs in these patients. In this 24-month mirror-image study, we compared health-care utilization and costs before and after the initiation of paliperidone palmitate 3-monthly (PP3M) treatment in patients with schizophrenia spectrum disorders. Before the initiation of PP3M, the patients received paliperidone 1-monthly (PP1M) treatment. The primary study outcomes were changes in health-care utilisation and costs over the study period. This study included 34 patients with schizophrenia spectrum disorders. During the 12-months period after the initiation of PP3M treatment, the mean duration of hospitalisation decreased from 57.7 to 28.5 days (p = 0.03). Moreover, significant reductions were noted in emergency room visits (PP1M vs PP3M: 0.3 vs 0.0, respectively; p = 0.05) and health-care costs (PP1M vs PP3M: 107,328.8 vs 57,848.6, respectively; p = 0.03). PP3M may significantly reduce hospitalisation duration, emergency room visits, and health-care costs in patients with schizophrenia.

Prehospital risk assessment and direct transfer to a percutaneous coronary intervention centre in suspected acute coronary syndrome

ObjectivePrehospital risk stratification and triage are currently not performed in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS). This may lead to prolonged time to revascularisation, increased duration of...

Healthcare costs among hemophilia A patients in the United States treated with rurioctocog alfa pegol (FVIII-PEG) or antihemophilic factor (recombinant), FC fusion protein (rFVIIIFc) using real-world data

AimsTo compare healthcare costs in patients with non-inhibitor hemophilia A treated with Rurioctocog Alfa Pegol (FVIII-PEG) versus Antihemophilic Factor (Recombinant), FC Fusion Protein (rFVIIIFc).Materials and methodsAdministrative claims data from the Merative MarketScan Commercial (Commerical) and Medicaid (Medicaid) databases were used for these analyses. Males with non-inhibitor hemophilia A treated with FVIII-PEG or rFVIIIFc from 1 January 2016 to 31 March 2021 were identified (earliest treatment = index). Patients were required to have continuous database enrollment for six months before and after the index date. Follow-up was variable in length until disenrollment or study end. All-cause and hemophilia-related healthcare costs were reported per-patient per month [PPPM] and the average weekly dose during follow-up was compared between treatment groups. Generalized linear regressions were used to estimate multivariable-adjusted differences in total costs and weekly dosage in the two treatment groups.ResultsA total of 131 FVIII-PEG (66 Commercial; 65 Medicaid) and 204 rFVIIIFc (111 Commercial; 93 Medicaid) patients were eligible. Mean age was 20.5 and 24.4 for FVIII-PEG and rFVIIIFc in Commercial and 14.9 and 17.5 for FVIII-PEG and rFVIIIFc in Medicaid. PPPM mean (standard deviations [SD]) total healthcare costs in Commercially insured patients were $35,868 [$21,717] for FVIII-PEG vs $40,424 [$25,882] for rFVIIIFc. Costs in Medicaid were $27,495 [$23,243] for FVIII-PEG vs $30,237 [$28,430] for rFVIIIFc. After adjusting for baseline characteristics, the costs for rFVIIIFc (vs FVIII-PEG) were higher by $5,215 in Commercial and $3,895 in Medicaid, but the differences were not statistically significant (p > 0.05). Similar findings were observed for hemophilia-specific healthcare costs. The adjusted mean weekly dose was 6,047 vs 4,892 IU, p = 0.21 for FVIII-PEG vs rFVIIIFc in Commercial and 5,549 vs 7,228 IU, p = 0.07 for FVIII-PEG vs rFVIIIFc in Medicaid.ConclusionsHealthcare costs and treatment dosing were similar (p > 0.05) for non-inhibitor hemophilia A patients treated with FVIII-PEG and rFVIIIFc.

