Healthcare Resource Costs Research Articles

Economic burden of locoregional and metastatic relapses in resectable early-stage non-small cell lung cancer in Spain

BackgroundThere are scarce data of the costs of non-small cell lung cancer (NSCLC) recurrence in Spain. The objective of this study is to assess the economic burden of disease recurrence, for both locoregional and/or metastatic relapses, after appropriate early-stage NSCLC treatment in Spain.Materials and methodsA two-round consensus panel of Spanish oncologists and hospital pharmacists was conducted to collect information on patient’s flow, treatments, use of healthcare resources and sick leaves in patients with relapsed NSCLC. A decision-tree model was developed to calculate the economic burden of disease recurrence after appropriate early-stage NSCLC. Both direct and indirect costs were considered. Direct costs included drug acquisition and healthcare resources costs. Indirect costs were estimated using the human-capital approach. Unit costs were obtained from national databases (euros of 2022). A multi-way sensitivity analysis was performed to provide a range to the mean values.ResultsAmong a cohort of 100 patients with relapsed NSCLC, 45 patients would have locoregional relapse (36.3 would eventually progress to metastasis and 8.7 would be considered in remission) and 55 patients would have metastatic relapse. Over time, 91.3 patients would experience a metastatic relapse (55 as first relapse and 36.6 after previous locoregional relapse). The overall cost incurred by the 100-patients cohort is €10,095,846 (€9,336,782 direct costs, €795,064 indirect costs). The average cost of a locoregional relapse is €25,194 (€19,658 direct costs, €5536 indirect costs), while the average cost a patient with metastasis who receives up to 4 lines of treatment is €127,167 (€117,328 direct, €9839 indirect).ConclusionsTo our knowledge, this is the first study that specifically quantifies the cost of relapse in NSCLC in Spain. Our findings shown that the overall cost of a relapse after appropriate treatment of early-stage NSCLC patients is substantial, and it increases considerably in the metastatic relapse setting, mainly due to the high cost and long duration of first-line treatments.

Economic outcomes associated with diagnosed behavioral symptoms among patients with dementia in the United States: a health care claims database analysis

BackgroundBehavioral symptoms are common in patients with dementia. However, there is limited evidence of their economic burden. Among commercially insured patients with dementia in the United States, this study assessed the prevalence of diagnosed behavioral symptoms and whether healthcare resources utilization and costs were associated with these symptoms.MethodsThis retrospective observational study was conducted using the IBM® MarketScan® Commercial Claims and Encounters and Medicare Supplemental database from October 1, 2015, to September 30, 2019. Diagnoses of dementia and behavioral symptoms were identified using the International Classification of Diseases, 10th Modification codes. To test differences in patient characteristics among those with and without diagnosed behavioral symptoms, t-tests were used for continuous variables, and chi-square tests were used for categories. Generalized linear models were used to compare healthcare resource utilization and costs between patients with and without diagnosed behavioral symptoms, adjusted for baseline characteristics.ResultsOf the 62,901 patients with dementia included in the analysis, 16.5% had diagnosed behavioral symptoms 12 months post dementia diagnosis. Patients with diagnosed behavioral symptoms used more health care resources (mean annual pharmacy visits per patient: 39.83 vs. 33.08, mean annual outpatient visits per patient: 24.20 vs. 16.94, mean annual inpatient visits per patient: 0.98 vs. 0.47, mean annual ER visits per patient: 2.45 vs. 1.21) and incurred higher cost of care than those without diagnosed behavioral symptoms (mean annual total health care costs per patients: $63,268 versus $33,383). Inpatient care was the most significant contributor to total costs (adjusted annual mean cost per patient: $28,195 versus $12,275).ConclusionBehavioral symptoms were significantly associated with higher healthcare resource utilization and costs among patients with dementia. Further research is warranted to address the unmet medical needs of this patient population.

