Differences In Healthcare Resource Utilization Research Articles

Comparison of Healthcare Costs for Women with Treated Versus Untreated Vasomotor Symptoms Due to Menopause.

The study objective was to estimate all-cause healthcare resource utilization (HCRU) and medical and pharmacy costs for women with treated versus untreated vasomotor symptoms (VMS) due to menopause. A retrospective study was conducted using US claims data from Optum Research Database (study period: January 1, 2012-February 29, 2020). Women aged 40-63years with a VMS diagnosis claim and ≥ 12 and ≥ 18months of continuous enrollment during baseline and follow-up periods, respectively, were included. Women treated for VMS were propensity score matched 1:1 to untreated controls with VMS. Standardized differences (SDIFF) ≥ 10% were considered meaningful. A generalized linear model (gamma distribution, log link, robust standard errors) estimated the total cost of care ratio. Subgroup analyses of on- and off-label treatment costs were conducted. Of 117,582 women diagnosed with VMS, 20.5% initiated VMS treatment and 79.5% had no treatment. Treated women (n = 24,057) were matched to untreated VMS controls. There were no differences in HCRU at follow-up (SDIFF < 10%). Pharmacy ($487 vs $320, SDIFF 28.4%) and total ($1803 vs $1536, SDIFF 12.6%) costs were higher in the treated cohort. Total costs were 7% higher in the treated cohort (total cost ratio 1.07, 95% CI 1.05-1.10, P < 0.001). The on-label treatment pharmacy costs ($546 versus $315, SDIFF 38.6%) were higher in the treated cohort. Off-label treatment had higher medical costs ($1393 versus $1201, SDIFF 10.4%). Most women with VMS due to menopause were not treated within 6months following diagnosis. While both on- and off-label treatment increased the total cost of care compared with untreated controls, those increases were modest in magnitude and should not impede treatment for women who report symptom improvement as a result of treatment.

Association between adherence with oral anticancer medications and short-term health care resource utilization: A 2010-2018 claims-based analysis.

There is limited evidence on the effect of adherence to oral anticancer medications on health care resource utilization (HRU) among patients with cancer. To determine the association between adherence to oral anticancer medication and subsequent HRU. A retrospective cohort study was conducted using Optum Clinformatics® Data Mart commercial claims database. Patients who initiated an oral anticancer medication between 2010 and 2017 were included. Proportion of days covered was used to calculate medication adherence in the first 6 months after oral anticancer medication initiation. All-cause HRU in the following 6 months was assessed. Multivariable negative binomial regressions were used to determine the association between oral anticancer medication adherence and HRU, after controlling for confounders. Of 37,938 patients, 51.9% were adherent to oral anticancer medications. Adherence with oral anticancer medication was significantly associated with more frequent physician office and outpatient visits for several cancer types with the strongest association among those with liver cancer (adjusted incidence rate ratio [aIRR] = 1.34; 95% CI = 1.18-1.52 and aIRR = 1.32; 95% CI = 1.13-1.55, respectively). Oral anticancer medication adherence was associated with more emergency department visits only among patients with lung cancer (aIRR = 1.22; 95% CI = 1.01-1.48). Oral anticancer medication adherence was significantly associated with a higher rate of inpatient hospitalizations and longer stays among patients with liver cancer (aIRRs were 1.45 [95% CI = 1.02-2.05] and 2.15 [95% CI = 1.21-3.81], respectively), whereas hospitalizations were fewer and length of stay was shorter among patients with colorectal cancer who were adherent with oral anticancer medication (aIRRs were 0.77 [95% CI = 0.68-0.86] and 0.77 [95% CI = -0.66 to 0.90], respectively). Other measures did not reveal statistically significant differences in HRU among adherent and nonadherent patients for the cancer types included in the study. HRU following the initial phase of oral anticancer medication therapy was generally similar among adherent and nonadherent patients. We observed a slightly higher rate of office and outpatient visits among adherent patients, which may reflect ongoing monitoring among patients continuing oral anticancer medication. Further studies are needed to determine how oral anticancer medication adherence may affect HRU over a longer time period.

Comorbidity of migraine and fibromyalgia in patients with cluster headache: psychological burden and healthcare resource utilization. A cross-sectional study