0429 ASSOCIATION BETWEEN HEALTHCARE COSTS AND CONTINUOUS POSITIVE AIRWAY PRESSURE ADHERENCE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Abstract Introduction The impact of positive airway pressure (PAP) therapy on healthcare cost among patients with obstructive sleep apnea (OSA) requires further exploration. This study evaluated the associations between PAP adherence and cost in a large integrated healthcare system. Methods The study included adult patients with OSA (apnea-hypopnea index (AHI) ≥5) with available PAP therapy data between 1/1/2015 to 8/31/2019 from Kaiser Permanente Southern California. We followed the identified patients from the date of highest AHI before PAP use (index) up to 2 years. Each patient had PAP usage and cost organized into 6-month intervals, and mean hours/night and cost was calculated for each interval. Patients were stratified into the following adherence groups: (a) high adherence (≥4 hours/night consistently across all intervals); (b) moderate adherence (2–3.9 hours/night or ≥4 hours/night in some but not all intervals); (c) low adherence (< 2 hours/night). Healthcare costs (2020 US dollars) were derived by assigning costs from federal fee schedules to healthcare utilization extracted from electronic health records. The 6-month mean healthcare costs associated with PAP adherence were estimated using generalized linear models adjusting for patient demographics, comorbidities, Medicaid coverage, prior healthcare cost, and AHI. Stratified analyses based on age (< 65, ≥65 years) and AHI (< 15, ≥15) were conducted. Results A total of 25,700 patients (63.3% male; 41.6% with AHI ≥30) were included in the study. Among those, 53.2% (n=13,684) categorized as having low PAP adherence, 24.2% (n=6221) as moderate adherence, and 22.5% (n=5795) as high adherence. High adherence was associated with the lowest average multivariable adjusted 6-month healthcare cost ($3,586, 95% CI: $3,428, $3,745) compared with moderate ($4,035, 95% CI: $3,859, $4,211) and low ($4,232, 95% CI $4,110, $4,355) adherence. The cost differences between “high vs low” and “moderate vs low” adherence were $646 (p< 0.001) and $197 (p=0.050), respectively. The cost differences between “high vs low” adherence were $999 (p< 0.001) for those with ≥65 years and $657 (p< 0.001) for those with AHI ≥15. Conclusion Better PAP adherence was associated with significantly lower healthcare costs in patients with OSA although further understanding of the relationship is needed. Support (if any) KPSC Regional Research Committee Grant: KP-RRC-20210506.

Metabolic Acidosis and Adverse Outcomes and Costs in CKD: An Observational Cohort Study

Metabolic acidosis is a risk factor for progression of chronic kidney disease (CKD), but little is known about its effect on health care costs and resource utilization. We describe the associations between metabolic acidosis, adverse kidney outcomes, and health care costs inpatients with CKD stages G3-G5 and not receiving dialysis. Retrospective cohort study. An integrated claims-clinical data set of US patients with CKD stages G3-G5, with serum bicarbonate values of 12 to<22 mEq/L (metabolic acidosis group) or 22 to 29 mEq/L (normal serum bicarbonate level group). The primary exposure variable was the baseline serum bicarbonate level. The primary clinical outcome was the composite of all-cause mortality, maintenance dialysis, kidney transplant, or a decline in the estimated glomerular filtration rate of≥40% (DD40). The primary cost outcome was all-cause predicted per-patient per-year cost, assessed over a 2-year outcome period. Logistic and generalized linear regression models, adjusted for key covariates such as age, sex, race, kidney function, comorbidities, and pharmacy insurance coverage, were used to assess serum bicarbonate levels as a predictor of DD40 and health care costs, respectively. 51,558 patients qualified. The metabolic acidosis group experienced higher rates of DD40 (48.3% vs. 16.7%, P<0.001) and higher all-cause yearly costs ($65,172 vs. $24,681, P<0.001). Two-year adjusted odds ratio of DD40 per 1-mEq/L increase in serum bicarbonate levels was 0.873 (95% CI, 0.866-0.879); the parameter estimate (±SE) for costs was-0.070±0.0075 (P<0.001). Possible residual confounding. Patients with CKD and metabolic acidosis had higher costs and rates of adverse kidney outcomes compared with patients with normal serum bicarbonate levels. Each 1-mEq/L increase in serum bicarbonate levels was associated with a 13% decrease in 2-year DD40 events and a 7% decrease in per-patient per-year cost.

