Healthcare Resource Utilization Costs Research Articles

Frequency of skeletal-related events and associated healthcare resource use and costs in US patients with multiple myeloma

Objective:A potential complication for all new multiple myeloma (MM) patients is the clinical presentation of osteolytic lesions which increase the risk for skeletal-related events (SREs). However, the contribution of SREs to the overall economic impact of MM is unclear. The impact of SREs on healthcare resource utilization (HCRU) and costs for US patients with MM was analyzed in Truven Health Marketscan Commercial Claims and Medicare Supplemental Databases.Methods:Adults diagnosed with MM between January 1, 2005 and December 31, 2010 with ≥2 claims ≥30 days apart (first claim = index date) were included. SREs included: hypercalcemia, pathologic fracture, surgery for the prevention and treatment of pathologic fractures or spinal cord compression, and radiation for bone pain. Rates of HCRU (outpatient [OP], inpatient [IP], emergency room [ER], orthopedic consultation [OC], and ancillary) and healthcare costs were compared between MM patients with and without SREs. Inverse propensity weighting was applied to adjust for potential bias.Results:Of 1028 MM patients (mean age = 67, standard deviation = 13.2), 596 patients with ≥1 SRE and 432 without SREs were assessed. HCRU rates in IP, ER, and ancillary (p < 0.01) and mean total costs of OP, IP, and ER were significantly higher (p < 0.05) for patients with vs without SREs during follow-up. HCRU rates also increased with SRE frequency (p < 0.05 in OP, IP, ER, OC, and ancillary), as did mean total healthcare costs, except for OC (p < 0.001).Limitations:A broad assessment of pharmacotherapy for the treatment of MM was not an objective of the current study. Bisphosphonate use was evaluated; however, results were descriptively focused on frequency of utilization only and were not included in the broader cost and HCRU analysis.Conclusions:Among US patients with MM, higher SRE frequency was associated with a significant trend of higher HCRU and total healthcare costs in several settings.

Treatment persistence among patients with immune-mediated rheumatic disease newly treated with subcutaneous TNF-alpha inhibitors and costs associated with non-persistence.

The main objective of this study was to describe real-world treatment persistence with subcutaneous tumor necrosis factor-alpha inhibitors (SC-TNFi) in patients with ankylosing spondylitis, psoriatic arthritis, or rheumatoid arthritis [collectively immune-mediated rheumatic disease, (IMRD)] in Sweden. A secondary objective was to describe potential effects on health care resource utilization (HCRU) cost from non-persistence. Patients were identified through filled prescriptions for adalimumab (ADA), etanercept (ETA), certolizumab pegol (CZP), and golimumab (GLM) between 5/6/2010 and 12/31/2012 from the Swedish Prescribed Drug Register. Persistence was estimated using survival analysis. Costs were derived from HCRU and comprised specialized outpatient care, inpatient care and non-disease-modifying antirheumatic drug medications. A total of 4903 patients were identified (ADA: 1823, ETA: 1704, CZP: 622, GLM: 754). Comparisons over 3years showed that GLM had significantly higher persistence than ADA (p=0.022) and ETA (p=0.004). The mean difference in non-biologic HCRU costs between persistent and non-persistent patients was higher after compared to before the start of biologic therapy. SC-TNFi-naïve IMRD patients initiating treatment with GLM had significantly higher persistence rates than patients initiating treatment with ADA or ETA in Sweden. Furthermore, persistence rates observed in the study were lower than those observed in clinical trials, highlighting the need for an all-party (provider-patient-payer-drug manufacturer) engagement and development of programs to increase persistence rates in clinical practice, thus leading to improved clinical outcomes. In addition, the results of this study indicate that persistence to treatment with SC-TNFi may be associated with cost offsets in terms of non-biologic costs.

A longitudinal, retrospective cohort study on the impact of roflumilast on exacerbations and economic burden among chronic obstructive pulmonary disease patients in the real world.