The aim was to describe the comorbidity and impact of fibromyalgia and/or migraine on patients with cluster headache. Comorbid diseases can exacerbate the physical and psychological burden experienced by patients. The comorbidities of cluster headache have been scarcely investigated, with the exception of migraine, which is well-known to coexist with cluster headache. In contrast, the comorbidity of migraine and fibromyalgia has been well investigated and firmly established. An internet survey was uploaded to the webpage of a cluster headache patient association. The survey collected sociodemographic and clinical data, and patients completed questionnaires that assessed depression, sleep quality, health-related quality of life, and health care resource utilization (HCRU) over the preceding six months. Differences in total depression, sleep quality, and health-related quality of life scores among the groups were analyzed with the Kruskal-Wallis test, and differences in HCRU were analyzed with the chi-square test. Ninety-one patients with cluster headache participated in the survey; 39 (42.9%) experienced only cluster headache, 15 (16.5%) experienced cluster headache and migraine, 10 (11%) experienced cluster headache and fibromyalgia, and 27 (29.7%) experienced cluster headache with comorbid fibromyalgia and migraine. Moderate depression scores and positive suicidal ideation were found across all subgroups. Sleep quality and health-related quality of life were consistently poor across the different subgroups, with the cluster headache with comorbid fibromyalgia and migraine subgroup showing significantly lower scores. Heavy use of health care resources was observed across all subgroups, with no notable differences among them. The comorbidity of cluster headache with fibromyalgia and/or migraine does not seem to be infrequent. This comorbidity substantially increases the psychosocial burden experienced by patients and decreases their overall quality of life.

Abstract 14596: Differences in Healthcare Resource Utilization Among Patients Receiving Comprehensive Guideline-Directed Medical Therapy by Prior History of Worsening Heart Failure Events

Background: Heart failure (HF) is a leading cause of hospitalizations in the US. While Guideline-Directed Medical Therapy (GDMT) improves outcomes in patients with heart failure with reduced ejection (HFrEF), healthcare resource utilization (HCRU) among patients with worsening heart failure (WHF) has not been well characterized. Aim: We compare HCRU by history of WHF at initiation of “2022 GDMT” (i.e., ARNi+β-blocker+MRA+SGLT2i). Methods: Patients with HFrEF who had concurrent exposure for ARNi, SGLT2i, β-blocker, and MRA between Jan 2020-Jun 2022 were identified using Optum’s deidentified Clinformatics® Data Mart Database. HCRU (i.e., all-cause hospitalizations [ACH] and HF hospitalizations [HFH]) was compared by history of WHF (i.e., HFH or IV diuretic administration) in the prior 12 months. Cox proportional hazard and negative binomial regressions estimated factors independently associated with risk of first and recurrent hospitalizations and their durations, respectively. Results: The analytical cohort included 3,881 HFrEF patients receiving 2022 GDMT, 1,835 (47%) with a prior history of WHF. Patients with and without a history of WHF had similar sociodemographic characteristics. The median (IQR) follow-up time was 352 (244, 544) days for the cohort. Patients with WHF were hospitalized sooner, more frequently, and for a longer duration of time ( Table ) compared to those without. After adjusting for sociodemographic characteristics, WHF was independently associated with longer length of stay of ACH (coefficient, 95% CI: 1.91, 1.59-2.31) and HFH (2.13, 1.74-2.61) and almost three times the risk of first and recurrent ACH (HR, 95% CI: 2.93, 2.64-3.26) and HFH (2.93, 2.61-3.29). Conclusion: Prior history of WHF was associated with clinically meaningful and statistically significant worse HCRU, despite first-line “2022 GDMT”. Additional care strategies and novel therapies are required to further decrease residual risk among these patients.

Examining predictors for 6-month mortality and healthcare utilization for patients admitted for heart failure in the acute care setting

BackgroundAcute heart failure (AHF) is a leading cause of mortality and hospitalization. Past studies reported increased healthcare spending in the last year of life in high-income countries, and this has been characterized as inappropriate healthcare resource utilization. The study aimed to examine potentially (in)appropriate healthcare utilization by comparing healthcare utilization patterns across predicted and observed 6-month mortality among patients admitted for HF. MethodsWe conducted a retrospective cohort study among patients presenting at the emergency department (ED) of a tertiary hospital with HF as primary diagnosis and admitted after their ED discharge. We used LASSO Cox proportional hazards models to predict 6-month mortality, and estimated healthcare utilization patterns of predicted and observed mortality across inpatient healthcare services. Results3946 patients were admitted into the emergency department with a primary diagnosis of HF. From 57 candidate variables, 17 were retained in the final 6- month mortality model (C-statistic 0.66). Patients who died within 6-months of ED admission had longer length of stay (LOS) and less inpatient surgeries than those who survived. Patients with a greater predicted mortality risk were admitted to the ICU more often and had a longer LOS than those with a lower predicted mortality risk. ConclusionsThere were significant differences in healthcare resource utilization in patients admitted for AHF across predicted versus actual mortality. Lack of information on patients' preferences prevents the estimation of (in)appropriateness. Future studies should account for these considerations to estimate inappropriate healthcare utilization among these patients.

