Impact Health Care Costs Research Articles

Green Cover and Direct Health Care Costs

Background/Aims Prior studies have shown higher green cover levels to be associated with numerous beneficial health outcomes. We sought to determine if residential green cover was associated with direct health care costs. Methods We studied 5,189,303 members of Kaiser Permanente Northern California (KPNC), linking Normalized Differentiated Vegetation Index (NDVI) satellite data to direct health care costs for 2013-2017. Using generalized linear regression to adjust for demographic, socioeconomic and environmental factors, we examined the association between direct health care costs and green cover within 250, 500, and 1000 meters (m) of an individual’s residence. Direct health care costs were determined from the KPNC Cost Management Information System, which captures administrative and patient care costs for each clinical encounter. Results We observed a significant trend between higher levels of residential green cover and lower direct health care costs, with the bulk of this association occurring in the top five deciles of green cover. The relative rate of total cost for the highest compared to the lowest decile of NDVI was 0.86 (95% CI 0.85-0.87). The association was robust to adjustment from a broad array of confounders and was largely driven by costs associated with hospitalization, outpatient visits, and emergency department visits. Individuals in the top decile of residential green cover had adjusted health care costs of approximately $300 per person per year less than individuals residing in the bottom or least green decile. Sensitivity analyses related to buffer size and an alternative measure of green space (tree canopy cover, yielded consistent findings. Analyses that included adjustment for comorbidity were consistent with the hypothesis that green cover reduces health care costs by improving health status. Conclusion Above-median green cover was associated with lower direct health care costs, raising the possibility that residential greening can have a significant healthcare cost impact across the population.

Underreporting of Obesity in Hospital Inpatients: A Comparison of Body Mass Index and Administrative Documentation in Australian Hospitals

Despite its high prevalence, there is no systematic approach to documenting and coding obesity in hospitals. This study aimed to determine the prevalence of obesity among inpatients, the proportion of obese patients recognised as obese by hospital administration, and the cost associated with their admission. A cross-sectional study was undertaken in three hospitals in Queensland, Australia. Inpatients present on three audit days were included in this study. Data collected were age, sex, height, and weight. Body mass index (BMI) was calculated in accordance with the World Health Organization’s definition. Administrative data were sourced from hospital records departments to determine the number of patients officially documented as obese. Total actual costing data were sourced from hospital finance departments. From a combined cohort of n = 1327 inpatients (57% male, mean (SD) age: 61 (19) years, BMI: 28 (9) kg/m2), the prevalence of obesity was 32% (n = 421). Only half of obese patients were recognised as obese by hospital administration. A large variation in the cost of admission across BMI categories prohibited any statistical determination of difference. Obesity is highly prevalent among hospital inpatients in Queensland, Australia. Current methods of identifying obesity for administrative/funding purposes are not accurate and would benefit from reforms to measure the true impact of healthcare costs from obesity.

Should Lipoprotein(a) be Measured in Youth?

Should Lipoprotein(a) be Measured in Youth?

Acromegaly: 'You must know it to think of it'.

Acromegaly is a debilitating and disfiguring chronic disease, which occurs in both sexes at any age, associated with multiple comorbidities and increased mortality. It is typically caused by a GH-secreting pituitary adenoma that promotes exposure of body tissues to increased concentrations of GH and IGF-I. The diagnosis of acromegaly is still made very late in a substantial number of patients when the disease is already in advanced stages. An epidemiological study from Sweden has elegantly demonstrated that the longer the diagnostic delay in acromegaly, the higher the number of comorbidities. Moreover, about 25% of the Swedish patients had 10 years or more of diagnostic delay and in this group mortality rate was significantly increased. These results reinforce the importance of shortening the latency period between disease onset, diagnosis and treatment to improve patient outcomes. This commentary article discusses strategies to be embraced by the endocrine community to allow early identification of acromegaly among public and health professionals, as internists, primary care clinicians, different specialists and dentists are the first point of contact for most of the patients. We emphasize that acromegaly should be presented as a sporadic, rather than rare, insidious disease, meaning that there is a considerable chance for health professionals to see a patient with acromegaly throughout their careers. The motto 'you must know it to think of it' is advocated in awareness efforts to reduce time to diagnosis, which results in lower rates of morbidity and mortality and might positively impact healthcare costs.