Healthcare Resource Utilization and Healthcare Costs of COVID-19 Patients in A Tertiary Care Public Hospital: A Retrospective Cohort Study in Thailand

Objective: Health care costs (HCCs) are a significant concern in developing countries. The authors investigated the healthcare resource utilization (HCRU) and HCCs for patients with COVID-19 based on disease severity and infection site. Materials and Methods: The authors reviewed data from the electronic medical records of COVID-19 patients admitted to the present study hospital between January 2020 and April 2020. The authors used comorbidities and patient characteristics as covariates. Analyses were conducted using simple linear regression and generalized linear regression models with a log-link and gamma distribution. Results: Two hundred two patients had confirmed SARS-CoV-2 infection. Total costs per patient were 6,626 USD (756 to 45,586). Personal protection equipment costs were the most significant cost for COVID-19 patients with a mean of 3,778 USD. The mean treatment cost per patient was 326 USD. Patients with severe symptoms and lower respiratory tract infection (LRI) had a higher cost and resource utilization value before and after adjusting for covariates. Conclusion: COVID-19 patients with severe symptoms and LRI had higher HCRU. Length of stay, severity of symptoms, and LRI were associated with higher cost of treatment. Keywords: SARS-CoV-2; COVID-19; Healthcare resource utilization; Healthcare costs; Thailand

Identifying disability level in multiple sclerosis patients in a U.S.-based health plan claims database

Aims In clinical trials, disability progression in multiple sclerosis (MS) is measured by the Kurtzke expanded disability status scale (EDSS), which is not captured in routine clinical care in the U.S. This study developed a claims-based disability score (CDS) based on the EDSS for assigning MS disability level in a U.S. claims database. Methods This retrospective cohort study of patients with MS in the U.S., utilized adjudicated health plan claims data linked to electronic medical records (EMRs) data. Patients were identified between 1 January 2012 and 31 December 2016 and indexed on the first date of MS diagnosis. The CDS was developed to assign disability level at baseline using claims and ambulatory EMR records observed over the 1-year baseline period. All-cause healthcare costs were assessed by baseline disability level to validate the CDS. Results In total, 45,687 patients were identified in claims (full sample) and 1,599 linked to EMR (core sample). Over half of patients in both samples were classified with mild disability at baseline. Adjusted healthcare costs in patients with moderate and severe disability were 15% (p<.0001) and 20% higher, respectively, than in patients with mild disability at baseline in the full sample. Disease-modifying therapy (DMT) costs accounted for 89%, 82%, and 78% of outpatient pharmacy costs in patients with mild, moderate, and severe disability, respectively. Conclusions The CDS is the first claims-based measure of MS disability utilizing data from EMR. This novel measure advances the opportunity to examine outcomes by disability accumulation in the absence of standard markers of disease progression. Although formal validation of the CDS was not possible due to lack of available EDSS in the EMR, the economic burden results align with prior publications and show that healthcare costs increase with increasing disability. Future validation studies of the CDS are warranted.

Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium

BackgroundEVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services.MethodsAn accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation.ResultsSimulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1.ConclusionsEVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.

Evaluation of machine learning methodology for the prediction of healthcare resource utilization and healthcare costs in patients with critical limb ischemia-is preventive and personalized approach on the horizon?

Critical limb ischemia (CLI) is a severe stage of peripheral arterial disease and has a substantial disease and economic burden not only to patients and families, but also to the society and healthcare systems. We aim to develop a personalized prediction model that utilizes baseline patient characteristics prior to CLI diagnosis to predict subsequent 1-year all-cause hospitalizations and total annual healthcare cost, using a novel Bayesian machine learning platform, Reverse Engineering Forward Simulation™ (REFS™), to support a paradigm shift from reactive healthcare to Predictive Preventive and Personalized Medicine (PPPM)-driven healthcare. Patients ≥ 50years with CLI plus clinical activity for a 6-month pre-index and a 12-month post-index period or death during the post-index period were included in this retrospective cohort of the linked Optum-Humedica databases. REFS™ built an ensemble of 256 predictive models to identify predictors of all-cause hospitalizations and total annual all-cause healthcare costs during the 12-month post-index interval. The mean age of 3189 eligible patients was 71.9years. The most common CLI-related comorbidities were hypertension (79.5%), dyslipidemia (61.4%), coronary atherosclerosis and other heart disease (42.3%), and type 2 diabetes (39.2%). Post-index CLI-related healthcare utilization included inpatient services (14.6%) and ≥ 1 outpatient visits (32.1%). Median annual all-cause and CLI-related costs per patient were $30,514 and $2196, respectively. REFS™ identified diagnosis of skin and subcutaneous tissue infections, cellulitis and abscess, use of nonselective beta-blockers, other aftercare, and osteoarthritis as high confidence predictors of all-cause hospitalizations. The leading predictors for total all-cause costs included region of residence and comorbid health conditions including other diseases of kidney and ureters, blindness of vision defects, chronic ulcer of skin, and chronic ulcer of leg or foot. REFS™ identified baseline predictors of subsequent healthcare resource utilization and costs in CLI patients. Machine learning and model-based, data-driven medicine may complement physicians' evidence-based medical services. These findings also support the PPPM framework that a paradigm shift from post-diagnosis disease care to early management of comorbidities and targeted prevention is warranted to deliver a cost-effective medical services and desirable healthcare economy.