Total healthcare cost savings through improved bipolar I disorder identification using the Rapid Mood Screener in patients diagnosed with major depressive disorder

Introduction Misdiagnosis of bipolar I disorder (BP-I) as major depressive disorder (MDD) leads to increased healthcare resource utilization and costs. The cost-effectiveness of the Rapid Mood Screener (RMS), a tool to identify BP-I in patients with depressive symptoms, was assessed in patients diagnosed with MDD presenting with depressive episodes. Methods A decision-tree model of a hypothetical cohort of 1000 patients in a US health plan was used to estimate the number of correct diagnoses and overall total, direct healthcare costs over a 3-year timeframe for RMS-screened versus unscreened patients. Model inputs included the prevalence of BP-I in patients diagnosed with MDD, RMS sensitivity/specificity, and the cost of misdiagnosing BP-I as MDD. Results Screening with the RMS resulted in 171, 159, and 143 additional correct BP-I or MDD diagnoses at Years 1, 2, and 3, respectively. Total healthcare plan cost savings were $1279 per patient in Year 1. Cumulative cost savings per patient for RMS screening versus no RMS screening were $2307 over 2 years and $3011 over 3 years. Scenario analyses showed that the RMS would remain cost-saving assuming a lower prevalence of BP-I (20% or 10%) versus the base case (24.3%). Conclusion The RMS is a cost-effective tool to identify BP-I in patients who would otherwise be misdiagnosed with MDD. Screening with the RMS resulted in cost-savings over 3 years, with model results remaining robust even with lower prevalence of BP-I and reduced RMS sensitivity assumptions.

Clinical and economic burden associated with graft-versus-host disease following allogeneic hematopoietic cell transplantation in France

The real-world clinical and economic burden of graft-versus-host disease (GVHD) following allogeneic hematopoietic stem cell transplantation has not been comprehensively studied in France. Clinical outcomes, healthcare resource utilization and costs associated with acute GVHD (aGVHD), chronic GVHD (cGVHD), acute plus chronic GVHD (a+cGVHD) versus no GVHD were compared using French administrative claims data. After propensity score matching, 1934, 408, and 1268 matched pairs were retained for the aGVHD, cGVHD, and a+cGVHD cohorts, respectively. Compared with patients with no GVHD, odds of developing severe infection were greater in patients with aGVHD (odds ratio: 1.7 [95% confidence interval: 1.4, 2.1]). Compared with patients with no GVHD, mortality rates were higher in patients with aGVHD (rate ratio (RR): 1.6 [1.4, 1.7]) and with a+cGVHD (RR: 1.1 [1.0, 1.2]) but similar in patients with cGVHD (RR: 0.9 [0.7, 1.1]). Mean overnight hospital admission rates per patient-year were significantly higher in patients with aGVHD and a+cGVHD compared with no GVHD. Total direct costs (range €174,482–332,557) were 1.2, 1.5, and 1.9 times higher for patients with aGVHD, cGVHD, and a+cGVHD, respectively, versus patients with no GVHD. These results highlight the significant unmet need for effective treatments of patients who experience GVHD.

Early versus late administration of long-acting injectable antipsychotic agents among patients with newly diagnosed schizophrenia: an analysis of a commercial claims database.

This study was designed to assess healthcare resource utilization (HCRU) and costs in patients with newly diagnosed schizophrenia based on timing and context of long-acting injectable antipsychotic agent (LAI) initiation. Using claims data, patients (aged 18-40 years) with first schizophrenia diagnosis January 2013-September 2019 (index date), no LAI or oral antipsychotic agent claims during 12-month preindex period, and continuous benefit enrollment from 12 months before index date to 12 months after first LAI administration were identified. Patients were grouped based on timing [early (≤1 year after index date) vs. late] and circumstances [reactive (after schizophrenia-related event) vs. proactive] of LAI initiation. Of 1290 patients with at least one LAI claim, 306 met criteria for early ( n = 204; reactive, n = 107; proactive, n = 97) and late ( n = 102; n = 75; n = 27) initiation. HCRU and costs were numerically lower in early versus late groups, and significantly lower for proactive initiation in both groups. Comparing worst-case (late-reactive) and best-case (early-proactive) scenarios, the average annual cost difference was $7195.13 ( P = 0.0233), with major drivers being emergency department ($171.28; P < 0.05) and other outpatient ($2845.73; P < 0.00001) visits. In addition to the clinical advantages previously described in the literature, the proactive use of LAIs in early-phase schizophrenia is associated with lower healthcare costs.

Healthcare Resource Use And Costs Among A Large, Diverse Sample Of Asthma Patients In The United States

The economic impact of asthma is substantial; however, burden estimates are outdated. We examined real-world healthcare resource use (HCRU) and costs among a large, diverse sample of patients with asthma in the United States.

Burden of illness in metastatic colorectal cancer.