THE IMPACT OF INNOVATION, KNOWLEDGE SPILLOVERS AND OIL PRICES ON ECONOMIC GROWTH OF THE REGIONS OF KAZAKHSTAN

The study of impact of innovation and diffusion of knowledge for economic growth of European regions and other developed countries is increasingly attracting attention of scientists. Along with this, there are many studies for impact of world economic growth of oil prices. At the same time, there is an insufficient attention to joint assessment and comparative analysis of effectiveness of these internal and external growth factors. Moreover, this important issue has been studing a little in relation to countries with economies in transition. This paper is devoted to the study of the impact of innovation and the knowledge spillover in combination with an assessment of the impact of fluctuations in the world oil price on economic growth of regions of Kazakhstan. Catching-up development models are constructed according to annual data from 2005 to 2016 for 16 regions of Kazakhstan. Calculations based on the panel data with fixed effects have confirmed that costs of technological innovations, their spillovers between regions, healthcare costs, as well as the growth rate of the world oil price positively influenced for economic growth in regions. Moreover, socio-economic conditions reinforced their positive impact on growth. It has established that changes in the world oil price and costs of technological innovations and their spillovers between regions effects at the same order, and impact of health care costs and socio-economic conditions on regional growth is noticeably weaker. The results of the study confirm that for innovation activity is essential for the economic growth of the oil exporting country as well. Keywords: oil prices, R&D, innovations, knowledge spillovers, regional growth, Kazakhstan JEL Classifications: C33, O11, O32, O40 DOI: https://doi.org/10.32479/ijeep.9034

P041: Point-of-care ultrasound utilization and monetary outcomes (POCUMON) study

Introduction: Point-of-care ultrasound (POCUS) is an integral tool in the modern emergency physician's toolkit. Evidence suggests many imaging and lab investigations are ordered without true medical indications; it is unknown how POCUS utilization impacts health care costs at a patient level. The purpose of this study was to assess whether POCUS use in the emergency department (ED) was associated with cost savings via decreased laboratory and radiographic testing. Methods: POCUMON is a single-center, prospective pilot study. The participants were a convenience sample of ED staff physicians and PGY-5 Emergency Medicine (EM) residents working in the ED from July-October 2019. Physicians who used POCUS as part of their assessment had the cost of their patient investigation plans compared with those proposed by a control group of ED physicians simultaneously on-shift. The control group was blinded to the POCUS findings but had access to the patient and medical record. The lab investigations and imaging studies ordered by both groups were recorded with respective costs. Data were analyzed using a paired T-test, with sub-group analyses. Ethics approval was obtained from the Queen's University HSREB (No.6026732). Results: 50 patient assessments using POCUS were captured in the study period. 76% of patient assessments were performed by EM staff physicians; 94% of control assessments were provided by EM staff physicians. Patient chief complaints included abdominal pain (7), chest pain/dyspnea (10), flank pain (3), pregnancy concerns (4), trauma (7), extremity complaints (4), back pain (3), and other (12). The POCUS group had a trend for lower number of laboratory tests (4.7 ± 0.44 vs 5.22 ± 0.39; p = 0.28) and imaging studies (0.94 ± 0.14 vs 1.1 ± 0.11; p = 0.33). Overall health care costs were similar in both groups, with a trend to cost savings in the POCUS group ($142.00 ± 15.44 vs $174.60 ± 17.00; p = 0.12). Subgrouping identified significant cost savings in the POCUS group for patients with a chief complaint of flank pain ($43.64 vs $248.82, p = 0.01). Conclusion: POCUS use was not associated with significant health care cost savings. ED POCUS usage did see a trend towards decreased laboratory and imaging investigations. Patients presenting with flank pain had significantly lower expenditures associated with their visit when POCUS was incorporated into their assessment. Large scale prospective studies are needed to investigate if POCUS is associated with cost-savings in ED patients.