Patterns of treatment switching and healthcare resource utilization differences among real-world Medicare patients with metastatic pancreatic ductal adenocarcinoma who received first-line FOLFIRINOX.

e16286 Background: Modifications to the FOLFIRINOX (FFX) regimen are used in the real world to attempt to decrease side effects and increase tolerability. This study assesses differences in healthcare resource utilization (HCRU) among patients who switched regimens following initial administration of first-line (1L) FFX among the Medicare fee-for-service (FFS) population with metastatic pancreatic ductal adenocarcinoma (mPDAC). Methods: We identified patients aged 65+ with mPDAC between 2018-2021 in the Medicare Parts A, B, and D 100% Research Identifiable Files (RIF) data. Patients were required to have at least two malignant neoplasm of pancreatic duct diagnosis on different dates AND at least one diagnosis of a metastasis anytime on or after the first pancreatic cancer diagnosis. Patients were assigned to cohorts based on drugs present within a 48-hour (2-day) period of a FFX chemo infusion cycle: 1) FFX with all 4 component drugs (oxaliplatin, irinotecan, leucovorin, 5-FU bolus and infusion), 2) FFX with no 5-FU bolus, but with 5-FU infusion, 3) FFX with a 5-FU bolus, but no 5-FU infusion, 4) FFX with no 5-FU of any kind and, 5) FFX with no leucovorin. Lines of therapy (LOTs) were assigned based on therapies used. LOTs ended the day before a new chemotherapy began, 28 days after the last chemotherapy (if no new chemotherapy), or upon death. The number of patients receiving FFX and the percentage of patients who switched cohorts (e. g. had a change in the FFX drug components received) at any time during the study was identified. HCRU differences were examined for patients at 60, 120, and 180 days after the initial administration for patients who did and did not switch cohorts. Results: We identified a total of 8,889 unique patients receiving 45,755 total administrations of 1L FFX. Cohort switching was observed in 16.7% of patients. Among patients receiving FFX with all 4 component drugs in the first cycle, 19% of subsequent administrations were different. Among patients who received modified FFX regimens, switching on subsequent regimens varied (7% for FFX with no 5-FU bolus, 47% for FFX with a 5-FU bolus but with no 5-FU infusion, 18% for FFX with no 5-FU of any kind, and 5% for FFX with no leucovorin). Inpatient costs were lower and hospital outpatient and growth factor costs were higher for patients who switched cohorts vs those that did not at 60 days, 120 days, and 180 days. Conclusions: One in six patients with mPDAC receiving first-line FFX switched component drugs at least once throughout the course of their treatment. These patients had higher hospital outpatient, higher growth factor, and lower inpatient costs compared to patients who did not switch. Over time, differences in inpatient costs between the two groups were sustained, while differences in hospital outpatient and growth factor exacerbated.

RWD130 Differences in Healthcare Resource Utilization for the Management of Immunoglobulin a Nephropathy in Europe, the US, China and Japan

Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis worldwide, with an annual incidence of ∼25/1000000. Healthcare resource utilization (HCRU) for IgAN patients is not well documented. Here we describe HCRU across four geographical regions.

RWD119 Real-World Evidence on the Association between the Use of Cannabis and Healthcare Resource Utilization Among Patients with Chronic Post-Traumatic Stress Disorder

To describe differences in healthcare resource utilization (HCRU) between chronic post-traumatic stress disorder (cPTSD) patients who use and do not use cannabis and explore moderation by tetrahydrocannabinol (THC) containing products.

Benzodiazepine Usage, Healthcare Resource Utilization, and Costs Among Older Adults Treated with Common Insomnia Medications: A Retrospective Cohort Study.

Benzodiazepines are commonly prescribed for insomnia management but are often associated with negative safety outcomes such as falls and abuse, particularly among older adults. The purpose of this real-world study was to compare the impact of benzodiazepines, low-dose trazodone, and zolpidem immediate release (IR) on healthcare resource utilization (HCRU), and costs among older adults (age ≥ 65 years) with insomnia in the US. Using the IBM MarketScan Medicare Supplemental Database, older adults with >1 physician-assigned diagnosis of insomnia and treated with benzodiazepines were matched 1:1 on age, sex, and index-date to individuals treated with trazodone, and separately matched 1:1 on age and sex, to individuals treated with zolpidem immediate release (IR). Between-groups differences were analyzed using general linear models (GLMs) that controlled for multiple confounders. Significant between-groups differences in HCRU and costs were observed such that relative to zolpidem IR and separately relative to low-dose trazodone, benzodiazepines were consistently associated with worsened outcomes. These findings build upon and extend prior knowledge on the negative impact of benzodiazepines and suggest directions for future research.

Alzheimer’s Disease Linkage to Evidence (AD-LINE) Study Early Results: Linking Real-World Claims Data to Phase III GRADUATE Study of Gantenerumab (P7-6.009)

