Incremental Healthcare Research Articles

Trends in health care expenditures and incremental health care cost in adults with atrial fibrillation in the United States

BackgroundAtrial fibrillation (AF) is associated with increased healthcare costs; however, comprehensive data on the financial burden of AF remain limited. ObjectivesTo delineate healthcare expenditures among patients with AF. MethodsWe used the longitudinal panels from the Medical Expenditure Panel Survey (MEPS) covering 2016-2019 to estimate healthcare expenditures associated with AF. We identified individuals aged ≥18 with AF in the first year of each panel (2016-2018) using the ICD-10 code. Covariates included sociodemographic characteristics and comorbidities. Healthcare expenditures were derived from the second year of each panel (2017-2019) to reflect the cost of having the condition for an entire year. Adjusted mean annual costs were calculated, including total healthcare expenditure, hospital inpatient, emergency room visits, office based, outpatient visits, home health visits, prescribed medicines, and other expenses. Adjusted models were used to estimate the mean annual incremental total healthcare cost associated with AF. ResultsThe weighted study population included 3,080,055 adults with AF (382 respondents, mean age 71.5, 89.9% White). The adjusted annual total healthcare cost among adults with AF totaled $14,083 (95% CI, $10,887 – 17,279) compared to $8,771 (95% CI, $ 8,106 – 9,436) for those without AF. Primary drivers of cost over time were hospital inpatient care, office based visits, and prescribed medications. The annual incremental total healthcare cost associated with AF was $5,312 per adult (in 2019 US dollars). ConclusionAdults with AF in the US face a higher financial burden across various healthcare services compared to those without the condition, with consistently increasing expenses in inpatient care and prescribed medicines. Further research is needed to identify the independent contribution of AF to these costs.

Incremental health care expenditures associated with hypertension in South Korea.

Hypertension is a significant risk factor for cardiovascular disease and the number of deaths due to hypertension increases annually. The increasing healthcare costs of hypertension are a major societal and personal issue. By estimating the medical expenses incurred by patients with hypertension, this study aimed to provide information on the additional costs of hypertension and emphasize the importance of blood pressure management. Health Panel data from 2014 to 2018 were used to calculate incremental out-of-pocket healthcare costs associated with hypertension. First, we compared the mean annual differences in medical expenditure of people with and without hypertension each year. Second, we analyzed five-year panel data from 2014 to 2018 using random Generalized Least Squares. In a cross-sectional mean difference analysis, we found that as of 2018, individuals with hypertension spent an average of 545,489 won more per year on healthcare than those without hypertension. In a five-year panel data analysis, hypertension was associated with an average of 338,799 won in medical expenses per year for the same sex, age, income groups, number of cormorbility and other lifestyle factor. Hypertension incurs incremental costs in treating the condition and its complications. This study aimed to provide information on out-of-pocket healthcare costs associated with hypertension. We highlight the importance of ongoing disease management by discussing the financial burden of chronic diseases on individuals. Managing blood pressure at a young age can reduce healthcare costs throughout an individual's lifetime.

Comparative effectiveness and healthcare utilization for ambulatory cardiac monitoring strategies in Medicare beneficiaries

Objective data comparing the diagnostic performance of different ambulatory cardiac monitors (ACMs) are lacking. To assess variation in monitoring strategy, clinical outcomes and healthcare utilization in patients undergoing ambulatory monitoring without a pre-existing arrhythmia diagnosis. Using the full sample (100%) of Medicare claims data, we performed a retrospective cohort study of diagnostic-naïve patients who received first-time ACM in 2017 to 2018 and evaluated arrhythmia encounter diagnosis at 3-months, repeat ACM testing at 6 months, all-cause 90-day emergency department (ED) and inpatient utilization, and cost of different strategies: Holter; long-term continuous monitor (LTCM); non-continuous, event-based external ambulatory event monitor (AEM); and mobile cardiac telemetry (MCT). We secondarily performed a device-specific analysis by manufacturer, identified from unique claim modifier codes. ACMs were used in 287,789 patients (AEM = 10.3%; Holter = 53.8%; LTCM = 13.3%; MCT = 22.5%). Device-specific analysis showed that compared to Holter, AEM, MCT, or other LTCM manufacturers, a specific LTCM (ZioⓇ XT 14-day patch, iRhythm Technologies, San Francisco, CA) had the highest adjusted odds of diagnosis and lowest adjusted odds of ACM retesting. Findings were consistent for specific arrhythmia diagnoses of ventricular tachycardia, atrioventricular block, and paroxysmal atrial fibrillation. As a category, LTCM was associated with the lowest 1-year incremental health care expenditures (mean Δ$10,159), followed by Holter ($10,755), AEM ($11,462), and MCT ($12,532). There was large variation in diagnostic monitoring strategy. A specific LTCM was associated with the highest adjusted odds of a new arrhythmia diagnosis and lowest adjusted odds of repeat ACM testing. LTCM as a category had the lowest incremental acute care utilization. Different monitoring strategies may produce different results with respect to diagnosis and care.