Extent of Household Catastrophic Health Expenditure among Urban Dwellers in Mandalay City

Self-payments (out-of-pocket payments OOP) are the principal means of financing health care throughout Myanmar. It leaves households exposed to the risk of unforeseen expenditures that absorb a large share of the household budget. The OOP expenditures may be considered as catastrophic in the sense that they absorb a large fraction of household resources. Catastrophic impact of health care costs among households in selected area of Mandalay City is measured by indices such as incidence, intensity and mean positive gap and explored the opinions of people paying for health care by conducting focus group discussion. As expected, households’ catastrophic impacts are considerably high in Mandalay. The incidence of catastrophic health care payment is 8%, 4% and 1.3% for the defined catastrophic thresholds of 10, 20 and 30 percent, respectively. The intensities are 1.62, 1.09 and 0.8 percents for the same thresholds. Mean Positive Gaps are 20.2, 27.3 and 61.5 percents for the three defined threshold levels. Because of heavy out-of-pocket health care expenditure, most of the households’ income absorbed with repeated borrowing and lending mechanisms can push these households into impoverishment. Although they pay heavily, Myanmar people do not blame anyone but their destiny because they know nothing about social protection mechanisms.

The effect of platelet-rich fibrin exudate addition to porous poly(lactic-co-glycolic acid) scaffold in bone healing: An in vivo study.

Bone grafting procedures have been widely utilized as the current state-of-the-art for bone regeneration, with autogenous bone graft being the gold-standard bone reconstructive option. However, the use of autografts may be limited by secondary donor-site comorbidities, a finite amount of donor supply, increased operating time, and healthcare cost impact. Synthetic materials, or alloplasts, such as the polymeric material, poly(lactic-co-glycolic acid) (PLGA) has previously been utilized as a transient scaffold to support healing of bone defects with the potential to locally delivery osteogenic additives. In this study a novel procedure was adopted to incorporate both the dissolved contents and mechanical components of leukocyte- and platelet-rich fibrin (L-PRF) into an PLGA scaffold through a two-step method: (a) extraction of the L-PRF membrane transudate with subsequent immersion of the PLGA scaffold in transudate followed by (b) delivering a fibrin gel as a low-viscosity component that subsequently polymerizes into a highly viscous, gel-like biological material within the pores of the PLGA scaffold. Two, ~0.40 cm3 , submandibular defects (n = 24) were created per side using rotary instrumentation under continuous irrigation in six sheep. Each site received a PLGA scaffold (Intra-Lock R&D, Boca Raton, FL), with one positive control (without L-PRF exudate addition [nL-PRF]), and one experimental (augmented with PLGA/L-PRF Blocks [L-PRF]). Animals were euthanized 6 weeks postoperatively and mandibles retrieved, en bloc, for histological analysis. Histomorphometric evaluation for bone regeneration was evaluated as bone area fraction occupancy (BAFO) within the region of interest of the cortical bone (with specific image analysis software) and data presented as mean values with the corresponding 95% confidence interval values. Qualitative evaluation of nondecalcified histologic sections revealed extensive bone formation for both groups, with substantially more bone regeneration for the L-PRF induced group relative nL-PRF group. Quantitative BAFO within the defect as function of the effect of L-PRF exudate on bone regeneration, demonstrated significantly (p = .018) higher values for the L-PRF group (38.26% ± 8.5%) relative to the nL-PRF group (~28% ± 4.0%). This in vivo study indicated that L-PRF exudate has an impact on the regeneration of bone when incorporated with the PLGA scaffold in a large translational model. Further studies are warranted in order to evaluate the L-PRF exudate added, as well as exploring the preparation methods, in order to facilitate bone regeneration.

The financial impact of physician practice patterns: An analysis of as-needed filgrastim versus prophylactic pegfilgrastim in patients with prostate cancer receiving docetaxel.