<h3>Objective:</h3> We sought to demonstrate a first-of-its-kind successful linkage of real-world Medicare claims data from the Centers for Medicare &amp; Medicaid Services to data from the GRADUATE I and II phase III clinical trials of gantenerumab, and to understand differences in healthcare resource utilization (HCRU) in participants with early symptomatic AD. <h3>Background:</h3> The detailed clinical and patient-reported outcomes data typically collected in clinical trials are often missing a broader, more holistic understanding of HCRU and costs, particularly before and after the clinical trial. <h3>Design/Methods:</h3> AD-LINE is a non-interventional cohort study of Medicare patients with early symptomatic AD who were enrolled in the GRADUATE pivotal trials. Participants consented to combine existing (including year preceding GRADUATE entry) and future medical claims with clinical trial data. HCRU was examined for the year preceding their baseline trial visit. <h3>Results:</h3> In total, 111 GRADUATE participants were included in AD-LINE. Mean age was 75.1 years (SD: 5.5); 67 participants (60.4%) were female. At baseline, 55 participants (49.5%) had MCI-AD and 56 (50.5%) had mild AD dementia. This early proof-of-concept linkage analysis includes data from the GRADUATE baseline visit and Medicare claims through December 2019 (latest currently available). Excluding 2020 clinical trial entrants, there were 79 patients; of those, 78 were continuously enrolled in Medicare Parts A/B and 46 were not in a health maintenance organization (HMO) in the preceding year. Sample size and data availability will increase as more Medicare claims and GRADUATE study data become available. Initial results show that in the year preceding GRADUATE trial entry, these 46 AD-LINE patients had an average of 4.09 outpatient visits. <h3>Conclusions:</h3> AD-LINE is the first study to successfully link large phase III clinical trial and real-world claims data. Linking trial data with HCRU data may provide critical information for payers and population health decision makers. <b>Disclosure:</b> Chris Wallick has nothing to disclose. Howard Fillit has nothing to disclose. The institution of Prof. Tcheremissine has received research support from Eli Lilly . The institution of Prof. Tcheremissine has received research support from Genentech/Roche. The institution of Prof. Tcheremissine has received research support from Janssen . The institution of Prof. Tcheremissine has received research support from Athira Pharma. Dr. Abbass has received personal compensation for serving as an employee of Genentech. Carmen Ng has received personal compensation for serving as an employee of Genentech. Carmen Ng has stock in Roche. Tu My To has received personal compensation for serving as an employee of Genentech. Tu My To has received stock or an ownership interest from Genentech. Sheila Seleri has received personal compensation for serving as an employee of Genentech, a member of the Roche group. Sheila Seleri has received stock or an ownership interest from Genentech, a member of the Roche group.

622 Differences in Healthcare Resource Utilization After Surgery for Metastatic Spinal Column Tumors in Safety-Net Hospitals

INTRODUCTION: Safety Net Hospitals (SNH) are those which serve an especially high proportion of Medicaid, uninsured, and charity care patients, though few have studied the impact of SNH status on healthcare resource utilization for patients with metastatic spinal column tumors. METHODS: A retrospective cohort study was performed using the 2016-2019 National Inpatient Sample database. Adult patients undergoing surgery for metastatic spinal column tumors were identified using ICD-10-CM codes. Admissions were dichotomized by SNH status, defined as the top quartile of Medicaid and uninsured burden. Hospital characteristics, patient demographics, comorbidities, intraoperative variables, and outcomes were assessed. Multivariate logistic regression analyses were used to identify predictors of extended LOS, non-routine discharge, and increased cost. RESULTS: Of the 11,505 patients identified, 24.0% (n = 2,760) were treated at a SNH and 76.0% (n = 8,745) were treated at a Non-SNH (N-SNH). Compared to patients treated at N-SNH, a greater proportion of patients at SNH were African American, male, and of lower income quartile. Number of comorbidities (p = 0.324), intraoperative complications (p = 0.488) and postoperative complications (p = 0.064) were similar between cohorts. Patients treated at SNH typically experienced greater LOS (SNH: 12.3 ± 11.3 days vs. N-SNH: 10.1 ± 9.5 days, p&lt;0.001), though total cost of admission (SNH: $58,804 ± 39,088 vs. N-SNH: $54,569 ± 36,781, p = 0.550), non-routine discharge disposition (SNH: 48.2% vs. N-SNH: 48.4%, p = 0.715) and mortality rate (SNH: 3.1% vs. N-SNH: 2.7%, p = 0.629) were similar. On multivariate analysis, SNH status independently predicted extended LOS [OR: 1.41, p = 0.009], but not non-routine discharge [OR: 0.97, p = 0.773] or increased cost [OR: 0.93, p = 0.655]. CONCLUSIONS: Our study suggests that the quality of care provided by SNH is largely similar to that provided by non-SNH for patients undergoing surgical intervention of metastatic spinal column tumors

469. Healthcare Resource Utilization (HRU) among Hospitalized Patients (Pts) with Candidemia (C) and Invasive Candidiasis without Candidemia (IC) Who Received Definitive Treatment with an Echinocandin (EC) Across United States (US) Hospitals