BackgroundRoflumilast is approved in the United States to reduce the risk of COPD exacerbations in patients with severe COPD. Exacerbation rates, health care resource utilization (HCRU), and costs were compared between roflumilast patients and those receiving other COPD maintenance drugs.MethodsLifeLink™ Health Plan Claims Database was used to identify patients diagnosed with COPD who initiated roflumilast (roflumilast group) or ≥3 other COPD maintenance drugs (non-roflumilast group) from May 1, 2011 to December 31, 2012. Patients must have been enrolled for 12 months before (baseline) and 3 months after (postindex) the initiation date, ≥40 years old, not systemic corticosteroid dependent, and without asthma diagnosis at baseline. Difference-in-difference models compared change from baseline in exacerbations, HCRU (office, emergency visits, and hospitalizations), and total costs between groups, adjusting for baseline differences.ResultsA total of 14,211 patients (roflumilast, n=710; non-roflumilast, n=13,501) were included. During follow-up, the rate of overall exacerbations per patient per month decreased by 11.1% in the roflumilast group and increased by 15.9% in the non-roflumilast group (P<0.001). After controlling for baseline differences, roflumilast-treated patients experienced a greater reduction in exacerbations (0.0160 fewer exacerbations per month, P=0.01), numerically greater reductions in hospital admissions (0.003 fewer per month, P=0.57), office visits (0.46 fewer per month, P=0.26), and total costs from baseline compared with non-roflumilast patients ($116 less per month, P=0.62).ConclusionIn a real-world setting, patients initiating roflumilast experienced reductions in exacerbations versus patients treated with other COPD medications.

The cost reduction in hospitalization associated with paliperidone palmitate in the People's Republic of China, Korea, and Malaysia.

BackgroundSchizophrenia results in substantial health care utilization costs. Much of these costs can be attributed to health care use resulting from nonadherence to treatment, relapse, and hospitalization.Aims of the studyThe objective of this research is to further estimate the health care resource utilization costs of patients with schizophrenia in the People’s Republic of China, Korea, and Malaysia with a specific focus on the reduction in hospitalization costs associated with the use of long-acting, injectable paliperidone palmitate (PP) relative to alternative treatment medications.MethodsThe study focuses exclusively on the estimated reduction in hospitalization days following treatment with PP and the potential associated cost savings. Cost analysis was done using a payer’s perspective and only includes direct health care costs associated with hospitalization. Localized cost data were taken from published sources, and health care utilization was estimated based on a clinical study conducted in countries in the Asia-Pacific region. People’s Republic of China, Korea, and Malaysia had the highest number of patients enrolled in the clinical study, and thus were chosen for this research. Analysis looked at 12-month and 18-month periods following initial treatment with PP relative to a retrospective 12-month period utilizing alternative treatment medications.ResultsResults suggest that reductions in hospital utilization cost over 12 months may occur through the use of PP relative to alternatives–ranging from $1,991 for the People’s Republic of China to $6,698 for Korea and $6,716 for Malaysia.ConclusionGiven the substantial costs associated with the treatment of schizophrenia both worldwide and in Asia, it is important to fully understand the costs and outcomes associated with various treatment options. In this research, we have specifically analyzed the direct health care cost savings associated with hospital utilization for patients taking PP relative to alternative treatment methods. The results suggest that reductions in hospital utilization cost were associated with PP treatment, likely largely due to increased adherence to treatment.