6506 Background: Docetaxel improves survival in metastatic prostate cancer. Patients receiving docetaxel are at an intermediate risk of febrile neutropenia (FN). Granulocyte-colony stimulating factor (G-CSF) reduces the incidence of neutropenia and infection. There is no consensus among physicians on G-CSF use with docetaxel in prostate cancer, and physician preference may significantly impact healthcare costs. The purpose of this study is to assess physician practice patterns by comparing efficacy and cost of as-needed filgrastim (ANF) to prophylactic pegfilgrastim (PPF) for neutropenia in patients with prostate cancer receiving docetaxel. Methods: This retrospective cohort study included patients with prostate cancer that received standard docetaxel and G-CSF, either ANF or PPF, from February 2016 to October 2018 at our institution. In the ANF arm, patients with an ANC less than 1000 cells/µL on day 8 of the cycle received filgrastim. In the PPF arm, patients received pegfilgrastim on day 2 for primary prophylaxis. Patient characteristics, chemotherapy dose intensity, delays, and reductions, and incidence of FN were collected. Results: Of the 65 patients included in this study, 32 received ANF and 33 received PPF. Patients in the ANF arm received an average of 6.0 cycles versus 4.8 cycles in the PPF arm (p = 0.013). The completion rate of planned cycles differed, with 93.8% completion in the ANF arm versus 66.7% in the PPF arm (p = 0.001). Average total drug exposure per patient was greater in the ANF arm than the PPF arm (437.5 mg/m2 versus 343.4 mg/m2; p = 0.007). In both groups, there was no significant difference in dose delays or reductions, or incidence of FN. However, there was a significant difference in cost, with an average of $740.26 per cycle per patient for filgrastim, versus $7327.72 per cycle per patient for pegfilgrastim, based on current average wholesale price. Conclusions: In our study, use of ANF was safe, and did not impact planned dose, intensity, or duration when compared to PPF. In addition, the administration of ANF was associated with significant cost savings. Analysis of G-CSF use in patients with prostate cancer receiving docetaxel at our institution has identified an opportunity for substantial healthcare cost savings.

Intravenous medication errors in Selangor, Malaysia: prevalence, contributing factors and potential clinical outcomes

Medication errors may have serious implications to both the patient and the healthcare system, and may also compromise patient safety and significantly impact healthcare costs. Therefore, assessing the prevalence and factors associated with intravenous medication errors will significantly improve the quality of care and hospital services. The aim of this study was to determine the prevalence of intravenous medication errors and their potential clinical outcomes. Additionally, this study evaluates the relationship between medication errors and the factors associated with their occurrences. This prospective study was conducted using a direct observation technique and medication record reviews in a secondary hospital in Malaysia. The preparation and administration of intravenous drugs were observed for a total of 213 doses using a checklist supplemented with a review of medication charts. Medication administration errors were detected in 85% (181/213) of the doses observed. Overall, 307 errors were identified. After excluding the 39 wrong-time errors, 66.7% (142/213) remained erroneous. More errors were detected during the drug administration stage (62.5%) than in the drug preparation stage (37.5%). Central nervous system drugs recorded the highest error rate at 94.1%. Overall, a total of 43 errors (14.3%) were found to be potentially severe. In a bivariate analysis, the occurrence of errors was significantly associated with nurses’ experience and level of education. Intravenous preparation and administration errors were highly prevalent in a resource-restricted secondary hospital in Malaysia. Targeted and prompt remedial actions such as training and enforcing existing standard operating procedures to reduce medication errors should be implemented.

The impact of natural disasters on medicare costs in U.S. gulf coast states.