Abstract Background Guidelines recommend ECs as preferred agents for C/IC. Although studies demonstrate that the ECs are safe and effective for the treatment of pts with C/IC, there are scant HRU data among hospitalized adult pts who received an EC for C/IC. This study sought to describe current EC use patterns and outcomes for C/IC across US hospitals. Methods A retrospective, multi-centered observational study was performed using the Premier Healthcare Database (1/2016-4/2019). Inclusion criteria: hospitalized; age ≥ 18 years, presence of Candida sp. on clinical culture consistent with C/IC; and received ≥3 days of an EC between -2 days of index culture to discharge. Pts were stratified by presence of C/IC. Baseline characteristics and treatment patterns (EC received, receipt of EC in relation to index culture, and EC duration) were assessed. Outcomes: discharge status (in-hospital death vs discharge location), hospital length of stay (LOS) post index culture, and hospital costs (overall and component costs) post index culture. Results 1,865 pts met study criteria. The mean (SD) age was 58.9 (19), 48% were female, mean (SD) Charlson Comorbidity Index was 3.4 (2.7) and 55% resided in the ICU at index culture. The most common Candida sp. were C. albicans (37%), C. glabrata (28%), C. parapsilosis (11%), and C. tropicalis (10%). Most pts had C (66%). Baseline characteristic and treatment patterns were largely similar between C/IC pts except for Candida sp., EC received, and EC duration (Table). Mean HRU was greater in pts with IC vs C (Table and Figure). No differences in HRU were observed in pts who died vs survived. In-hospital mortality was higher in pts with C vs IC. Most pts with C/IC received additional medical care post-discharge and pts with IC vs C were more likely to be discharged to a home health agency. Conclusion Hospital costs associated with C/IC are substantial, with most attributable to room and board costs. In-hospital mortality was considerable for pts with C/IC and many pts with C/IC required additional medical care in a long-term care facility or with a home health agency post-discharge. New treatment options are needed to mitigate the costs and outcomes associated with daily receipt of EC for pts with C/IC. Disclosures Thomas Lodise, Jr., Pharm.D., PhD, BioFire Diagnostics: Grant/Research Support|cidara: Advisor/Consultant|cidara: Honoraria|Entasis: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Paratek: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant|Venatrox: Advisor/Consultant Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|cidara: Advisor/Consultant|cidara: Grant/Research Support|Paratek: Grant/Research Support|Seres Health: Grant/Research Support|Summit: Grant/Research Support Brian H. Nathanson, Ph.D., cidara: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support.

Abstract 13528: Sex Differences in Healthcare Resource Utilization in Patients With Atrial Fibrillation Receiving Dronedarone versus Sotalol Following Ablation

Introduction: Patterns of anti-arrhythmic drug therapy for atrial fibrillation (AF) treatment and outcomes may differ by sex. Dronedarone has shown clinical benefit vs sotalol post-ablation in males and females with AF; however, the impact of these drugs on healthcare resource utilization (HCRU) remains unknown among sex subgroups. Methods: We conducted two retrospective, observational cohort analyses using IBM MarketScan® data (Jan 2012-Mar 2020) in adult male and female patients with AF who received dronedarone or sotalol post-ablation. Patients were required to have had 12 months’ available pre-ablation data; follow-up ended at the earliest of health-plan disenrollment, death or end of data availability (Dec 2020). Prevalence (per 100 patient-years [PY]) during the post-ablation period was calculated for all-cause HCRU (hospitalizations; emergency room [ER] visits; outpatient office visits; other outpatient services). Patients receiving sotalol were propensity score matched 1:1 to patients receiving dronedarone and outcomes were compared using univariate generalized linear models with Poisson distribution. Results: In females (n=460 per cohort ; age at ablation: ~64 years; mean follow-up: ~29 months; prior heart failure: ~14.6%; mean Charlson comorbidity index [CCI]: ~0.8), post-ablation prevalence of ER visits, outpatient office visits, and other outpatient services were significantly lower with dronedarone than sotalol (Table). In males (n=1112 per cohort; age at ablation: ~60 years; mean follow-up: ~29 months; prior heart failure: ~12%; mean CCI: ~0.8), post-ablation prevalence of hospitalizations was significantly lower with dronedarone than sotalol, but other HCRU measures were similar. Conclusions: In females post-AF ablation, dronedarone was generally associated with lower HCRU than sotalol. In males, dronedarone was associated with lower hospitalization prevalence than sotalol, but other HCRU was similar.

S1051 Differences in Healthcare Resource Utilization and Costs by Race/Ethnicity in Patients With Inflammatory Bowel Disease: Results From the National Health and Wellness Survey