Abstract 242: Healthcare Resource Utilization and Costs among Patients with Non-Valvular Atrial Fibrillation using Dabigatran or Warfarin For Stroke Prevention

Background: Dabigatran was the first novel oral anticoagulant (OAC) approved in the US for stroke risk reduction in patients with non-valvular atrial fibrillation (NVAF). The aim of this study was to evaluate the healthcare resource utilization (HCRU) and costs among newly diagnosed NVAF patients who were newly treated with dabigatran or warfarin in the real world setting. Methods: Medical and pharmacy claims from the HealthCore Integrated Research Database were used to identify NVAF patients who initiated dabigatran or warfarin during 10/1/2010-12/31/2011. The index date was defined as the date of first OAC claim during this period. Newly diagnosed (first AF diagnosis within 3 months prior to index date) and newly treated (no OAC claim within 12 months prior to index date) patients with continuous 12-month health plan enrollment before index date were identified. HCRU (all-cause office visits (OV), emergency room (ER) visits, hospitalizations (INP)) and costs (in 2013 US$) were measured in per-patient-per-month (pppm) from the index date to the date of discontinuation/switch, health plan disenrollment, death, or end of 12 months, whichever came first. The dabigatran and warfarin cohorts were matched on baseline characteristics using propensity scores. The unadjusted HCRU, pharmacy and medical costs of the matched cohorts were compared using the Wilcoxon signed-rank test. Differences in adjusted total healthcare costs (sum of pharmacy and medical costs) between cohorts were assessed using a generalized linear model with log link and gamma variance function. A sensitivity analysis on previously diagnosed (first AF diagnosis between 12 and 3 months prior to index date), newly treated NVAF patients was also performed. Results: There were 824 matched patients in each cohort (mean age 64±12 years, 67% males). The dabigatran cohort had similar numbers of all-cause INP (mean±SD pppm: 0.08±0.20 vs. 0.09±0.29, p=0.866) and ER visits (mean±SD pppm: 0.04±0.13 vs. 0.04±0.14, p=0.760) but significantly fewer OV (mean±SD pppm: 1.29±0.95 vs. 2.02±1.53, p&lt;0.001) compared to the warfarin cohort. The dabigatran cohort had significantly higher pharmacy costs than the warfarin cohort (mean±SD pppm: $455±429 vs. $328±517, p&lt;0.001) but similar medical costs (mean±SD pppm: $2,696±6,699 vs. $2,893±6,819, p=0.179). There was no difference in the adjusted total healthcare costs between the two cohorts (mean pppm cost, dabigatran vs. warfarin: $2949 vs. $2959; percentage difference in costs: -0.35% [95%CI:-17.24% to 19.98%], p=0.970). The analysis on previously diagnosed, newly treated NVAF patients showed similar results. Conclusions: Although newly diagnosed, newly treated NVAF patients initiated on dabigatran had higher pharmacy costs than those on warfarin, the total healthcare costs were similar between the two cohorts. In addition, fewer office visits were observed in the dabigatran cohort.

PUK24 - Health Care Resource Utilization Costs Related to Anaemia Management in Chronic Kidney Disease Non-Dialysed Patients: A Retrospective Clinical and Administrative Database Analysis

PUK24 - Health Care Resource Utilization Costs Related to Anaemia Management in Chronic Kidney Disease Non-Dialysed Patients: A Retrospective Clinical and Administrative Database Analysis

Cost-effectiveness of an aprepitant regimen for prevention of chemotherapy-induced nausea and vomiting in patients with breast cancer in the UK

PurposePrevention of chemotherapy-induced nausea and vomiting (CINV) remains an important goal for patients receiving chemotherapy. The objective of this study was to define, from the UK payer perspective, the cost-effectiveness of an antiemetic regimen using aprepitant, a selective neurokinin-1 receptor antagonist, for patients receiving chemotherapy for breast cancer.MethodsA decision-analytic model was developed to compare an aprepitant regimen (aprepitant, ondansetron, and dexamethasone) with a standard UK antiemetic regimen (ondansetron, dexamethasone, and metoclopramide) for expected costs and health outcomes after single-day adjuvant chemotherapy for breast cancer. The model was populated with results from patients with breast cancer participating in a randomized trial of CINV preventative therapy for cycle 1 of single-day chemotherapy.ResultsDuring 5 days after chemotherapy, 64% of patients receiving the aprepitant regimen and 47% of those receiving the UK comparator regimen had a complete response to antiemetic therapy (no emesis and no rescue antiemetic therapy). A mean of £37.11 (78%) of the cost of aprepitant was offset by reduced health care resource utilization costs. The predicted gain in quality-adjusted lifeyears (QALYs) with the aprepitant regimen was 0.0048. The incremental cost effectiveness ratio (ICER) with aprepitant, relative to the UK comparator, was £10,847/QALY, which is well below the threshold commonly accepted in the UK of £20,000–£30,000/QALY.ConclusionThe results of this study suggest that aprepitant is cost-effective for preventing CINV associated with chemotherapy for patients with breast cancer in the UK health care setting.