Incremental health care resource utilization and costs associated among patients with Parkinson's disease psychosis and incident dementia: An analysis of medicare beneficiaries.

Real-world evidence examining the incremental health care resource use (HCRU) and cost burden of incident dementia among patients with Parkinson's disease psychosis (PDP) are needed within the United States (US). To compare HCRU and cost burden between PDP patients with incident dementia (PDP+D) versus without incident dementia (PDP). A retrospective analysis of inpatient (Part A), outpatient (Part B), and prescription drug (Part D) claims from the 100% Medicare sample was conducted to compare PDP+D patients versus PDP patients between 01/01/14-12/31/18. Patients with a diagnosis of dementia, psychosis, secondary parkinsonism, or other psychotic disorders, during 12-month pre-index were excluded. Patients in both groups were matched using 1:1 propensity score matching (PSM) methodology using 31 variables (age, sex, race, region and 27 Elixhauser comorbidity characteristics). Differences in 12-month post-index HCRU rates and mean per patient per year (PPPY) costs for all-cause inpatient (IP) hospitalizations, and by type of IP stay (i.e., short-term [ST-stay], skilled nursing facility [SNF-stay] and long-term [LT-stay]) were analyzed via logistic and gamma log-link regression models. Of the 12,484 patients who met our study criteria, 1855 PSM-matched cohorts were identified. Mean age, gender, and comorbidities were similar in PSM groups. Approximately, 50.3% with PDP+D reported ≥1 all-cause IP hospitalizations versus 36.0% with PDP (p<0.05) during 12-month follow-up. Specifically, all-cause ST-stay, SNF-stay, and LT-stay among PDP+D versus PDP patients were: 45.2% versus 35.7%, 28.3% versus 15.7%, and 8.5% versus 6.0% (p<0.05), respectively. Psychiatric-related ST-stay, SNF-stay, and LT-stay among PDP+D versus PDP patients were: 12.3% versus 9.0%, 7.5% versus 3.4%, and 2.4% versus 1.2% (p<0.05), respectively. Mean PPPY all-cause IP hospitalization costs for PDP+D patients versus PDP patients was $17,891 (±29,882) versus $11,599 (±$25,247) (p<0.05). Patients with PDP+D experience significantly higher all-cause and psychiatric-related IP hospitalizations, including ST-stays, LT stays, and SNF stays. They also had 54% greater mean PPPY IP hospitalization costs versus PDP patients.

Clinical Leadership Experience of Dental Hygienists Participating in Preventaion based Incremental Oral Health Care Project: Applying Focus Group Interviews

Objectives: This study aimed to specifically identify and explore the clinical leadership experience of clinical dental hygienists. Methods: The study subjects were 5 dental hygienists who participated in a prevention-based incremental oral health care program operated by some dental clinics. Focus group interviews were conducted with the study subjects; all the content from the interviews was recorded and transcribed, and a qualitative analysis was conducted based on thematic analysis. Results: The clinical leadership experienced by them was shown as skills and competencies to lead the organizational change of the dental team and the patient’s health change, and to take the lead in the management and operation of dental clinics. They recognized that leadership can be better demonstrated when dental hygienists have work competencies, effective communication, and professional confidence, but it is difficult to demonstrate leadership qualities when experiencing work environments such as hierarchical peer relationships, excessive treatment, and emotional labor. Conclusions: The leadership competencies of dental hygienists can be a basis for explaining the role model of dental hygienists in the field of primary health care and dental care. Therefore, follow-up studies on the leadership behaviors used by dental hygienists need to be conducted, and the leadership capabilities of dental hygienists and dental hygiene students need to be developed and applied.