Introduction: Across many chronic diseases, racial and ethnic disparities are evident in healthcare resource utilization (HCRU). Inflammatory bowel disease (IBD) is associated with significant morbidity, particularly with sub optimal care, and rates of inpatient care may act as a surrogate for disease severity. The objective of this study was to characterize the relationship of race/ethnicity and with HCRU and costs in patients with IBD. Methods: Adults with a self-reported physician diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) who participated in the United States National Health and Wellness Survey (2018-2020) were included. Bivariate (interim) analyses were conducted to compare HCRU and costs across racial/ethnic groups. Results: Analyses included 2,577 participants (CD: 818 White, 109 Black, and 150 Hispanic; UC: 1,150 White, 99 Black, and 251 Hispanic). Hispanic participants reported more mean emergency room (ER) visits (CD: 1.92 [SD 5.63]; UC: 1.93 [4.20]) and hospitalizations (CD: 1.98 [4.44]; UC: 1.76 [5.63]) over six months than White participants (CD: 0.96 [2.18] and 0.75 [1.99], P=0.001 and P< 0.001, respectively; UC: 0.66 [2.56] and 0.60 [3.22], both P< 0.001). Hispanic participants with CD also had more mean hospitalizations than Black participants (1.98 [4.44] vs. 1.02 [2.00], P< 0.006), and Black participants with UC had more ER visits than White participants (1.44 [2.39] vs. 0.66 [2.56], P=0.03). Higher annualized direct medical costs were found for Hispanic (CD: $92,636 [$169,447]; UC: $94,919 [$214,961]) than for White participants with CD and UC (CD: $53,681 [$90,905]; UC: $45,721 [$147,649], both P< 0.001) and Black participants with CD ($56,803 [$80,328], P=0.02). Total annual costs due to work productivity impairment were higher for Hispanic participants than for White participants with CD ($20,852 [$19,775] vs. $15,961 [$17,847], P = 0.03), but were not significantly different for any other comparisons. (Table) Conclusion: Black and Hispanic participants with IBD had higher HCRU and direct medical costs than White participants. Notably, Hispanic participants with CD also had higher HCRU and direct medical costs than Black participants, highlighting the need to consider different racial/ethnic groups separately when assessing health outcomes and burden of disease. Further research is needed to better characterize the relationship between race/ethnicity and HCRU, including consideration of disease severity as a factor. Table 1. - HCRU and medical costs in White, Black, and Hispanic participants with IBD CD (N = 1,077) UC (N = 1,500) White (n = 818) Black (n = 109) Hispanic (n = 150) White (n = 1,150) Black (n = 199) Hispanic (n = 251) Gender, n (%)MaleFemale 397 (48.5%)421 (51.5%) 54 (49.5%)55 (50.5%) 95 (63.3%)† 55 (36.7%)† 454 (39.5%)696 (60.5%) 52 (52.5%)*47 (47.5%)* 113 (45.0)138 (55.0%) Age in years, mean (SD) 48.34 (16.48) 36.84 (14.39)* 34.05 (11.05)† 52.48 (16.28) 38.48 (16.08) 38.45 (14.27)† HCRU (past 6 months), mean (SD)Total number of HCP visitsa Total number of GE visitsTotal number of ER visitsTotal number of hospitalizations 7.24 (9.87)0.76 (1.18)0.96 (2.18)0.75 (1.99) 6.02 (6.93)0.87 (1.65)1.45 (3.27)1.02 (2.00) 7.33 (8.61)0.43 (1.05)†,‡ 1.92 (5.63)† 1.98 (4.44)†,‡ 6.11 (6.70)0.54 (1.00)0.66 (2.56)0.60 (3.22) 7.32 (8.98)0.41 (0.83)1.44 (2.39)*1.40 (2.32) 10.55 (31.50)† 1.10 (4.68)†,‡ 1.93 (4.20)† 1.76 (5.63)† Costs (USD), mean (SD)Total annualized direct medical costs Total annual costs due to workproductivity impairmentb $53,681 ($90,905)$15,961 ($17,847) $56,803 ($80,328)$14,963 ($16,977) $92,636($169,448)†,‡ $20,852 ($19,775)† $45,721 ($147,649)$14,344 ($18,673) $74,117 ($90,924)$12,652 ($16,339) $94,919 ($214,961)† $17,240 ($16,399) a Includes visits to any of the following: general practitioner/family practitioner; internist; allergist; cardiologist; dentist; dermatologist; diabetologist; endocrinologist; gastroenterologist; geriatrician; gynecologist; hepatologist; infectious disease specialist/infectologist (diseases such as HIV or hepatitis); neurologist; nephrologist; nurse practitioner/physician assistant; obstetrician; oncologist; ophthalmologist; orthopedist; otolaryngologist (ears, nose, and throat specialist); plastic surgeon; podiatrist; psychiatrist; psychologist/therapist; pulmonologist (lung specialist); respiratory therapist; rheumatologist; urologist; other medical specialist. b Total annual costs due to work productivity impairment were only calculated among respondents who were participating in the labor force at the time of the survey and who had a valid response (i.e., non-missing) for the number of hours working in the past 7 days and the number of hours missed in the past 7 days. * P < 0.05 between Black/African American and White participants. † P < 0.05 between Hispanic and White participants. ‡ P < 0.05 between Hispanic and Black/African American participants. Note: P values were calculated using Bonferroni-adjusted pairwise comparisons. Abbreviations: BMI = body mass index; CD = Crohn’s Disease; ER = emergency room; GE = gastroenterologist; HCP = healthcare provider; HCRU = healthcare resource utilization; IBD = inflammatory bowel disease; UC = ulcerative colitis, USD = United States dollar.