53 Background: Current treatment options for patients with metastatic colorectal cancer (mCRC) have limited efficacy and are associated with substantial toxicity, especially for patients with mCRC refractory to standard therapies. Targeted agents may improve outcomes, compared with traditional chemotherapeutic approaches, in those patients with mCRC expressing actionable biomarkers. The objective of this study was to evaluate clinical outcomes and associated health care costs by line of therapy among patients with mCRC. Methods: A retrospective analysis of Merative MarketScan Commercial and Medicare Supplemental Administrative health claims databases was conducted. Adult patients with mCRC initiating systemic therapy between January 1, 2017 and September 30, 2021 were identified. Patient characteristics, time to discontinuation (TTD), time to next treatment (TTNT), and per-patient-per-month (PPPM) healthcare resource utilization and costs were evaluated for each line of therapy. Results: 3,455 patients with mCRC initiated systemic therapy during the study period and met all patient selection criteria. The median age at index was 56 years and median follow-up was 14 months. 1082 (31%), 372 (11%), and 185 (5%) patients went on to receive 2L, 3L, and 4L+ treatment, respectively. The most common regimens in 1-3L were as follows: 1L – FOLFOX; capecitabine, oxaliplatin; 2L - FOLFIRI+Bev; tipiracil/trifluridine; 3L – tipiracil/trifluridine; regorafenib. Median TTD in 1L through 3L was 22.0, 16.6, and 14.4 weeks, respectively. Median TTNT was 47, 26, and 21 weeks, in 1-3L, respectively. 184 (17%) and 265 (25%) of 2L patients experienced ≥1 inpatient and ≥1 emergency department (ED) visit during 2L treatment, respectively. During 2L treatment, patients had an average of 3.7±7.3 mCRC treatment-related outpatient visits per month. PPPM inpatient, ED, outpatient, and pharmacy costs are displayed. Conclusions: There is an unmet need for effective therapies in 2L+ mCRC, where clinical outcomes are poor. Later lines of therapy are associated with substantial HCRU and costs. [Table: see text]

Asthma-Related Healthcare Resource Use And Costs In Patients With Documented Food Allergies

Asthma is a common comorbidity in patients with food allergy (FA) leading to significant burden on patients. We quantified healthcare resource use (HRU) and medical costs related to asthma in patients with documented FA.

Incidence and costs associated with clinically significant events in real-world patients with unresectable hepatocellular carcinoma on systemic therapy.

514 Background: First-line (1L) treatments for unresectable HCC (uHCC) include atezolizumab plus bevacizumab (ATEZO+BEV), and the tyrosine kinase inhibitors (TKIs) sorafenib (SOR) and lenvatinib (LEN). In clinical trials, these therapies were associated with clinically significant events (CSEs): bleeding, clotting, encephalopathy, and portal hypertension. The objective of this study was to evaluate the real-world incidence of these CSEs and their impact on healthcare resource utilization (HCRU) and costs in patients with uHCC receiving ATEZO+BEV or a TKI. Methods: We conducted a retrospective, observational, cohort study using Clinformatics Data Mart to characterize 1379 US patients diagnosed with uHCC between January 2007 and June 2021 who received treatment with ATEZO+BEV (n=271) or a TKI (SOR, n=891; LEN, n=217). Incidence of the selected CSEs was evaluated as incident cases per 100-person-years (PY) of treatment. Descriptive statistics assessed patient characteristics, HCRU, and medical costs. Results: Mean age at diagnosis was 67.7 years; most patients were male (76.1%), white (52.4%), and had Medicare (74.2%); these characteristics were consistent across treatment groups. While on ATEZO+BEV, SOR or LEN, 147 (54.2%), 481 (54.0%), and 121 (55.8%) patients experienced ≥1 CSEs, respectively. For the ATEZO+BEV group, the most common CSEs were clotting (61.2 cases/100-PY [95% confidence interval {CI}: 45.1, 81.1]) and bleeding (55.4 [40.3, 74.4]). For the SOR group the most common CSEs were encephalopathy (54.5 [46.9, 63.1]) and clotting events (51.3 [44.1, 59.4]), for the LEN group the most common CSEs were clotting events (63.5 [47.4, 83.3]) and encephalopathy (56.7 [42.2, 74.5]). Overall, mean HCRU was high in the outpatient visits, while increases in the cohorts and among events (e.g., for surgery and inpatient visits) were seen in patients with ≥1 CSEs versus those without CSEs. Mean monthly medical costs were also substantially higher with ≥1 CSEs (Table). Conclusions: There were high levels of CSEs in patients receiving ATEZO+BEV or TKIs for 1L uHCC, and the occurrence of these events is associated with an economic burden to the healthcare system. Safety should continue to be monitored for patients treated for uHCC and new therapy options with reduced risks for developing CSEs are needed. [Table: see text]