DISPARITY IN HEALTHCARE COSTS AMONG AFRICAN AMERICANS AND CAUCASIANS WITH TRALI COMPLICATED WITH UNDERLYING CKD

SESSION TITLE: Tuesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM PURPOSE: In 2016, the US spent 17.8% of its gross domestic product on healthcare, much higher compared to other countries. Despite this, health care costs continue to rise without much improvements in outcomes. Transfusion related acute lung injury (TRALI) is a type of blood transfusion adverse reaction that usually develops within 6 hours of transfusion and is a leading cause of morbidity and mortality [2]. It occurs due to the presence of donors antibodies recognizing leukocyte antigens in the recipient. Millions of blood transfusions take place in the US within hospitalized patients with underlying co-morbidities including chronic kidney disease (CKD), comprising 0.9%-6.8% of all admitted patients in the intensive care unit. Patients with CKD are more likely to require transfusions given decreased erythropoietin synthesis. To our knowledge, there is insufficient evidence looking at the racial differences between healthcare costs for patients with TRALI. We propose to look at healthcare cost differences between Caucasians and African Americans admitted for TRALI with underlying CKD. METHODS: The National Inpatient Sample (NIS) was used to query the prevalence of TRALI with the International Classification of Disease (ICD) Code 518.7 in all discharge diagnoses. ICD codes of 585.x were used to identify the various stages of CKD and those without CKD. Comparisons in subgroup analysis were also looked at with patients with CKD vs without. Analysis was carried out via the software SAS using multivariate analysis. Variables that were looked at included age, length of stay (LOS), mortality, number of procedures, mean charges, mean income quartile by zip code. RESULTS: During the years of 2003 and 2014 there were a total of 9,844 hospitalizations for TRALI in the United States. Of these, 8241 were of Caucasian descent and 1603 were of African American. Results for Caucasians vs African Americans, respectively, are as follows: average age 64 years vs 50 years (p =0.5); LOS 15.37 days vs 17.19 days (p = 0.95); mortality 19.71% vs 15.88%, (p = 0.79); number of procedures 6.53 vs 6.57 (p = 0.74); total charges $191,320 vs $215, 550 (p = < 0.05). CONCLUSIONS: Healthcare costs and disparities are a major concern in the current practice of medicine despite large amount of health care spending in the United States. In the data that was analyzed there was no mortality difference between Caucasians and African Americans with TRALI. Additionally, age, length of stay and number of procedures were of no statistical significance. Despite no major differences, African Americans paid $24,000 more for the admission in spite of making less income based off the income quartile. CLINICAL IMPLICATIONS: Further research is needed to further elucidate the discrepancy of cost and racial healthcare disparities in patients who experience TRALI. DISCLOSURES: No relevant relationships by Nikhila Kethireddy, source=Web Response No relevant relationships by Shashank Sama, source=Web Response No relevant relationships by Varun Tandon, source=Web Response

Beyond transfusion therapy: new therapies in thalassemia including drugs, alternate donor transplant, and gene therapy.

Transfusion combined with chelation therapy for severe β thalassemia syndromes (transfusion-dependent thalassemia [TDT]) has been successful in extending life expectancy, decreasing comorbidities and improving quality of life. However, this puts lifelong demands not only on the patients but also on the health care systems that are tasked with delivering long-term treatment and comprehensive support. Prevention programs and curative approaches are therefore an important part of overall strategy. Curative treatments alter the dynamic of a patient's health care costs, from financial commitment over 50 years, into a potential "one-off" investment. Since the 1980s, this has usually been available only to the 30% or so of young children with matched sibling donors. By improving the safety of matched related donors and haploidentical hematopoietic stem cell transplants, the potential size of the donor pool for curative therapies may be increased. Recent advances in gene therapy demonstrate that even patients lacking a matched donor can be rendered transfusion independent with an autograft of genetically modified autologous stem cells, with a low short-term risk. Noncurative treatments are also of potential value by decreasing use of blood and chelators and decreasing hospital visits. An example is luspatercept, an activin-receptor trap that modifies transforming growth factor-β signaling, thereby increasing the efficiency of erythropoiesis. This has entered phase 3 clinical trials for TDT and non-TDT and, usefully increases in both Hb and quality of life in non-TDT as well as decreasing transfusion requirements in TDT. Other novel noncurative treatments are entering clinical trials such improvement of erythropoiesis through pharmacological manipulation of hepcidin and iron metabolism.