Health care cost of severe obesity and obesity-related comorbidities: A retrospective cohort study from Alberta, Canada.

Estimates of health care costs associated with severe obesity, and those attributable to specific health conditions among adults living with severe obesity are needed. Administrative data was used to identify adults who previously received a procedure, and had (investigational cohort) or did not have (control cohort) a body mass index ≥35kg/m2. Two-part models were used to estimate the incremental health care cost of severe obesity and related health conditions during a 1-year observation period. Adjusting for potential confounders, the total health care cost ratio was higher in the investigational (n=220,190) versus control (n=1,955,548) cohort (1.32 [95% CI: 1.32, 1.33]) with a predicted incremental cost of $2221 (95% CI $2184, $22,265) per person-year; costs were less when obesity-related health conditions were controlled for (1.13 [95% CI: 1.13, 1.14]; $1097 [95% CI: $1084, $1110] per person-year). Among those living with severe obesity, incremental costs associated with specific health conditions ranged from $737 (95% CI: $747, $728) lower (dyslipidemia) to $12,996 (95% CI: $12,512, $13,634) higher (peripheral vascular disease) per person-year. Adults living with severe obesity had greater costs than those without, largely driven by obesity-related health conditions. For the Alberta adult population with a severe obesity prevalence of 11%, severe obesity may account for an estimated additional $453-918 million in health care costs per year. Findings of this study provide rationale for resources and strategies to prevent and manage obesity and its complications.

Cost of Care for Patients With Cirrhosis.

There are limited longitudinal data on the cost of treating patients with cirrhosis, which hampers value-based improvement initiatives. We conducted a retrospective cohort study of patients with cirrhosis seen in the Veterans Affairs health care system from 2011 to 2015. Patients were followed up through 2019. We identified a sex-matched and age-matched control cohort without cirrhosis. We estimated incremental annual health care costs attributable to cirrhosis for 4 years overall and in subgroups based on severity (compensated, decompensated), cirrhosis complications (ascites, encephalopathy, varices, hepatocellular cancer, acute kidney injury), and comorbidity (Deyo index). We compared 39,361 patients with cirrhosis with 138,964 controls. The incremental adjusted costs for caring of patients with cirrhosis were $35,029 (95% confidence interval $32,473-$37,585) during the first year and ranged from $14,216 to $17,629 in the subsequent 3 years. Cirrhosis complications accounted for most of these costs. Costs of managing patients with hepatic encephalopathy (year 1 cost, $50,080) or ascites ($50,364) were higher than the costs of managing patients with varices ($20,488) or hepatocellular cancer ($37,639) in the first year. Patients with acute kidney injury or those who had multimorbidity were the most costly at $64,413 and $66,653 in the first year, respectively. Patients with cirrhosis had substantially higher health care costs than matched controls and multimorbid patients had even higher costs. Cirrhosis complications accounted for most of the excess cost, so preventing complications has the largest potential for cost saving and could serve as targets for improvement.

Incremental Health Care Costs of Self-Reported Functional Impairments and Phenotypic Frailty in Community-Dwelling Older Adults : A Prospective Cohort Study.

Health care systems need better strategies to identify older adults at risk for costly care to select target populations for interventions to reduce health care burden. To determine whether self-reported functional impairments and phenotypic frailty are associated with incremental health care costs after accounting for claims-based predictors. Prospective cohort study. Index examinations (2002 to 2011) of 4 prospective cohort studies linked with Medicare claims. 8165 community-dwelling fee-for-service beneficiaries (4318 women, 3847 men). Weighted (Centers for Medicare & Medicaid Services Hierarchical Condition Category index) and unweighted (count of conditions) multimorbidity and frailty indicators derived from claims. Self-reported functional impairments (difficulty performing 4 activities of daily living) and frailty phenotype (operationalized using 5 components) derived from cohort data. Health care costs ascertained for 36 months after index examinations. Average annualized costs (2020 U.S. dollars) were $13906 among women and $14598 among men. After accounting for claims-based indicators, average incremental costs of functional impairments versus no impairment in women (men) were $3328 ($2354) for 1 impairment increasing to $7330 ($11760) for 4 impairments; average incremental costs of phenotypic frailty versus robust in women (men) were $8532 ($6172). Mean predicted costs adjusted for claims-based indicators in women (men) varied by both functional impairments and the frailty phenotype ranging from $8124 ($11831) among robust persons without impairments to $18792 ($24713) among frail persons with 4 impairments. Compared with the model with claims-derived indicators alone, this model resulted in more accurate cost prediction for persons with multiple impairments or phenotypic frailty. Cost data limited to participants enrolled in the Medicare fee-for-service program. Self-reported functional impairments and phenotypic frailty are associated with higher subsequent health care expenditures in community-dwelling beneficiaries after accounting for several claims-based indicators of costs. National Institutes of Health.