P175 Burden of Inflammatory Bowel Disease in Mexico: RISE-MX, a Multi-center, Retrospective, 3-Year Data Study

Abstract Background The incidence and prevalence of inflammatory bowel disease (IBD) has increased significantly in the last decade in Mexico. This work describes the burden of disease in terms of healthcare resources utilization and costs (direct and indirect) related to the management of patients (pts) diagnosed with moderate/severe ulcerative colitis (UC) and Crohn’s disease (CD), over 3 years. Methods This multicenter, retrospective, non-interventional study enrolled 335 IBD pts. Upon written consent for eligible pts, data regarding disease activity, treatment patterns and burden of disease were collected (Fig 1). Direct costs calculation was obtained by a micro-cost analysis and cross-sectional indirect costs (human capital/income) by proportional hours of absence/productivity, based on Work Productivity and Activity Impairment score. Unitary costs were taken from institutional data: Groups Related to the Diagnosis (GRD-IMSS) 2017 updated with the INEGI explosion factor in the middle of the year 2022 and IMSS Unit Costs 2022, the price of the drugs used was from the Annual Acquisitions, Leasing and Services Program updated to September 2022. Direct costs were obtained by multiplying resource use with relevant unit costs. Unit costs for each resource items were collected in Mexican reliable administrative databases or other sources. All data were descriptively analyzed. Results There were 335 pts enrolled and 326 eligible. 95 (29.1%) had CD and 231 (70.9%) had UC. In the CD group, 52 pts had remission/mild activity and 43 had moderate/severe activity. A total of 26.3% (25/95) disease–related hospitalizations were reported in CD pts and 15.6% (36/231) for UC pts. The mean of hospitalization duration was 11.7 days for pts with moderate/severe CD and 8.5 days for pts with moderate/severe UC. The absenteeism in CD pts was 19.9% for moderate/severe and 17.3% for remission/mild activity, while in UC pts was 9.8% for moderate/severe and 10.6% for remission/mild activity. Considering comorbidities, extraintestinal manifestations, previous treatments, medical appointments, hospitalizations and other medical procedures, the annual direct costs per-patient impact in CD was US$19,026 (moderate/severe) and US$12,126 (remission/mild). Furthermore, in pts with UC, the cost was US$11,516 (moderate/severe) and US$8,952 (remission/mild). The indirect costs represent US$1,191 for CD and US$376 for UC (Fig 1F). Conclusion The disability rate of CD is 25% [20-34%], this study reports 18.4%. CD was associated with higher rates of hospitalization and increase in cost of health care resources, compared to UC patients.

P416 The impact of remission on healthcare resource utilisation and costs amongst patients with inflammatory bowel disease in France, Germany, Italy, Spain, and the United Kingdom

Abstract Background Crohn’s disease (CD) and ulcerative colitis (UC) are chronic inflammatory bowel diseases (IBD) with increasing healthcare resource utilisation (HCRU) and associated costs. Optimal management of CD and UC aims to induce and maintain remission which may subsequently lower HCRU and costs. This study reports on the potential impact on HCRU and associated direct HCRU costs (excluding drug costs) from achieving CD or UC remission in France, Germany, Italy, Spain and the United Kingdom (EU5). Methods Data were drawn from an Adelphi Real World IBD Disease Specific ProgrammeTM, a point in time survey collected from gastroenterologists and their IBD patients in EU5 in Sep 2020-Jan 2021. GEs completed a patient record form for their next 5-10 consulting IBD patients covering demographics, remission status, healthcare professional visits, tests used to diagnose and monitor CD/UC, hospitalisations and surgeries related to IBD. Patients were stratified into two groups based on GE stated remission status from set categories: remission (RE) vs non-remission (NR). Associated HCRU costs were sourced from published healthcare system reports per country. Outcomes and costs were compared between patients in RE vs NR using inverse probability weighted regression statistical analysis (α=0.05), adjusting for age, sex, BMI, smoking status, disease location, and current treatment. Results A total of 1,526 CD patients were analysed and split into patients in RE (n=1,021) and NR (n=505; Figure 1). Compared with CD patients in NR, patients in RE experienced a lower risk of at least one hospitalization (12.8% vs 29.8%; p&amp;lt;0.001) and surgery (13.8% vs 26.0%; p&amp;lt;0.0001) (Figure 2), and fewer visits to HCPs in the last 12 months (6.5 vs 7.4; p=0.005) (Figure 3). Furthermore, total HCRU cost was 53% less for patients in RE vs NR (€1410.4 vs €2153.4; p=0.0002), with 16% lower HCP visit and test costs (€637.1 vs €737.3; p&amp;lt;0.001) and 83% lower hospitalisation and surgery costs (€773.3 vs €1416.2; p=0.001) (Figure 3). In addition, 1,447 UC patients were analysed and split into patients in RE (n=968) and NR (n=479; Figure 1). Compared to UC patients in NR, patients in RE experienced a lower risk of at least one hospitalization (11.4% vs 24.3%; p&amp;lt;0.0001) and surgery (1.8% vs 5.0%; p=0.004 (Figure 1), and fewer HCP visits (6.0 vs 7.1; p&amp;lt;0.001) (Figure 3). Total HCRU cost trended lower amongst patients in RE vs NR (€1219.6 vs €1443.0; p=0.085), with 19% lower costs of HCP visit and test costs (€617.3 vs €734.7; p&amp;lt;0.0001). Conclusion Patients with IBD who achieve remission present lower HCRU burden, lower risk of hospital and surgery, and ultimately lower associated direct HCRU costs to healthcare systems in EU5.