Medicare utilization and costs for residents of the U.S. Gulf Coast, who are highly vulnerable to natural disasters, may be impacted by their disaster exposure.To estimate differences in healthcare utilization by disaster exposure, we calculated Medicare expenditures among residents of U.S. Gulf States and compared them with expenditures among residents of other regions of the U.S.Panel models were used to calculate changes in overall Medicare expenditures, inpatient expenditures, and home health expenditures for 32,819 Medicare beneficiaries. Individual demographic characteristics were included as predictors of change in expenditures.Medicare beneficiaries with National Health Interview Survey participation were identified and Part A claims were linked. Federal Emergency Management Agency (FEMA) data was used to determine counties that experienced no, some, high, and extreme hazard exposure. FEMA data was merged with Medicare claims data to create a panel dataset from 2001 to 2007.Medicare Part A claims for the years 2001 to 2007 were merged with FEMA data related to disasters in each U.S. County. Overall Medicare costs, as well as costs for inpatient and home health care for residents of states located along the U.S. Gulf Coast (Texas, Louisiana, Mississippi, Alabama, and Florida) were compared to costs for residents of the rest of the U.S.Expenditures among residents of U.S. Gulf States decreased with increased hazard exposure. Decreases in inpatient expenditures persisted in the years following a disaster.The use of beneficiary-level data highlights the potential for natural hazards to impact health care costs. This study demonstrates the possibility that exposure to more severe disasters may limit access to health care and therefore reduce expenditures. Additional research is needed to determine if there is a substitution of services (e.g., inpatient rehabilitation for home health) in disaster-affected areas during the post-disaster period.

Investigating consumer hospital choice: Demand and supply-side levers could address health care costs

ObjectivePolicies that aim to steer patients from higher to lower cost providers of comparable quality have potential to impact health care cost growth – but their effectiveness depends, in part, on consumer perceptions of value and willingness to make tradeoffs. We sought to understand what was required to shift substantial numbers of consumers to higher-value care settings for several “shoppable” conditions. MethodsA discrete choice experiment (DCE) was conducted to elicit patient preferences for hospital type. We used an Internet panel of 1005 Massachusetts residents to conduct this experiment in 2016. The DCE data were analyzed using alternative-specific conditional logit regression. ResultsConsumers reported large influences of out of pocket costs, physician referrals and quality ratings on their choice of hospital. For example, up to a third of consumers would shift from Academic Medical Centers to community hospitals if the latter had higher quality ratings, lower copays or a physician referral. Choice of site for maternity care was most influenced by physician referral; cancer treatment and orthopedic procedures by quality ratings; and MRI by cost, suggesting that patients prioritize quality over cost as perceived risk increases. Conclusions and implicationsOur findings provide guidance for identifying promising policy levers that most influence consumer choice of provider. However, the extent to which potential levers can influence choice is likely to be dependent upon the kind of care being sought.

Health-care Cost Impact of Continued Anticoagulation With Rivaroxaban vs Aspirin for Prevention of Recurrent Symptomatic VTE in the EINSTEIN-CHOICE Trial Population

Using data from the Reduced-Dose Rivaroxaban in the Long-Term Prevention of Recurrent Symptomatic Venous Thromboembolism (EINSTEIN-CHOICE) trial, this study assessed cost impact of continued anticoagulation therapy with rivaroxaban vsaspirin. Total health-care costs (2016 USD) associated with rivaroxaban and aspirin were calculated as the sum of clinical event costs and drug costs from a US managed care perspective. Clinical event costs were calculated by multiplying event rate by cost of care. One-year Kaplan-Meier clinical event rates for recurrent pulmonary embolism, recurrent DVT, all-cause mortality, and bleeding were obtained from EINSTEIN-CHOICE. Cost of care was determined by literature review. Drug costs were the product of drug price (wholesale acquisition cost) and treatment duration. A one-way sensitivity analysis was conducted. Rivaroxaban users had lower per patient per month (PPPM) clinical event costs compared with aspirin users ($123, $243, and $381 for rivaroxaban 10mg, rivaroxaban 20mg, and aspirin, respectively). However, vsaspirin, PPPM total health-care costs were $24 higher for patients treated with rivaroxaban 10mg ($143 higher for rivaroxaban 20mg) due to higher cost of rivaroxaban. With a 15%discount for rivaroxaban 10mg, the lower cost of clinical events for the rivaroxaban-treated patients more than fully offset the higher drug costs, and yielded a $19 lower total health-care cost. Continued therapy with rivaroxaban 10 and 20mg vsaspirin was associated with lower clinical event costs but higher total health-care costs; with a 15%drug discount rivaroxaban 10mg had lower total health-care costs than aspirin.