Economic Burden of Recurrence Among Resected Medicare Patients With Early Stage NSCLC

IntroductionPatients with early NSCLC (eNSCLC) who experience recurrence are associated with worse survival outcomes, but the economic burden of recurrence is not well characterized. This study evaluated the incremental health care resource utilization and costs of recurrence in Medicare patients with resected eNSCLC. MethodsThis retrospective observational study used Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims. Eligible patients were 65 years and older with newly diagnosed NSCLC stages IB to IIIA (American Joint Committee on Cancer Staging Manual, seventh edition) and surgery between January 2010 and December 2017. Continuous enrollment criteria were applied to ensure appropriate data capture. Per patient per month (PPPM) health care resource utilization and all-cause direct costs were compared for patients with versus without recurrence, which was identified from claims data using diagnosis, procedure, or drug codes. Patients were matched (1:1) using exact matching on cancer stage and treatment, and propensity score matching on other characteristics. ResultsIn total, 2035 (44%) out of 4595 patients had evidence of recurrence. After matching, 1494 patients were included in each cohort. Patients with recurrence had a significantly higher number of inpatient visits (+0.25 PPPM), outpatient visits (+1.10 PPPM), physician services (+3.70 PPPM), and emergency department (ED) visits (+0.25 PPPM; all p < 0.001). The average follow-up PPPM cost in the recurrence cohort was U.S. dollars $7437 and $1118 in the no-recurrence cohort, resulting in a difference of $6319 PPPM (p < 0.001) with inpatient costs as the largest contributor. ConclusionsOn the basis of a real-world population, the recurrence among patients with resected eNSCLC is associated with increased health care resource utilization and costs.

Incremental Health Care Costs of Anxiety and Depression Among Medicare Beneficiaries With Cancer.

Mental health comorbidities are commonplace among patients with cancer and have been associated with adverse health outcomes and elevated health care costs. Given the rapidly evolving cancer care landscape, an updated understanding of the prevalence and costs of mental health conditions among patients with cancer is needed. This study assessed the incremental costs of anxiety and depression among Medicare beneficiaries with cancer. This retrospective cohort study used the SEER-Medicare database. Patients diagnosed with melanoma, breast, lung, prostate, or colorectal cancer between July 2013 and December 2017 were followed for at least 12 months and up to 36 months after cancer diagnosis. Patients were categorized on the basis of anxiety/depression (AD) diagnosis: (1) predating cancer, (2) onset after cancer, or (3) no AD. Multivariable regression was used to estimate differences in all-cause incremental costs (before v after cancer) between the three groups. Of 230,626 patients, 10% had AD before their cancer diagnosis and 22% were diagnosed after cancer. In the first year after cancer diagnosis, average monthly health care costs were $5,750 in US dollars (USD) for patients with newly onset, $5,208 (USD) for patients with preexisting, and $3,919 (USD) for patients without a diagnosis of AD. The incremental cost of cancer was the greatest among patients with newly onset AD-$1,458 (USD) per month greater than those with no AD. Similar patterns were observed across cancer types and stages. One in three Medicare beneficiaries with cancer in this study had a diagnosis of anxiety or depression. Newly onset AD is associated with an increase in health care costs of $17,496 (USD) per year. Screening and management of mental health conditions for patients with cancer should be part of coordinated oncology care.