A multicenter clinical trial of intravesical BCG in combination with ALT-803 in patients with BCG-unresponsive non-muscle invasive bladder cancer.

TPS544 Background: BCG unresponsive NMIBC includes patients with persistent high-grade disease or recurrence within 6 months of receiving at least two courses of BCG; or T1 high-grade disease at the first evaluation following BCG induction alone. The recommendation after failing BCG in patients suitable for surgery is cystectomy or for unwilling/unfit patients, salvage chemotherapy or immunotherapy (administered with limited success). This highlights a critical need for novel preservation therapies to facilitate a better quality of life and reduce health-care costs for patients who are unresponsive to BCG (Correa 2015, Dalbagni 2006, Dinney 2013, Kamat 2017). Altor BioScience has initiated a phase II clinical study in BCG unresponsive patients to expand on promising data collected from a compassionate use patient who remains disease free more than 2.5 years after ALT-803 plus BCG treatment for refractory NMIBC (Huang 2017). Methods: This is a Phase II, open-label, single-arm, multicenter study of intravesical BCG plus ALT-803 in patients with BCG unresponsive high grade NMIBC. Group A will enroll patients who have histologically confirmed presence of CIS [with or without Ta or T1 disease]. Group B will enroll patients who have histologically confirmed high-grade Ta or T1 disease (in the absence of CIS). All patients will receive BCG plus ALT-803 weekly for 6 consecutive weeks. A cystoscopy will be performed at Week 12. Patients with no disease or low-grade Ta will receive a maintenance course of therapy (3 weekly instillations of BCG plus ALT-803). Patients with residual CIS and/or high-grade Ta will receive a re-induction course of therapy. Presence of Ta will require a TURBT. Patients with greater than or equal to T1 disease or new CIS will be deemed treatment failures. Patients with a Complete Response (CR) or low-risk disease at Months 6, 9 and 12 are eligible for continued BCG plus ALT-803 maintenance. Patients will be followed for recurrence, progression, and survival. The primary endpoint is to assess complete response (CR; absence of lesions on cystoscopy or negative, for cause, biopsies along with negative urine cytology) of CIS at six months. Enrollment is underway. Clinical trial information: NCT03022825.

All-cause Healthcare Costs and Mortality in Patients with Systemic Sclerosis with Lung Involvement.

Patients with systemic sclerosis (SSc) often develop interstitial lung disease (ILD) and/or pulmonary arterial hypertension (PAH). The effect of ILD and PAH on healthcare costs among patients with SSc is not well described. The objective of this analysis was to describe healthcare costs in patients with newly diagnosed SSc and SSc patients newly diagnosed with ILD and/or PAH in the United States. This retrospective cohort analysis was conducted in the Truven Health MarketScan Commercial and Medicare Supplemental healthcare claims databases from 2003 to 2014. Based on International Classification of Diseases-9-Clinical Modification diagnosis codes on medical claims, patients were classified into 3 groups: incident SSc, SSc with incident ILD (SSc-ILD), and SSc with incident PAH (SSc-PAH). Patients were required to have continuous enrollment for 5 years to measure all-cause healthcare costs. Costs (adjusted to US$) were reported overall and by service type and year following diagnosis. Because of the overlap between groups, statistical comparisons were not conducted. There were 1957 patients with incident SSc, 219 with incident SSc-ILD, and 108 patients with incident SSc-PAH. Average (mean ± SD) all-cause healthcare costs over followup were higher for patients with incident SSc-ILD ($191,107 ± $322,193) or patients with incident SSc-PAH ($254,425 ± $240,497), compared to patients with incident SSc ($101,839 ± $167,155). Average annual costs over the 5-year period ranged from $18,513 to $23,268 for patients with incident SSc, from $31,285 to $55,446 for patients with incident SSc-ILD, and from $44,454 to $63,320 for patients with incident SSc-PAH. Costs tended to be the highest in the fifth year of followup. Among patients with SSc, ILD and PAH can result in substantial increases in healthcare costs.