The Impact of Obesity in Saudi Arabia: Healthcare Resource Use and Costs Associated with Obesity-Related Complications.

Saudi Arabia has a high prevalence of obesity, which increases the risk of individuals experiencing multiple chronic complications. Only a few publications highlight the healthcare costs of obesity-related complications (ORCs) in Saudi Arabia. A micro-costing approach was used to estimate the healthcare costs associated with 10 ORCs. Experienced clinicians in public and private practice across different geographical regions in Saudi Arabia were asked to estimate healthcare resource use associated with each ORC, and estimated unit costs were obtained from hospital administrators. Estimated overall annual costs per patient were calculated as a weighted average of separate public and private sector costs. Individuals in Saudi Arabia with any single ORC incurred overall average annual healthcare costs of 2165-7558 US dollars (USD). Heart failure, chronic kidney disease, dyslipidemia, and type2 diabetes (T2D) were the most costly complications, mainly driven by monitoring and/or pharmacological treatment costs. In contrast, asthma, hypertension, and angina were the least costly complications. Costs in private healthcare were higher than in public healthcare; the largest differences (2359-2793USD) were noted for dyslipidemia, T2D, and osteoarthritis, mainly explained by differences in pharmacological treatment costs. These data suggest that ORCs result in a considerable financial burden to the healthcare system, and highlight the substantial cost savings that could be achieved by preventing or delaying the occurrence of ORCs in Saudi Arabia.

Healthcare Resource Utilization and Costs of Rivaroxaban Versus Warfarin Among Non-valvular Atrial Fibrillation (NVAF) Patients with Diabetes in a US Population.

The healthcare resource utilization (HRU) and costs of oral anticoagulant-naïve patients with non-valvular atrial fibrillation (NVAF) and diabetes initiated on rivaroxaban or warfarin in the United States (US) has not been previously evaluated. This retrospective study used data from the Optum's de-identified Clinformatics® Data Mart Database (1 January, 2012 to 30 September, 2021) to evaluate the HRU and costs of adult patients with NVAF and diabetes newly initiated on rivaroxaban or warfarin (on or after January 2013). Inverse probability of treatment weighting (IPTW) was used to adjust for confounding between cohorts. HRU and costs (USD 2021) were assessed per patient-year (PPY) post-treatment initiation. Weighted cohorts were compared using rate ratios (RR) from Poisson regression models, odds ratios (OR) from logistic regression models, and cost differences; 95% confidence intervals (CI) and p values were generated using non-parametric bootstrap procedures. After IPTW, 17,881 and 19,274 patients initiated on rivaroxaban and warfarin were included, respectively (mean age: 73years; 40% female). During 12months of follow-up, the rivaroxaban cohort had lower all-cause HRU PPY across all components, including lower rates of inpatient stays (RR: 0.84, 95% CI 0.81, 0.88), outpatient visits (RR: 0.67, 95% CI 0.66, 0.68), and 30day hospital readmission (OR: 0.75, 95% CI 0.66, 0.83; all p<0.001) compared to the warfarin cohort. Moreover, rivaroxaban was associated with medical cost savings PPY (mean cost difference: -$9306, 95% CI -$11,769, -$6607), which compensated for higher pharmacy costs relative to warfarin (mean cost difference: $5518, 95% CI $5193, $5839), resulting in significantly lower all-cause total healthcare costs for rivaroxaban versus warfarin (mean cost difference: -$3788, 95% CI -$6258, -$1035; all p<0.001). Among NVAF patients with diabetes in a real-world US setting, rivaroxaban was associated with lower healthcare costs compared to warfarin.