Overview of the main incremental health care reforms introduced between 2014 and 2020 in Romania

Aim: On 2014 the Government of Romania has committed to improving health and health system through the implementation of the 2014–2020 National Health Strategy: Health for Prosperity. An official evaluation of the strategy implementation is not publicly available yet. This paper aims to provide an overview of the main incremental reforms taken during this period in Romania and to analyse the results from the perspective of the main Strategy goals. Methods: Information was collected from legislative documents, statistical and scientific publications. The main implemented or initiated incremental reforms, during the assessed period, were assigned to five main clusters: ”governance”, “resources for health”, “coverage and access”, “organization of health care”, “quality of care” and were analysed in accordance with the aim, the type, the implementation stage and the corresponding objectives of the Strategy. Results: The 2014–2020 National Health Strategy has definitely not reached all its objectives, but one sign of prosperity, is that based on 2019 per capita income (of $12,630) World Bank classified Romania, for the first time, as a high-income country. The health status of the population has increased in many aspects, yet Romanians’ health has still remained among the poorest in the European Union (EU). Conclusion: Incremental reforms might be successful, but the small steps should be taken in a holistic approach, and should be tailored to specific needs. Previous strengthening health systems resilience and plans for overcoming possible risks and obstacles might ensure successful implementation. Assessments of the reforms might draw lessons that help policymakers in shaping further health policies and designing of next strategies.

Herpes Zoster Incidence and Burden in Adults With Type 2 Diabetes in the U.S.: A Retrospective Database Analysis.

Data on the real-world burden of herpes zoster (HZ) in adults with type 2 diabetes (T2D) in the U.S. are limited. We assessed HZ in patients with and without T2D and measured the impact of HZ on health care resource use (HCRU) and costs. This retrospective cohort analysis used U.S. commercial claims data (sourced from claims incurred between 1 January 2012 and 31 July 2018). HZ incidence rates/1,000 person-years (PYs) were calculated in patients with and without T2D. HZ risk was evaluated using Poisson regression to generate adjusted incidence rate ratios (aIRRs). Patients with T2D with HZ were propensity score matched to patients with T2D only and to patients with HZ without T2D. HCRU and costs were compared across cohorts during a 1-year follow-up period. Cox proportional hazards analyses evaluated factors associated with HZ-related complications. Crude HZ incidence rates in patients with and without T2D were 9.8/1,000 PY and 2.6/1,000 PY, respectively. T2D patients were almost twice as likely to be diagnosed with HZ (aIRR 1.84; 95% CI 1.82-1.85). HZ was associated with increased HCRU and health care costs. At 12 months, unadjusted incremental all-cause health care costs for patients with T2D with HZ versus patients with T2D without HZ were $5,216. The unadjusted incremental HZ-related health care costs for patients with T2D with HZ versus patients with HZ without T2D were $2,726. Age was the most important predictor for HZ-related complications. Given the increased risk of HZ and HCRU and cost burden in patients with T2D, HZ prevention in patients with T2D may be beneficial.

Health care costs and lost productivity costs related to excess weight in Belgium

BackgroundThis study aimed to estimate annual health care and lost productivity costs associated with excess weight among the adult population in Belgium, using national health data.MethodsHealth care costs and costs of absenteeism were estimated using data from the Belgian national health interview survey (BHIS) 2013 linked with individual health insurance data (2013–2017). Average yearly health care costs and costs of absenteeism were assessed by body mass index (BMI) categories – i.e., underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 25 kg/m2), overweight (25 ≤ BMI < 30 kg/m2) and obesity (BMI ≥ 30 kg/m2). Health care costs were also analysed by type of cost (i.e. ambulatory, hospital, reimbursed medication). The cost attributable to excess weight and the contribution of various other chronic conditions to the incremental cost of excess weight were estimated using the method of recycled prediction (a.k.a. standardisation).ResultsAccording to BHIS 2013, 34.7% and 13.9% of the Belgian adult population were respectively affected by overweight or obesity. They were mostly concentrated in the age-group 35–65 years and had significantly more chronic conditions compared to the normal weight population. Average total healthcare expenses for people with overweight and obesity were significantly higher than those observed in the normal weight population.The adjusted incremental annual health care cost of excess weight in Belgium was estimated at €3,329,206,657 (€651 [95% CI: €144-€1,084] and €1,015 [95% CI: €343–€1,697] per capita for individuals with overweight and obesity respectively). The comorbidities identified to be the main drivers for these incremental health care costs were hypertension, high cholesterol, serious gloom and depression. Mean annual incremental cost of absenteeism for overweight accounted for €242 per capita but was not statistically significant, people with obesity showed a significantly higher cost (p < 0.001) compared to the normal weight population: €2,015 [95% CI: €179–€4,336] per capita. The annual total incremental costs due to absenteeism of the population affected by overweight and obesity was estimated at €1,209,552,137. Arthritis, including rheumatoid arthritis and osteoarthritis, was the most important driver of the incremental cost of absenteeism in individuals with overweight and obesity, followed by hypertension and low back pain.ConclusionsThe mean annual incremental cost of excess weight in Belgium is of concern and stresses the need for policy actions aiming to reduce excess body weight. This study can be used as a baseline to evaluate the potential savings and health benefits of obesity prevention interventions.