An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence.

AimsTo determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost‐effective use of health‐care resources.DesignA probabilistic cost‐effectiveness analysis was conducted, using a decision‐tree to estimate the short‐term clinical and health‐care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long‐term clinical consequences and costs associated with hepatitis B infection.Settings and participantsData on attendance to vaccination from a UK cluster randomized trial.InterventionTwo contingency management options were examined in the trial: fixed versus escalating schedule financial incentives.MeasurementLife‐time health‐care costs and quality‐adjusted life years discounted at 3.5% annually; incremental cost‐effectiveness ratios.FindingsThe resulting estimate for the incremental life‐time health‐care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = –£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8–30). The probabilistic incremental cost per quality adjusted life‐year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297–7172), with an 89% probability of being considered cost‐effective at a threshold of £20 000 per quality‐adjusted life years gained (97.60% at £30 000).ConclusionsUsing financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost‐effective use of health‐care resources in the UK as long as the incidence remains above 1.2%.

Healthcare Cost of Over-Diagnosis of Low-Grade Dysplasia in Barrett's Esophagus.

Published reports have demonstrated that many Barrett's esophagus patients are over-diagnosed as low-grade dysplasia (BE-LGD). We performed an analysis of the surveillance and treatment costs associated with the over-diagnosis of BE-LGD. As the principal cost variables, we used endoscopic and histologic procedures performed during the recommended surveillance intervals for patients with BE-LGD, the national average Medicare reimbursement for the Current Procedural Terminology codes of the procedures performed, and a spreadsheet-based tool we created to determine the overall healthcare cost associated with the over-diagnosis of BE-LGD in the US population. The average excess cost (range) for every patient in the US who is over-diagnosed with BE-LGD is estimated to be $5557 ($3115 to $8072). The principal contributors to the excess cost of over-diagnosis of BE-LGD in these patients are: endoscopy ($2626 to $4639), pathologist biopsy review ($275 to $2185), and esophagogastroduodenoscopy-guided endoscopic ablation ($214 to $1249). The healthcare cost of over-diagnosis of BE-LGD is significant. To reduce the overall healthcare cost impact of over-diagnosis of BE-LGD, strict adherence to the recommendations of the American Gastroenterological Association, American College of Gastroenterology, and American Society for Gastrointestinal Endoscopy that pathology review of all BE biopsy specimens be performed by a gastrointestinal pathologist is warranted.

Abstract 244: Sex-based Differences in Economic and Health-related Burden of Depression on Adults With Cardiovascular Disease

Background: Depression is commonly present in patients with cardiovascular disease (CVD). Among those with established CVD, depression is more common in women and associated with worse outcome. However, how depression affects overall health care expenditures, as well as whether depression among women has a greater impact on medical costs, has not been well studied, which is the aim of the present study. Methods: The 2012 Medical Expenditure Panel Survey was analyzed to explore this project. Variables of interest were defined as CVD (coronary artery disease, stroke, peripheral artery disease, dysrhythmias or heart failure) and depression diagnoses, ascertained by ICD-9-CM codes (410, 413, 433-437, 427-28, 440, 443, 447 and 296, 311, respectively). We restricted our study population to non-institutionalized adults ≥ 18 years of age. Two-part models were utilized to study cost data; a generalized linear model with gamma distribution and link log was used to assess the mean expenditure per capita for each sex/depression status. Results: 27,288 surveyed persons constituted our study population (mean age 67 ± 12.4, 46% female), translating to an approximate of 231 million people across the U.S. Overall, CVD was noted in 15.6 million, of which 18% were patients with depression (2.9 million). Of this nationally representative sample, those with CVD were 86% more likely to be diagnosed with depression (OR 1.86, 95% CI 1.51, 2.28, p<0.001) than Non-CVD. Additionally, among CVD individuals, females were 66% more likely be diagnosed with depression than males (OR 1.66, 95% CI 1.23, 2.23, p=0.001). CVD diagnosis was independently associated with higher healthcare costs among individuals with depression. Moreover, on adjusted analysis, females with depression were also associated with $4,380.14 higher medical costs than those without depression (Table 1). When comparing female vs. males with CVD and depression diagnoses, adjusted mean expenditure per capita was $14,162 (95% CI 10,211 - 18,112) and $11,325 (95% CI 7,769 - 14,881), respectively. Conclusion: CVD patients, especially women, were more likely to have depression, and had considerable higher medical expenditures. The results reinforce the paramount importance of assessing and managing depression among those with CVD to favorably impact healthcare costs.