Predictors of total morbidity burden on days 3, 5 and 8 after cardiac surgery

BackgroundPost-operative morbidity affects up to 36% of cardiac surgical patients. However, few countries reliably record morbidity outcome data, despite patients wanting to be informed of all the risks associated with surgery. The Cardiac Post-Operative Morbidity Score (C-POMS) is a new tool for describing and scoring (0–13) total morbidity burden after cardiac surgery, derived by noting the presence/absence of 13 morbidity domains on days 3, 5, 8 and 15. Identifying modifiable C-POMS risk factors may suggest targets for intervention to reduce morbidity and healthcare costs. Thus, we explored the association of C-POMS with previously identified predictors of post-operative morbidity.MethodsA systematic literature review of pre-operative risk assessment models for post-operative morbidity was conducted to identify variables associated with post-operative morbidity. The association of those variables with C-POMS was explored in patients drawn from the original C-POMS study (n = 444).ResultsSeventy risk factors were identified, of which 56 were available in the study and 49 were suitable for analysis. Numbers were too few to analyse associations on D15. Thirty-three (67.3%) and 20 (40.8%) variables were associated with C-POMS on at least 1 or 2 days, respectively. Pre-operative albumin concentration, left ventricular ejection fraction and New York Heart Association functional class were associated with C-POMS on all days. Of the 16 independent risk factors, pre-operative albumin and haemoglobin concentrations and weight are potentially modifiable.ConclusionsDifferent risk factors are associated with total morbidity burden on different post-operative days. Pre-operative albumin and haemoglobin concentrations and weight were independently predictive of post-operative total morbidity burden suggesting therapeutic interventions aimed at these might reduce both post-operative morbidity risk and health-care costs in patients undergoing cardiac surgery.

Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective: results from a prospective intervention study.

Background:The delay between onset of macroscopic haematuria and diagnosis of bladder cancer is often long.Methods:We evaluated timely diagnosis and health-care costs for patients with macroscopic haematuria given fast-track access to diagnostics. During a 15-month period, a telephone hotline for fast-track diagnostics was provided in nine Swedish municipalities for patients aged ⩾50 years with macroscopic haematuria. The control group comprised 101 patients diagnosed with bladder cancer in the same catchment area with macroscopic haematuria who underwent regular diagnostic process.Results:In all 275 patients who called ‘the Red Phone' hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14−104) days and 50 (IQR 27−165) days in the intervention and the control group, respectively (P=0.03). The median health-care costs were lower in the intervention group (655 (IQR 655−655) EUR) than in the control group (767 (IQR 490−1096) EUR) (P=0.002).Conclusions:Direct access to urologic expertise and fast-track diagnostics is motivated for patients with macroscopic haematuria to reduce diagnostic intervals and lower health-care expenditures.

Comparison of healthcare resource utilization and costs in patients hospitalized for acute coronary syndrome managed with percutaneous coronary intervention and receiving prasugrel or ticagrelor

Objective:To compare healthcare resource utilization (HCRU) and healthcare costs in patients with acute coronary syndrome (ACS) managed with percutaneous coronary intervention (PCI) and treated with prasugrel or ticagrelor.Methods:Hospital charge master data were used to identify ACS-PCI patients aged ≥18 years with ≥1 in-hospital claim for prasugrel or ticagrelor between August 1, 2011–April 30, 2013. Treatment groups were propensity matched for baseline and index hospitalization characteristics. HCRU and costs were assessed through 90-days post-discharge. Costs were determined based on hospital-specific cost-to-charge ratios and adjusted to 2013 US dollars.Results:Before matching, ticagrelor patients were older, more-often female, and had increased cardiovascular (CV) and bleeding risks compared with prasugrel patients. Propensity-matched length of index hospital stay (4.7 vs 4.9 days, p = 0.23) and risk for all-cause [30-day: relative risk (RR) = 0.86; 95% CI = 0.73–1.0; 90-day: RR = 0.90; 95% CI = 0.80–1.0, and CV-related (30-day: RR = 0.77; 95% CI = 0.59–1.0; 90-day: RR = 0.89; 95% CI = 0.73–1.1) re-hospitalizations did not significantly differ between prasugrel and ticagrelor, respectively. Compared to ticagrelor, the propensity-matched risk of re-hospitalization for myocardial infarction (MI) (30-day: RR = 0.39; 95% CI = 0.21–0.75; 90-day: RR = 0.53; 95% CI = 0.34–0.81) and an outpatient medical encounter for dyspnea (30-day: RR = 0.49; 95% CI = 0.33–0.74; 90-day: RR = 0.60; 95% CI = 0.46–0.80) were significantly lower for prasugrel patients, with no significant differences in bleeding encounters between groups (30-day: RR = 0.87; 95% CI = 0.54–1.40; 90-day: RR = 1.0; 95% CI = 0.71–1.50). Matched total healthcare costs were not significantly different between groups during the index hospitalization ($36,011 vs $37,247, p = 0.21), 30-days post-discharge ($2007 vs $2522, p = 0.48), 90-days post-discharge ($4564 vs $5242, p = 0.49), and aggregate of the index hospitalization through 90-day follow-up ($40,576 vs $42,494, p = 0.09) timeframes.Conclusions:Re-hospitalization for MI and outpatient encounters for dyspnea were lower in prasugrel treated than in ticagrelor treated ACS-PCI patients up to 90-days post-index hospitalization discharge, with no difference in bleeding encounters or healthcare costs between the two populations. This data supports the utility of prasugrel in routine clinical practice. These findings should be considered within limitations of observational research.