35025 Incremental financial burden and health care services associated with depression in dermatology patients

While the prevalence of depression grows among patients with dermatologic disease, there are limited data on its incremental economic burden. The objective of this retrospective cross-sectional study is to quantify the cost of depression in patients with concurrent dermatologic conditions. Using the Medical Expenditure Panel Survey (MEPS) from January 1, 2016, through December 31, 2018, patients with dermatologic conditions and at least 1 outpatient visit were identified using ICD-10-CM codes and stratified based on the presence or absence of depression. A cross-validated 2-step multivariate regression model was used to determine the incremental system-wide economic burden, health care sector utilization, and expenditures associated with depression in this patient cohort. Of the 10122 dermatology patients included, 1593 (15.74%) were diagnosed with depression (mean expenditures: 16,327.45 ± 1640.86) and 8529 patients (84.26%) without depression (mean expenditures: 10,222.83 ± 519.01). Patients with depression were more likely to be female (71%), white (72%), lower income (40.8%), use Medicare or Medicaid (42%), and have comorbidities (P < .001 for all). In these patients, healthcare expenditure was 1.44-fold higher and incurred an additional $4988.94 attributed to depression (95% CI, $3471.19 – $6248.78, P < .001), resulting in a system-wide annual cost of $26.7 billion. These patients required more inpatient visits (OR 1.19, P = .042), medication visits (OR 1.62, P < .001) and were more likely to visit the emergency room (OR 1.37, P < .001). As the prevalence of depression in dermatology grows, dermatologists need to be more cognizant of its economic impact and develop strategies to identify and manage depression.

Cost-effectiveness analysis of implementing screening on preterm pre-eclampsia at first trimester of pregnancy in Germany and Switzerland

To assess the cost-effectiveness of preterm preeclampsia (PE) screening versus routine screening based on maternal characteristics in Germany and Switzerland. A health economic model was used to analyse the cost-effectiveness of PE screening versus routine screening based on maternal characteristics. The analysis was conducted from the healthcare perspective with a time horizon of one year from the start of pregnancy. The main outcome measures were incremental health care costs and incremental costs per PE case averted. The incremental health care costs for PE screening versus routine screening per woman were €14 in Germany, and -CHF42 in Switzerland, the latter representing cost savings. In Germany, the incremental costs per PE case averted were €3,795. In Switzerland, PE screening was dominant. The most influential parameter in the one-way sensitivity analysis was the cost of PE screening (Germany) and the probability of preterm PE in routine screening (Switzerland). In Germany, at a willingness-to-pay for one PE case avoided of €4,200, PE screening had a probability of more than 50% of being cost-effective compared to routine screening. In Switzerland, at a willingness-to-pay of CHF0, PE screening had a 78% probability of being the most cost-effective screening strategy. For Switzerland, PE screening is expected to be cost saving in comparison to routine screening. For Germany, the additional health care costs per woman were expected to be €14. Future cost-effectiveness studies should be conducted with a longer time horizon.