Characterization of health care resource utilization and costs in women with metastatic breast cancer in Medicaid.

e16521 Background: The costs of treating patients with metastatic breast cancer (mBC) have been examined in several studies, but there is very limited information regarding healthcare resource utilization (HCRU) and costs of mBC among Medicaid beneficiaries. The objective of this study was to characterize HCRU and costs in Medicaid among women with mBC. Methods: Women with mBC who were younger than 65 were identified using Thomson Reuters’ Medicaid claims data from 12-13 states (2005-2009). Overall HCRU and medical costs were estimated in those patients and compared to breast cancer (BC) patients without metastasis identified in the same population. Index date is the date of BC (or mBC) diagnosis and patients were followed to the date of disenrollment or the end of the study period, whichever occurred first. Mean (95% CI) cumulative healthcare costs were estimated using Kaplan-Meier Sample Average method. Results: 4,745 patients were included in the analysis. Among them, 3,767 were BC patients without metastasis and 978 with mBC. During an average of 14 months of follow up time, mBC patients on average incurred 1.56 hospital admissions, 9.01 inpatient days, and 1.97 emergency room (ER) visits, 25.54 physician office visits, 21.43 hospital outpatient visits, and 40.96 prescriptions. The total medical cost averaged at $63,068 (95% CI: $59,504, $66,624) per mBC patient, of which 33.0% were hospitalization costs, followed by hospital outpatient cost (27.4%) and physician office visit cost (14.8%). The average follow up time for BC patients was 18 months, during which BC patients on average incurred 0.69 hospital admissions, 3.79 inpatient days, 1.96 ER visits, 19.96 physician office visits, 12.27 hospital outpatient visits, and 40.89 prescriptions, and the total cost averaged at $29,776 (95% CI: $28,795, $30,762). Major cost drivers by type of service are similar to mBC. Conclusions: Overall HCRU and costs are substantially higher in mBC patients compared to BC patients of earlier stages in the Medicaid population, and the major cost drivers are similar in mBC and BC. Continuous Medicaid coverage is essential for BC/mBC patients in financial disadvantage to have access to quality medical care.

Cost analysis of adding pregabalin or gabapentin to the management of community‐treated patients with peripheral neuropathic pain

To compare the cost of adding either pregabalin or gabapentin to the management of community-treated patients with peripheral neuropathic pain (PNP). A retrospective observational study was conducted using medical records from a Spanish health care provider claims database. Patients receiving health care for PNP, above 18 years and for which either pregabalin or gabapentin was initiated between 2006 and 2008 were included. Economic evaluation included health care resource utilization costs and costs due to sick leave. A total of 1163 patients with PNP were eligible for analysis: 764 were prescribed pregabalin and 399 gabapentin in addition to current pain therapy. Mean age was 59.2 years and 62.2% were female. Concomitant use of analgesics was higher in the gabapentin cohort (3.2 vs. 2.7; P = 0.003), mainly due to non-steroidal anti-inflammatory drugs (74.9% vs. 69.5%; P = 0.018) and opioids (27.7% vs. 17.9%; P = 0.031). Adjusted total costs per patient was lower in pregabalin-treated patients (€2514 vs. €3241; P = 0.003), due to less sick leave (€1067 vs. €1633; P = 0.018) and lower health care costs (€1447 vs. €1609; P = 0.004). The higher acquisition cost of pregabalin (€351 vs. €191; P < 0.001) was largely compensated with lower costs in medical visits, physiotherapy, hospital stays and concomitant analgesics. In community-treated patients with PNP, total costs were considerably less for those patients initiated with pregabalin therapy than for those patients starting gabapentin add-on therapy. The relatively higher treatment acquisition cost of pregabalin was largely compensated by the overall lower costs for the other components of health care resources and sick leave, thus reducing the economic impact on the health care provider's budget and society.