Cost Benefit Analysis Of a Sickle Cell Infusion Center For The Treatment Of Vaso-Occlusive Crises

IntroductionThe most common reason for acute care utilization for individuals with sickle cell disease (SCD) is Vaso-Occlusive crisis (VOC). Patients typically seek out care through the emergency department (ED) At these locations patients often have long waits to get care and often receive sub optimal pain management, which Results in over 40% of patients requiring hospital admission. Johns Hopkins Hospital has implemented a new model of service for people with SCD; an outpatient Sickle Cell Infusion Clinic (SCIC) that was opened in 2008 as an alternative source of urgent care for patients having VOC. The purpose of this study is to determine the net financial benefit of implementing the sickle cell infusion clinic model. MethodsA cost-benefit analysis is conducted from the payer's perspective focusing on direct medical cost (procedures, drugs, tests, etc.) of SCD patients and excludes indirect medical costs (patients' productive changes). Health care costs and utilization data was available for the last 3 out of 5 years that the SCIC was opened. A literature review was conducted to determine the costs of individual components of the total costs for SCD patients: inpatient hospitalization, ED visit, primary care and secondary care visits, and other healthcare costs for patients with SCD. The overall and average visit cost of the SCIC was determined from the 2012-2013 budget and visits. The billing data for a subset of patients seen in the SCIC that were insured by one of the Medicaid's MCO was used to determine utilization and costs of healthcare services for 2010, 2011, and 2012. The baseline utilization of healthcare services before the SCIC was implemented was estimated from the literature. As we did not have baseline data we estimated that the 2010 utilization of healthcare services reflected a 20% decrease in hospitalizations and a 40% decrease in ED visits. The overall cost of care for patients with SCD was determined from the above-mentioned sample of billing claims data and utilization estimates. The costs of running the SCIC was added to the overall costs of care. Finally, net savings for the SCIC was determined by calculating the difference in overall cost and savings per beneficiary per month (PBPM). All values are reported in 2012 inflation-adjusted dollars. ResultsFor the subset of patients covered by the Medicaid MCO, the SCIC model resulted in a 7.6% ($676 PBPM) cost savings in the first year (estimated baseline compared to 2010) with savings of 29.2% ($2598 PBPM) when comparing estimated baseline to 2012. The total medical costs for the subset of patients using the SCIC in 2010 was $3,492,339 with an average cost of $94,388 per patient. The SCIC had 1,428 visits by 246 unique patients in FY2012 with an average cost per visit of $434 or $203 PBPM. Other costs in this patient population include: inpatient hospitalization ($3,985 PBPM), ED visits ($326 PBPM), primary and secondary care visits ($26 PBPM), and pharmacy ($493 PBPM). The total cost of care for the same number of sickle cell patients as in our sample who did not utilize the SCIC would have been $3,779,588, with an average cost of $102,151per patient. The SCIC model resulted in cost savings primarily due to a decrease in hospitalizations and ED visits. The number of hospitalization decreased 52.0% (2.88 HPY) and the number of ED visits decreased 48.4% (2.32 visits VPY) in the fifth year of operating the infusion clinic model (2012). The average cost of a hospitalization and an ED visit was $10,797 and $1,024 respectively. These values did not change with the implementation of the SCIC. If we extrapolate the cost savings seen in the subset of patients using the more conservative 7.6% cost savings, to the entire patient cohort this would result in a cost savings of $1.9 million. DiscussionPreliminary cost-benefit analysis shows that the SCIC model resulted in significant cost savings that increased significantly in successive years. Cost savings was driven by two major factors: 1) decrease in inpatient hospitalizations and 2) decrease in ED visits. Additional analysis to include actual baseline data is planned along with a sensitivity analysis to identify if there is a certain threshold population density for which this model would be most cost effective. Disclosures:Lanzkron: GlycoMimetics, Inc.: Research Funding.