Reduced Healthcare Resource Utilization in Patients with Opioid Use Disorder in the 12Months After Initiation of a Prescription Digital Therapeutic.

Background and AimsreSET-O, an FDA-authorized prescription digital therapeutic (PDT) delivering cognitive behavioral therapy and contingency management to patients with opioid u®se disorder (OUD), may help improve clinical outcomes. One-year differences in healthcare resource utilization (HCRU) and costs post-PDT initiation were evaluated.MethodsRetrospective analysis of healthcare claims data compared all-cause HCRU (across hospital facility encounters [sum of inpatient stays, treat-and-release emergency department [ED] visits, partial hospitalizations, and hospital outpatient department visits] and clinician services [procedure categories]) after PDT initiation (index) between reSET-O patients and controls. Overall and Medicaid-specific differences in HCRU, costs, and buprenorphine adherence were evaluated.FindingsCohorts included 901 reSET-O patients (median age 36 years, 62.4% female, 73.9% Medicaid) and 978 controls (median age 38 years, 51.1% female, 65.4% Medicaid). Compared to the control group, the reSET-O group experienced 12% fewer total unique hospital encounters (non-significant), driven by 28% fewer inpatient stays (IRR 0.72; 95% CI 0.55–0.96; P = 0.02), 56% fewer hospital readmissions [IRR 0.44; 95% CI 0.20–0.93; P = 0.033]), and 7% fewer ED visits (IRR 0.93; 95% CI 0.79–1.09; P = 0.386). Total clinician services increased by 1391 events versus controls. Differences were greater among the Medicaid patients. Adjustment for concomitant baseline substance use and mental health disorders resulted in similar HCRU incidence rate ratios. Changes in all-cause HCRU drove per-patient per-year cost differences of − $2791 versus controls (− $3832 versus Medicaid controls). Adjusted mean medication possession ratio was 0.848 (SE 0.0118) at 12 months for reSET-O patients, which was significantly higher than controls (0.761 [SE 0.0108]; P < 0.001).ConclusionsUse of reSET-O is associated with significant and durable real-world reductions in ED and inpatient (including readmissions) utilization, reduced net costs, and increased clinician services and buprenorphine adherence. Differences in costs versus controls were greatest among Medicaid patients.Infographic Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02217-y.

Health resource utilization, costs, and community treatment order status before and after the initiation of second-generation long acting-injectable antipsychotics in patients with schizophrenia in Alberta, Canada

IntroductionLong-acting injectable (LAI) antipsychotics and community treatment orders (CTOs) are used in patients with schizophrenia to improve treatment effectiveness through adherence.ObjectivesUnderstanding healthcare resource utilization (HRU) and associated costs, and medication adherence in patients with schizophrenia overall and by CTO status before and after second generation antipsychotic (SGA) LAI initiation may guide strategies to optimize health.MethodsA retrospective observational single-arm study using administrative data from Alberta was performed. Adults with schizophrenia who initiated SGA-LAI (index date) were included. Medication possession ratio (MPR) was determined; paired t-tests were used to examine differences in HRU and costs ($CDN) between the 2-year pre-index period and 2-year post-index period. Stratified analysis by presence or absence of an active CTO during the pre-post periods was performed.ResultsAmong 1,211 patients who initiated SGA-LAIs, MPR was greater post-index (0.84) compared with pre-index (0.45; 95% confidence interval [CI] 0.36, 0.41). All-cause and mental health-related HRU and costs were lower post-index versus pre-index (p&lt;0.001); total all-cause HRU costs were $33,788 lower post- versus pre-index ($40,343 [standard deviation, SD $68,887] versus $74,131 [SD $75,941], 95% CI [-$38,993, -$28,583]), and total mental health-related HRU costs were $34,198 lower post- versus pre-index ($34,205 [SD $63,428] CDN versus $68,403 [SD $72,088] CDN, 95%CI [-$39,098, -$29,297]). Forty-three percent had ≥1 active CTO during the study period; HRU and costs varied according to CTO status.ConclusionsSGA-LAIs are associated with improved adherence, and lower HRU and costs however the latter vary according to CTO status.DisclosureThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this abstract: SD and MS have no competing interest to declare. LR, SK, KW, and KM are members of the Real-World Evidence

Association between asthma control and healthcare costs: Results from a German linked data study.

Background: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.Methods: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACTTM questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACTTM score.Results: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACTTM score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACTTM score<20) Patients with uncontrolled asthma had significantly more hospitalizations (p = .035) and medication prescriptions (p < .001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; p = .004) and all-cause care (€4695 vs. €4117; p = .009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (p = .008), total asthma-related costs (p = .008), and costs of medication prescriptions (p = .001). However, no significant association was found for all-cause (p = .062) and asthma-related hospitalization costs (p = .576).Conclusion: Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden.