Cost Effectiveness of High-Dose Intravenous Esomeprazole for Peptic Ulcer Bleeding

Peptic ulcer bleeding (PUB) is a serious and sometimes fatal condition. The outcome of PUB strongly depends on the risk of rebleeding. A recent multinational placebo-controlled clinical trial (ClinicalTrials.gov identifier: NCT00251979) showed that high-dose intravenous (IV) esomeprazole, when administered after successful endoscopic haemostasis in patients with PUB, is effective in preventing rebleeding. From a policy perspective it is important to assess the cost efficacy of this benefit so as to enable clinicians and payers to make an informed decision regarding the management of PUB. Using a decision-tree model, we compared the cost efficacy of high-dose IV esomeprazole versus an approach of no-IV proton pump inhibitor for prevention of rebleeding in patients with PUB. The model adopted a 30-day time horizon and the perspective of third-party payers in the USA and Europe. The main efficacy variable was the number of averted rebleedings. Healthcare resource utilization costs (physician fees, hospitalizations, surgeries, pharmacotherapies) relevant for the management of PUB were also determined. Data for unit costs (prices) were primarily taken from official governmental sources, and data for other model assumptions were retrieved from the original clinical trial and the literature. After successful endoscopic haemostasis, patients received either high-dose IV esomeprazole (80 mg infusion over 30 min, then 8 mg/hour for 71.5 hours) or no-IV esomeprazole treatment, with both groups receiving oral esomeprazole 40 mg once daily from days 4 to 30. Rebleed rates at 30 days were 7.7% and 13.6%, respectively, for the high-dose IV esomeprazole and no-IV esomeprazole treatment groups (equating to a number needed to treat of 17 in order to prevent one additional patient from rebleeding). In the US setting, the average cost per patient for the high-dose IV esomeprazole strategy was $US14 290 compared with $US14 239 for the no-IV esomeprazole strategy (year 2007 values). For the European setting, Sweden and Spain were used as examples. In the Swedish setting the corresponding respective figures were Swedish kronor (SEK)67 862 ($US9220 at average 2006 interbank exchange rates) and SEK67 807 ($US9212) [year 2006 values]. Incremental cost-effectiveness ratios were $US866 and SEK938 ($US127), respectively, per averted rebleed when using IV esomeprazole. For the Spanish setting, the high-dose IV esomeprazole strategy was dominant (more effective and less costly than the no-IV esomeprazole strategy) [year 2008 values]. All results appeared robust to univariate/threshold sensitivity analysis, with high-dose IV esomeprazole becoming dominant with small variations in assumptions in the US and Swedish settings, while remaining a dominant approach in the Spanish scenario across a broad range of values. Sensitivity variables with prespecified ranges included lengths of stay and per diem assumptions, rebleeding rates and, in some cases, professional fees. In patients with PUB, high-dose IV esomeprazole after successful endoscopic haemostasis appears to improve outcomes at a modest increase in costs relative to a no-IV esomeprazole strategy from the US and Swedish third-party payer perspective. Whereas, in the Spanish setting, the high-dose IV esomeprazole strategy appeared dominant, being more effective and less costly.