893-P: Incremental Health Care Utilizations and Medical Expenditures Associated with Cognitive Impairment among Older Adults with Diabetes

Cognitive impairment (CI) poses a large economic burden on the US health care system, but little is known about how CI impacts health care (HC) utilization and medical expenditures among people with diabetes. Using data from the 2016-20Medical Expenditure Panel Survey, we quantified the incremental HC utilization and medical expenditures associated with CI among adults aged ≥ 60 years with diabetes. Diabetes status was based on self-report. Participants who reported having difficulty concentrating, remembering, or making decisions were defined as having CI. We used negative binomial regressions to model the number of ambulatory visits, prescriptions, and home health care days; logistic regressions to model the probabilities of ER visits and hospital admissions; and gamma regressions to model medical expenditures in total and by category. All models were adjusted for age, sex, race and ethnicity, income, education, and comorbidities. We included 6,714 adults ≥ 60 years with diabetes, of which 1,025 (15.27%) had CI. CI was associated with additional ambulatory visits (+4.7 [95% CI, 3.5-5.8]) , drug prescriptions (+10.6 [8.1-13.1]) , and home health care days (+32.6 [19.2-52.2]) ; and higher odds of ER visits (Odds Ratio (OR) : 1.55 [95% CI, 1.27-1.89]) and hospital admissions (OR: 1.27 [1.02-1.58]) . CI was also associated with additional expenditures for outpatient care (+$12[$731-$1720], or 28% higher than those without CI [17%-40%]) , prescription drugs (+$17[$1103-$2372], or 31% higher [20%-43%]) , and home health care (+$25[$445-$7060], or 197% higher [35%-555%]) . Overall, those with CI spent $70[$5168-$8835], or 42% [31%-53%] more than those without CI. All p &amp;lt; 0.05. CI is associated with higher HC utilization and medical expenditures among older adults with diabetes. Early detection of CI and additional assistance to those with CI may lower CI-related HC utilization and expenditure in this population. Disclosure D.Guan: None. P.Zhang: None. S.Tang: None. J.D.Brown: None. R.R.Fang: None. J.Guo: None. Y.Zhang: None. H.Shao: Board Member; BRAVO4HEALTH, LLC.

The cost impact of disease progression to metastatic castration-sensitive prostate cancer.

BACKGROUND: Metastatic prostate cancer (PC) is associated with declining survival rates and increased health care expenditure. However, there are few studies quantifying these increased costs. OBJECTIVE: To estimate overall health care resource utilization and costs associated with progression to metastatic disease in Medicare or commercially insured patients with nonmetastatic castration-sensitive PC (nmCSPC) or previously undiagnosed PC. METHODS: In this retrospective, observational cohort study, we used data from the IBM MarketScan Commercial and MarketScan Medicare Supplemental Databases. Included patients were aged 18 years or older, had 2 or more health care claims associated with a diagnosis of PC, and had a diagnosis of metastatic disease (index date) between January 1, 2014, and December 31, 2016. Patients with PC were identified at index as either progressing from a localized disease state (nmCSPC) without evidence of castration resistance (progressors) or de novo metastatic without a prior PC diagnosis. Unadjusted all-cause direct health care costs for the 2-year pre-index period and up to 2 years post-index were summarized. Metastasis-related incremental all-cause direct health care costs were estimated using regression modeling to adjust for patient baseline characteristics, follow-up duration, and possible selection bias. RESULTS: We identified 3,854 patients who met the criteria for CSPC at metastasis: 2,766 Medicare patients (mean age 78.8 ± 7.6 years) and 1,088 commercial patients (mean age 57.6 ± 4.3 years), with de novo patients accounting for 28.9% and 34.5% of the 2 analysis populations, respectively. Mean unadjusted total all-cause health care costs over the 24-month pre-index period among progressors were $52,661 (Medicare) and $43,111 (commercial); those among de novo patients were $39,756 (Medicare) and $22,090 (commercial). Mean unadjusted post-index costs for progressors were $100,331 (Medicare) and $127,374 (commercial) over a mean follow-up duration of 14.63 and 18.41 months, respectively, and $124,538 (Medicare) and $173,408 (commercial) over a mean follow-up duration of 14.14 and 17.29 months for patients with de novo disease. After multivariate adjustment, incremental cost increases due to metastasis in patients with CSPC pre-index were estimated at $104,051 (Medicare) and $93,334 (commercial), assuming data are available for 24 months post-index. Allowing for variation in the postindex observation period, estimates were $71,308 (Medicare) and $82,336 (commercial). Among de novo patients, cost increases due to metastasis were estimated at $180,932 (Medicare) and $215,397 (commercial), assuming all patients have data for 24 months postindex. Allowing for variable follow-up, estimates were $113,253 (Medicare) and $161,714 (commercial). CONCLUSIONS: Development of metastatic CSPC is associated with considerable costs over a 24-month follow-up period. Cost increases are greater for de novo patients than for those who progressed from localized disease. DISCLOSURES: Q.-D. Trinh received personal fees from Astellas, Bayer, and Janssen and grants from Intuitive Surgical. L. Passos Chaves, Q. Feng, J. Zhu, and T. Abbott are employees of Astellas Pharma Global Development, Inc. R. Sandin is an employee of, and holds stock in, Pfizer AB. This study was funded by Astellas Pharma Inc. (Northbrook, IL) and Pfizer Inc., the codevelopers of enzalutamide. Astellas Pharma Inc. was involved in the study design, data collection, analysis, interpretation of data, and decision to present these results.