Dasatinib Treatment Patterns after Pleural Effusion Among Patients with Chronic Myeloid Leukemia

Dasatinib Treatment Patterns after Pleural Effusion Among Patients with Chronic Myeloid Leukemia

Retrospective Analysis of Disease Severity, Health Care Resource Utilization, and Costs Among Patients Initiating Belimumab for the Treatment of Systemic Lupus Erythematosus

The goal of this study was to evaluate clinical and economic outcomes associated with the initiation of intravenous (IV) belimumab for the treatment of systemic lupus erythematosus (SLE) in clinical practice in the United States. This retrospective study used administrative claims data from the IBM MarketScan Commercial Claims and Encounters Database and the Medicare Supplemental and Coordination of Benefits Database. Data for patients with SLE who initiated (index) IV belimumab were collected for the 12 months before (pre-index) and the 12 months after (post-index) belimumab initiation. Outcomes included SLE disease severity and flares, all-cause health care resource utilization (HCRU) and health care costs, and hospital-based costs and service visits. Post hoc analyses of total hospital-based costs were conducted to further explore drivers of mean post-index costs. Baseline characteristics (N=908) are as follows: female, 93.4%; mean (SD) age, 45.6 (11.9) years; mean Charlson Comorbidity Index score, 0.9 (2.0); and moderate or severe disease, 94.9%. Disease activity (SLE flare episodes) was significantly reduced between the pre-index and post-index periods (severe flares, 16.4% vs 10.1% [P < 0.0001]; moderate flares, 92.1% vs 85.6% [P < 0.0001]; and mild flares, 77.4% vs 71.1%; [P=0.0003]). The proportion of patients receiving oral corticosteroids (OCS) was reduced between the pre-index and post-index periods, especially among patients at higher OCS thresholds (prednisone-equivalent dose: ≥60 mg/d, 7.3% vs 4.2%; >40 mg/d, 14.1% vs 7.9%). From the pre-index to the post-index period, few differences in HCRU were observed, although all-cause physician office visits, outpatient visits, and unique prescriptions filled increased significantly. In the 12-month post-index period, patients had a mean of 12.2 (9.0) encounters (eg, outpatient visit or prescription) associated with IV belimumab. All-cause total, medical, and pharmacy costs increased from the pre-index to the post-index period. Mean all-cause hospital-based costs increased from the pre-index to the post-index period ($7735 [26,603] vs $11,030 [88,086]; P=0.396). However, the 75th, 90th, and 95th percentile costs decreased from the pre-index to the post-index period ($305, $2107, and $3861, respectively). After initiation of IV belimumab, disease activity (number of moderate and severe SLE flares) and use of OCS were significantly reduced. However, HCRU and costs, including hospital-based costs, were generally greater in the post-index period. Further studies will increase understanding of SLE, with the specific goals of incorporating disease activity measures and long-term outcomes in studies of HCRU, costs, and patient outcomes.

PCV39 Association between Social Determinants of Health, Heathcare Resource Utilization, Medication Adherence, and Medication Persistence Among Patients with Hypertension

The objective of this study was to assess the relationship between social determinants of health (SDoH) characteristics, healthcare resource utilization (HCRU), adherence, and persistence among patients with hypertension. Data from the 2019 National Health and Wellness Survey were linked to medical and prescription claims from Komodo Health. Participants age≥18 who self-reported a physician-diagnoses of hypertension and had continuous medical and prescription eligibility 1/1/2019-12/31/2019 were included. HCRU outcomes include physician-office visits, outpatient visits, emergency room (ER) visits, hospitalizations, and antihypertensive utilization including beta-blockers (BB), calcium channel-blockers (CCB), and renin-angiotensin system antagonists (RASA). Adherence was calculated by class using pharmacy quality alliance proportion of days covered (PDC), with adherent defined as PDC≥80%. Nonpersistence was defined as a gap in therapy ≥30 days or discontinuation ≥30 days prior to observation period end, and was calculated by class among participants with ≥1 prescription claim. Statistical testing was used to assess differences in outcomes when stratified by SDoH (e.g., gender, race/ethnicity, income). 1763 eligible patients with hypertension were analyzed. Statistically-significant differences in HCRU were found for all SDoH characteristics, including: higher proportion of Hispanic patients with a physician-office visit (85.2%;p=0.038) and a higher proportion of non-Hispanic/black patients with an all-cause ER visit (31.8%;p<0.0001) or hospitalization (11.8%;p=0.037). 60.1% (N=1059) of all patients had ≥1 antihypertensive claim, with higher proportions seen in non-Hispanic/Black (65.9%;p=0.032) or patients with an income $25000-$49000 (67.6%;p<0.001). A larger proportion of Hispanic patients were nonpersistent (72.2%p<0.01) or nonadherent (70.6%;p=0.001) to CCBs, and nonadherent to RASAs (60.5%;p<0.05). Among patents with hypertension significant associations exist between SDoH characteristics, HCRU, adherence, and persistence. Further research is needed to understand why Hispanics are less persistent to their antihypertensives while having more frequent contacts with their physicians. A better understanding of the role SDoH plays in the management of hypertension could improve hypertension control and reduce healthcare costs.