Healthcare costs in patients with metastatic lung cancer receiving chemotherapy

BackgroundTo characterize healthcare resource utilization and costs in patients with metastatic lung cancer receiving chemotherapy in the US.MethodsUsing data from a large private multi-payer health insurance claims database (2000-2006), we identified all patients beginning chemotherapy for metastatic lung cancer. Healthcare resource use (inpatient, outpatient, medications) and costs were tallied over time from date of therapy initiation ("index date") to date of disenrollment from the health plan (in most instances, presumably due to death) or the end of the study period, whichever occurred first. Healthcare utilization and costs were characterized using Kaplan-Meier sample average methods.ResultsThe study population consisted of 4068 patients; mean (SD) age was 65 (11) years. Over a median follow-up of 334 days, study subjects averaged 1.5 hospital admissions, 8.9 total inpatient days, and 69 physician office and hospital outpatient visits. Mean (95% CI) cumulative total healthcare costs were $125,849 ($120,228, $131,231). Costs of outpatient medical services and inpatient care constituted 34% and 20% of total healthcare costs, respectively; corresponding estimates for outpatient chemotherapy and other medication were 22% and 24%.ConclusionOur study sheds additional light on the burden of metastatic lung cancer among patients receiving chemotherapy, in terms of total cost thru end of life as well as component costs by setting and type of service, and may be useful in informing medical resource allocation in this patient population.

PSS24 MEDICATION CHOICE AND ASSOCIATED HEALTH CARE OUTCOMES AND COSTS FOR PATIENTS WITH ACNE AND ACNE RELATED CONDITIONS IN THE UNITED STATES

PSS24 MEDICATION CHOICE AND ASSOCIATED HEALTH CARE OUTCOMES AND COSTS FOR PATIENTS WITH ACNE AND ACNE RELATED CONDITIONS IN THE UNITED STATES

Medical Utilization and Costs Associated with Statin Adherence in Medicaid Enrollees with Type 2 Diabetes

Statin adherence is a serious problem in patients with hyperlipidemia. However, it is not clear whether statin adherence is associated with medical utilization or health-care costs. To study statin adherence and assess associated medical utilization and health-care costs in patients with type 2 diabetes, based on a national Medicaid database. A retrospective claims-based study was conducted using the records of patients with type 2 diabetes with comorbid hyperlipidemia who were continuously enrolled in Medicaid from January 2004 to December 2006. All data were drawn from MarketScan Medicaid Database, including inpatient, outpatient, and drug claims. The eligible patients starting statins in 2005 were followed for 1 year to measure medication use, hospitalization, outpatient visits, emergency department (ED) visits, and health-care costs based on Medicaid medical and drug claims. Adherence was measured by medication possession ratio (MPR). Multiple regression analyses were implemented to assess statin adherence-associated outcomes, including medical utilization (risks for hospitalization and ED visits), all-cause costs, and hyperlipidemia-related medical costs. A total of 1705 eligible patients with type 2 diabetes and hyperlipidemia were identified. The average adherence rate to statins (MPR) at 1 year was 0.61, and 37% of the patients (n=624) were adherent to statins (MPR≥0.8). Regression analyses indicated that diabetic patients who were adherent to statins showed lower risks for hospitalization (OR 0.80; 95% CI 0.636 to 0.966) and ED visits (OR 0.71; 95% CI 0.519 to 0.812) and decreased all-cause medical costs by 15% (p<0.05) and hyperlipidemia-related medical costs by 12% (p<0.05). Our study found high prevalence of nonadherence to statins in Medicaid patients with type 2 diabetes. Adherence to statins (MPR≥0.8) was associated with reduced medical utilization and lower medical costs.