Economic Burden of Commercially Insured Patients With Major Depressive Disorder and Acute Suicidal Ideation or Behavior in the United States.

Objective: Suicidal ideation or behavior (SIB) is a symptom of major depressive disorder (MDD). This study evaluated health care resource utilization (HRU) and costs of commercially insured adults who had diagnosed MDD with acute SIB (MDSI).Methods: Adults with MDSI (index date: first SIB claim) and controls without MDD or suicide-related claims (random index date) were identified using International Classification of Diseases, Clinical Modification, 10th Revision codes in the OptumHealth Care Solutions, Inc. database (October 2014 to March 2017). Adults with < 12 months of plan enrollment pre-index and/or selected psychiatric comorbidities were excluded. MDSI and control cohorts were matched 1:1 on demographics and comorbidities. HRU and costs were compared between matched cohorts during up to 1 and 12 months post-index (inclusive) using regressions adjusted for baseline costs.Results: Among patients with MDSI (n = 1,576, mean age = 34 years, 55.6% female), most index events occurred in emergency department (ED; 50.7%) and inpatient (45.2%) settings. The MDSI cohort, compared with the control cohort within 1 and 12 months post-index, respectively, had 157.7 and 28.0 times more inpatient admissions, 16.4 and 5.4 times more ED visits, and 4.9 and 3.2 times more outpatient visits (all P < .01). Incremental health care costs per patient per month in the MDSI compared with the control cohort within 1 and 12 months were $7,839 and $2,757, respectively (both P values < .01). Inpatient and ED costs constituted 70.6% and 16.5% of the total incremental costs, respectively, within the first month of follow-up.Conclusions: Among commercially insured adults, MDSI was associated with significant economic burden; inpatient and ED services drove incremental costs of the condition. Further assessment of treatment options for this vulnerable patient population is warranted.

HSR22-131: Incremental Health Care Costs of Anxiety and Depression Among Medicare Beneficiaries With Cancer

HSR22-131: Incremental Health Care Costs of Anxiety and Depression Among Medicare Beneficiaries With Cancer

Incremental burden of relapse in patients with major depressive disorder: a real-world, retrospective cohort study using claims data

BackgroundRelapse is common in major depressive disorder (MDD). In this study, we evaluated the incremental health care burden of relapse in patients with MDD.MethodsThis real-world retrospective cohort study used administrative medical and pharmacy claims data to identify commercially insured adult patients in the United States diagnosed with MDD who initiated a new antidepressant between January 1, 2012, and September 30, 2017. All-cause health care resource utilization, total costs, and medication adherence were evaluated in two cohorts: patients with and patients without relapse. Relapse was defined as suicide attempts, psychiatric hospitalization, mental health–related emergency department (ED) visit, use of electroconvulsive therapy, or reinitiation of treatment after a gap ≥6 months.ResultsThe study population included 14,186 patients (7093 baseline-matched patients per cohort). The mean follow-up period was 27.5 and 26.0 months for patients with and patients without relapse, respectively. Patients with relapse had significantly higher rates of hospitalization (16.6% vs 8.5%; p < .0001) and ED visits (54.8% vs 34.7%; p < .0001) than patients without relapse. The total costs for patients with relapse were significantly higher ($12,594 vs $10,445; p < .0001). Patients with relapse were also less adherent to antidepressants (mean proportion of days covered, 0.43 vs 0.49; p < .0001).ConclusionsRelapse of MDD was associated with increased total costs and health care utilization and lower adherence to antidepressants. Reducing the risk of relapse may result in a reduction of the associated health care burden; however, findings may only be generalizable to patients with commercial insurance.