Impact of health care costs on utilization of needed health care in the Childhood Cancer Survivor Study (CCSS).

20 Background: Survivors of childhood cancer face increased risks for morbidity and premature mortality due to the sequelae of their primary disease and its treatment. Survivors may be socioeconomically vulnerable, which could negatively impact their healthcare utilization. We investigated sociodemographic factors associated with forgoing needed healthcare due to cost among long-term survivors within the CCSS. Methods: From a survey of insured and uninsured survivors conducted in 2011-12, forgoing needed healthcare due to cost was determined by the question “In the past year, was there a time when you did any of the following because you were worried about the cost? (Yes/No)” with 10 response categories (e.g., skipping a test/treatment, postponing medical care, taking a smaller cost of a prescription). ‘Yes’ responses were summarized using a categorical outcome variable of 0, 1-2, or ≥ 3 instances of forgoing healthcare. Ordinal logistic regression models assessed the association of sociodemographic factors with increased instances of forgoing healthcare due to cost, including survey weights to account for stratified sampling. Results: Of 1,110 mailed surveys, we received 698 (64%) responses. Mean age at time of survey was 39.6 (range 24-60) years and average time since diagnosis was 31.3 (SD = 4.6) years. 23% of survivors reported 1-2 instances of foregoing needed healthcare and 31% reported 3 or more. Odds of more forgone needed healthcare due to costs were increased for those who were uninsured, female, and had a chronic medical condition. [Table: see text]

Lenalidomide-Based Treatment for Newly Diagnosed Multiple Myeloma Patients, Ineligible for Transplant: A Healthcare Cost-Impact Analysis in Europe