The cost of illness analysis of inflammatory bowel disease

BackgroundInflammatory bowel disease (IBD) is a chronic inflammatory condition involving individuals across all age groups. Recent data suggests the increase in the prevalence of IBD and the surge in applying the biologic drugs in which both change the cost of IBD in recent years. Comprehensive assessment of direct and indirect cost profiles associated with IBD in our area is scarce. This study aimed to determine the economic burden of IBD in Iran from a societal perspective, using cost diaries.MethodsPatients available on clinic registry and hospital information system (HIS), who were diagnosed with IBD, were invited to take part in this study. Demographic and clinical data, the healthcare resource utilization or cost items, absenteeism for the patients and their caregivers were obtained. The cost of the used resources were derived from national tariffs. The data regarding premature mortality in IBD patients was extracted from HIS. Productivity loss was estimated based on the human capital method. Then, cost date were calculated as mean annual costs per patient.ResultsThe cost diaries were obtained from 240 subjects (Ulcerative colitis: n = 168, Crohn’s disease, n = 72). The mean annual costs per patient were 1077 US$ (95% CI 900–1253), and 1608 (95% CI 1256, 1960) for the patients with ulcerative colitis and Crohn’s disease, respectively. Of the total costs, 58% and 63% were in terms of the indirect costs for the patients with ulcerative colitis and Crohn’s disease, respectively. The cost of illness for country was found to be 22,331,079 US$ and 15,183,678 US$ for patients with ulcerative colitis and Crohn’s disease, respectively. Highest nationwide economic burden of IBD was found for patients older than 40 years were estimated to be 8,198,519 US$ and 7,120,891 US$, for ulcerative colitis and Crohn’s disease, respectively.ConclusionThe medication was found to be the greatest contributor of direct medical costs. Productivity loss in terms of long-term disability and premature mortality were major components of IBD’s economic burden in Iran.

Ceftolozane/tazobactam for the treatment of Pseudomonas aeruginosa infections: A multicenter case series analysis

IntroductionPseudomonas aeruginosa displays resistance to several available antibiotics. Infections caused by this pathogen are associated with a high mortality, morbidity, and considerable healthcare resource utilization and costs. This study was aimed at describing the use of ceftolozane/tazobactam (C/T) for the treatment of patients with P. aeruginosa infections. MethodsCase series analysis of hospitalized patients treated with C/T for P. aeruginosa infections in five public Portuguese hospitals. Patients presenting with infections caused by this pathogen and receiving C/T for at least 72h during hospitalization were eligible. ResultsSixty-four hospitalized patients with P. aeruginosa infections treated with C/T were evaluated between December 2016 and July 2019. Most patients were aged between 60 and 79 years (53.9%). Patients presented a total of 68 P. aeruginosa infections, with respiratory infections being the most common (28.1%, 18 out of 64). Most P. aeruginosa strains (85.9%, 55 out of 64) were extensively drug-resistant (XDR). C/T was mostly used as targeted therapy (98.4%, 63 out of 64 patients) and as monotherapy (72.7%, 47 out of 64 patients). Combination therapy was used in 47.4% (9 out of 19) of patients with bacteriemia. Most patients had successful microbiological (79.2%, 42 out of 53) and clinical (78.7%, 48 out of 61) outcomes. All-cause in-hospital mortality rate was 34.4%. ConclusionThe present case series contributes to the body of evidence suggesting that C/T is an effective and safe option for treating P. aeruginosa infections, namely those caused by XDR strains, both when used as mono- or combination therapy.