Promotion of the mind through exercise (PROMoTE): a proof-of-concept randomized controlled trial of aerobic exercise training in older adults with vascular cognitive impairment

BackgroundSub-cortical vascular ischaemia is the second most common etiology contributing to cognitive impairment in older adults, and is frequently under-diagnosed and under-treated. Although evidence is mounting that exercise has benefits for cognitive function among seniors, very few randomized controlled trials of exercise have been conducted in populations at high-risk for progression to dementia. Aerobic-based exercise training may be of specific benefit in delaying the progression of cognitive decline among seniors with vascular cognitive impairment by reducing key vascular risk factors associated with metabolic syndrome. Thus, we aim to carry out a proof-of-concept single-blinded randomized controlled trial primarily designed to provide preliminary evidence of efficacy aerobic-based exercise training program on cognitive and everyday function among older adults with mild sub-cortical ischaemic vascular cognitive impairment.Methods/DesignA proof-of-concept single-blinded randomized trial comparing a six-month, thrice-weekly, aerobic-based exercise training group with usual care on cognitive and everyday function. Seventy older adults who meet the diagnostic criteria for sub-cortical ischaemic vascular cognitive impairment as outlined by Erkinjuntti and colleagues will be recruited from a memory clinic of a metropolitan hospital. The aerobic-based exercise training will last for 6 months. Participants will be followed for an additional six months after the cessation of exercise training.DiscussionThis research will be an important first step in quantifying the effect of an exercise intervention on cognitive and daily function among seniors with sub-cortical ischaemic vascular cognitive impairment, a recognized risk state for progression to dementia. Exercise has the potential to be an effective, inexpensive, and accessible intervention strategy with minimal adverse effects. Reducing the rate of cognitive decline among seniors with sub-cortical ischaemic vascular cognitive impairment could preserve independent functioning and health related quality of life in this population. This, in turn, could lead to reduced health care resource utilization costs and avoidance of early institutional care.Trial RegistrationClinicalTrials.gov Protocol Registration System: NCT01027858.

Health care resource utilization among patients starting ACEI and ARB therapy

Medical and pharmacy claims from a database containing more than 2.5 million covered lives were examined to evaluate the costs of outpatient laboratory and physician visits, hospitalizations, and ER visits among patients initiating angiotensin converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), ACEI-diuretic combination, and ARB-diuretic combination. Continuously enrolled members (1/1/97 to 8/30/99) with at least one ICD-9 diagnosis code for hypertension, no claims for antihpertensive drug in 1997, and at least one claim for an ACEI, ACEI-diuretic, ARB, ARB-diuretic therapy filled between Jan 1, 1998 and August 30, 1999 were followed for 12 months after initial prescription fill. Patient demographics, cardiovascular comorbid conditions and costs of health care utilization (outpatient laboratory and physician visits, hospitalizations, and ER visits) were assessed. There were 3,725 ACEI patients, 426 ACEI-diuretic patients, 1,112 ARB patients, and 302 ARB-diuretic patients identified. The average age of patients in all groups was similar (57-59). The majority of patients starting ACEI and ARB were males (51% and 56%, respectively). Patients starting ACEI-diuretic and ARB-diuretic were mainly females (56% and 53%, respectively). Except for diabetes, baseline cardiovascular comorbid conditions were similar for all drug classes. Diabetes (17.4%) was more prevalent with ACEI patients than were ARB patients (10.8%) and similarly for ACEI-diuretic (12.2%) and ARB-diuretic (5.6%) patients. The average annual total costs of health care utilization per patient were $2551 for ACEI versus $2329 for ARB and $1665 for ACEI-diuretic versus $1411 for ARB-diuretic. Lower cardiovascular and non-cardiovascular hospitalizations contributed to the lower total health care costs associated with ARB therapy. When averaged over all groups, hospitalization accounted for 71.8%; outpatient physician visits accounted for 21.3%; ER visits accounted for 2.4%; and outpatient laboratory accounted for 4.5% of the total costs. This analysis suggests that patients initiating ARB therapy had lower total health care resource utilization costs one year following initiation of therapy.