Background: Multiple myeloma remains an incurable and relapsing haematological cancer. The FIRST study showed that lenalidomide, an immunomodulatory agent, plus dexamethasone improved overall survival of newly diagnosed multiple myeloma (ndMM) patients who are not eligible for transplants by 10.4 months when it was used continuously compared with fixed treatment duration (72 weeks) with melphalan, prednisone and thalidomide(Facon et al, EHA 2015). Compared with alternative intravenous agents, lenalidomide as an oral therapy has also been associated with fewer hospital visits(Gualtney et al, J Clin Pharm Ther, 2013; Armoiry et al, J Clin Pharm Ther, 2011; Arikian et al, Curr Med Res Opin, 2015). In an era of increasing cost conscious health systems, additional economic information is playing an important role in access decisions on innovative medicines. This analysis examines the cost impact of lenalidomide when used in the first-line setting for patients with ndMM in the EU5.Methods: A healthcare cost impact model was developed to estimate total costs associated with the treatment of ndMM over 5 years in the EU5 (France, Germany, Italy, Spain and the UK). The model included drug costs and hospitalisation costs of first-line treatment and up to four additional lines of post-progression treatment for lenalidomide-, thalidomide-, bortezomib as well as costs of pomalidomide-based regimens in later lines. The expected rate of lenalidomide uptake in the first-line setting was based on its observed uptake in the US over the last 5 years. Care pathway costs were calculated for the EU5 according to treatment duration and time to progression. Hospitalisation costs from a retrospective medical chart review in Dutch patients with relapse/refractory MM (Gualtney et al, J Clin Pharm Ther, 2013) were adapted to the first-line setting by adjusting for the duration of treatment and the time to progression for each regimen in each line.Results: Baseline yearly costs per patient were €48,032 ($53,066). In year 1, first-line lenalidomide use resulted in a cost increase by 1.9% (€923 [$1,020] per MM patient, on average). In year 5, annual costs were expected to increase by 7.7% (€3,732 [$4,123] per MM patient). The monthly drug cost per patient was greater in lenalidomide treated patients compared with those receiving bortezomib or thalidomide (€6,548 [$7,234] vs. €5,151 [$5,691] and €1,742 [$1,925], respectively). However, lenalidomide use was associated with the lowest monthly hospitalisation cost per patient (€641 [$708]) compared with bortezomib and thalidomide (€925 [$1,022] and €1,209 [$1,336] respectively).Conclusion: Lenalidomide as a treatment option for newly diagnosed patients is a significant development in the management of MM. Use of lenalidomide in this setting is expected to result in an overall MM care pathway cost impact of under 10% over 5 years. Whilst the drug acquisition cost of lenalidomide is relatively higher than currently used options for ndMM, this is partially offset by savings from displaced use of bortezomib and lenalidomide in the first and second lines, respectively. Additionally there are potential savings from lower resource use. Further studies should be undertaken to evaluate full real life healthcare costs. DisclosuresSchey:Celgene Corporation: Honoraria. Montero:Celgene Corporation: Honoraria. Stengel-Tosetti:Celgene Corporation: Consultancy. Gibson:Celgene Corporation: Employment, Equity Ownership. Dhanasiri:Celgene Corporation: Employment, Equity Ownership.

BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth.

Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years. We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014. We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years. Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

Costs and utilization of treatment in patients with hemophilia.

BackgroundAlthough hemophilia has a potentially high economic impact, there are no published estimates of healthcare costs for this disease in Portugal. The aim of this study was to evaluate costs of treatment and hospital utilization among patients with hemophilia A and B, with and without inhibitors, over a 3-year period in a Portuguese Comprehensive Care Hemophilia Centre. This is the first study on the financial impact of healthcare costs in patients with hemophilia in Portugal.MethodsThis retrospective, observational study identified patients diagnosed with hemophilia A and B using medical and pharmacy electronic medical records and data from Centro Hospitalar São João, between January 2011 and December 2013. Patients with inhibitors were all high responders (>5 Bethesda Units [BU]). Severity was classified as mild, moderate or severe based on clotting factor levels. Two main outcomes were measured: (1) cost associated with hospital pharmacy claims (clotting factor) and (2) number of hospital visits/hospitalization.ResultsA cohort of 103 patients were identified: 72 (69.9 %) with hemophilia A and 31 (30.1 %) with hemophilia B. Among these, five individuals were classified as patients with inhibitors (four with hemophilia A and one with hemophilia B). From the cohort of hemophilia A patients, 36 individuals (35.0 %) were identified as having severe disease; 20 (19.4 %) moderate; and 16 (15.5 %) mild. In the cohort of hemophilia B patients, 14 (13.6 %) were identified as having severe disease; 14 (13.6 %) moderate; and three (2.9 %) mild. The total mean aggregate cost per year (including clotting factor and hospital utilization) for patients with severe hemophilia B was €112,469, compared with €793 for mild hemophilia A. Clotting factor concentrate amounted for 90 % of total cost in severe cases and hospital utilization was also higher in these cases.ConclusionsHemophilia treatment is expensive, particularly for patients with severe disease and especially if they develop inhibitors to replacement clotting factors. In our study, severe hemophilia is associated with greater annual total costs in both types of hemophilia (A = €77,587 and B = € 112,469). Patients with inhibitors have costs 3.3 times higher than patients without inhibitors. Age was not associated with significantly greater total costs (clotting factor and hospital visits/hospitalizations).