Healthcare Resource Utilization and Costs Among Commercially Insured Patients With Advanced or Recurrent Endometrial Cancer Initiating First-Line Therapy in the United States

Background: Endometrial cancer (EC) represents a substantial economic burden for patients in the United States. Patients with advanced or recurrent EC have a much poorer prognosis than patients with early-stage EC. Data on healthcare resource utilization (HCRU) and costs for patients with advanced or recurrent EC specifically are lacking. Objectives: To describe HCRU and costs associated with first-line (1L) therapy for commercially insured patients with advanced or recurrent EC in the United States. Methods: This was a retrospective cohort study of adult patients with advanced or recurrent EC using the MarketScan® database. Treatment characteristics, HCRU, and costs were assessed from the first claim in the patient record for 1L therapy for advanced or recurrent EC (index) until initiation of a new anti-cancer therapy, disenrollment from the database, or the end of data availability. Baseline demographics were determined during the 12 months before the patient’s index date. Results: A total of 7932 patients were eligible for inclusion. Overall, mean age at index was 61 years, most patients (77.3%) had received prior surgery for EC, and the most common 1L regimen was carboplatin/paclitaxel (59.1%). During the observation period, most patients had at least one healthcare visit (all-cause, 99.9%; EC-related, 82.8%), most commonly outpatient visits (all-cause, 91.4%; EC-related, 68.7%). The highest mean (SD) costs (US dollars) were for inpatient hospitalization for both all-cause and EC-related events ($8396 [$15,130] and $9436 [$16,784], respectively). Total costs were higher for patients with a diagnosis of metastasis at baseline than for those without a diagnosis of metastasis. Discussion: For patients with advanced or recurrent EC in the United States, 1L therapy is associated with considerable HCRU and economic burden. They are particularly high for patients with metastatic disease. Conclusions: This study highlights the need for new cost-effective treatments for patients with newly diagnosed advanced or recurrent EC.

Iron deficiency anemia impacts disease progression and healthcare resource consumption in patients with inflammatory bowel disease: a real-world evidence study.

Iron deficiency anemia (IDA) is a common extraintestinal manifestation of inflammatory bowel disease (IBD), affecting around one-third of patients. To compare IBD progression and healthcare resource utilization in patients with and without a co-diagnosis of IDA in a real-world setting. A retrospective comparative study was conducted using Italian entities' administrative databases, covering 9.3 million health-assisted individuals. Adult IBD patients diagnosed with ulcerative colitis and/or Crohn's disease were enrolled between January 2010 and September 2017. Within 12 months from IBD diagnosis, IDA was identified by at least one prescription for iron and/or IDA hospitalization and/or blood transfusion (proxy of diagnosis). IBD population was divided according to the presence/absence of IDA. Given the nonrandom patients' allocation, propensity score matching (PSM) was applied to abate potential unbalances between the groups. Before and after PSM, IBD progression (in terms of IBD-related hospitalizations and surgeries), and healthcare resource costs were assessed. Overall, 13,475 IBD patients were included, with an average age at diagnosis of 49.9 years, and a 53.9% percentage of male gender. Before PSM, 1753 (13%) patients were IBD-IDA, and 11,722 (87%) were IBD-non-IDA. Post-PSM, 1753 IBD-IDA patients were matched with 3506 IBD-non-IDA. Before PSM, IBD progression was significantly higher in IBD-IDA (12.8%) than in IBD-non-IDA (6.5%) (p < 0.001). After PSM, IBD progression and IBD-related hospitalizations were significantly (p < 0.001) more frequent in IBD-IDA patients (12.8% and 12.0%, respectively) compared to IBD-non-IDA (8.7% and 7.7%). Consistently, healthcare expenditures resulted significantly higher among IDA patients (p < 0.001), with an overall mean annual cost of €5317 compared to €2798 for patients without IDA. These results were confirmed after PSM matching, as the mean annual total cost/patient in IBD-IDA versus IBD-non-IDA were €3693 and €3046, respectively (p < 0.001). In a real-life setting, IDA co-diagnosis in IBD patients was associated with disease progression and higher related economic burden.

Healthcare utilization, costs, and epidemiology of Huntington’s disease in Israel

IntroductionData on Huntington’s disease (HD) epidemiology, treatment patterns, and economic burden in Israel are scarce. MethodsAnnual prevalence and incidence of HD (ICD-9-CM 333.4) were assessed in the Israel-based Maccabi Healthcare Services (MHS) database 2016–2018. Adherence (medication possession rate [MPR], proportion of disease covered) were assessed for adult people with HD (PwHD) 2013–2018. Healthcare resources utilization (HCRU) and costs related to inpatient and outpatient visits and all medications in 2018 were assessed for PwHD, who were randomly matched to MHS members without HD (1:3) by birth-year and sex. ResultsOverall, 164 patients had at least one HD diagnosis. Annual prevalence and incidence were 4.45 and 0.24/100,000, respectively. A total of 67.0% of adult patients (n = 106) were taking tetrabenazine (median MPR and proportion of disease covered, 74.3% and 30.2%, respectively), 65.1% benzodiazepines (75.8% and 32.3%), and 11.3% amantadine (79.2% and 6.0%). Over a 1-year follow-up, PwHD (n = 81) had significantly more neurologist, psychiatrist, physiotherapist, and speech therapist visits (P < 0.05 for each) and more hospitalization days (P < 0.0001) compared with matched controls (n = 243). Total healthcare and medication costs per patient (US dollars) were significantly higher for PwHD than controls ($7,343 vs. $3,625; P < 0.001). Discussion/ConclusionPwHD have greater annual HCRU and medical costs than MHS members without HD in Israel. Among those who have taken medications, adherence was lower than 80% (both MPR and proportion of disease covered), which may translate into suboptimal symptom relief and quality of life.

Healthcare Resource Utilization and Costs Among Patients With Gastroesophageal Reflux Disease, Barrett’s Esophagus, and Barrett’s Esophagus-Related Neoplasia in the United States

Background: Gastroesophageal reflux disease (GERD) is a risk factor for Barrett’s esophagus (BE) and BE-related neoplasia (BERN). Objectives: This study aimed to evaluate healthcare resource utilization (HRU) and costs associated with GERD, BE, and BERN in the United States. Methods: Adult patients with GERD, nondysplastic BE (NDBE), and BERN (including indefinite for dysplasia [IND], low-grade dysplasia [LGD], high-grade dysplasia [HGD] or esophageal adenocarcinoma [EAC]), were identified from a large US administrative claims database, the IBM Truven Health MarketScan® databases (Q1/2015-Q4/2019). Patients were categorized into the corresponding mutually exclusive EAC-risk/diagnosis cohorts based on the most advanced stage from GERD to EAC using diagnosis codes in medical claims. Disease-related HRU and costs (2020 USD) were calculated for each cohort. Results: Patients were categorized into the following EAC-risk/diagnosis cohorts: 3 310 385 into GERD, 172 481 into NDBE, 11 516 into IND, 4332 into LGD, 1549 into HGD, and 11 676 into EAC. Disease-related annual mean number of inpatient admissions, office visits, and emergency department visits by cohort were 0.09, 1.45, and 0.19 for GERD; 0.08, 1.55, and 0.10 for NDBE; 0.10, 1.92, and 0.13 for IND; 0.09, 2.05, and 0.10 for LGD; 0.12, 2.16, and 0.14 for HGD; and 1.43, 6.27, and 0.87 for EAC. Disease-related annual mean total healthcare costs by cohort were $6955 for GERD, $8755 for NDBE, $9675 for IND, $12 241 for LGD, $24 239 for HGD, and $146 319 for EAC. Discussion: Patients with GERD, BE, and BERN had important HRU and costs, including inpatient admissions and office visits. As patients progressed to more advanced stages, there was substantially higher disease-related resource utilization, with associated costs being 16 times higher in patients with EAC than those with NDBE. Conclusions: Findings suggest the need for early identification of high-risk individuals prior to progression to EAC to potentially improve clinical and economic outcomes in this population.

A systematic review of real-world healthcare resource use and costs of Clostridioides difficile infections.

To conduct a systematic review of published real-world evidence describing the cost and healthcare resource use for Clostridiodes difficile infection (CDI) in the United States. A systematic literature review was conducted searching for terms for CDI and healthcare costs. Titles of articles and abstracts were reviewed to identify those that met study criteria. Studies were evaluated to examine overall design and comparison groups in terms of healthcare resource use and cost for CDI. In total, 28 articles met the inclusion criteria. Moreover, 20 studies evaluated primary CDI or did not specify, and 8 studies1-8 evaluated both primary CDI and recurrent (rCDI). Data from Medicare were used in 6 studies. Nearly all studies used a comparison group, either controls without CDI (N = 20) or comparison between primary CDI and rCDI (N = 7). Two studies examined costs of rCDI by the number of recurrences. Overall, the burden of CDI is significant, with higher aggregate costs for patients with rCDI. Compared with non-CDI controls, hospital length of stay increased in patients with both primary and rCDI compared to patients without CDI. Patients with primary CDI cost healthcare systems $24,000 more than patients without CDI. Additionally, 2 studies that evaluated the impact of recurrence among those patients with an index case of CDI demonstrated significantly higher direct all-cause medical costs among those with rCDI compared to those without. CDI, and particularly rCDI, is a costly condition with hospitalizations being the main cost driver.