Incremental Healthcare Costs Research Articles

Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease.

BackgroundThe prevalence of incidental gallbladder cancer is low when performing cholecystectomy for benign disease. The performance of routine or selective histological examination of the gallbladder is still a subject for discussion. The aim of this study was to assess the cost‐effectiveness of these different approaches.MethodsFour management strategies were evaluated using decision‐analytical modelling: no histology, current selective histology as practised in Sweden, macroscopic selective histology, and routine histology. Healthcare costs and life‐years were estimated for a lifetime perspective and combined into incremental cost‐effectiveness ratios (ICERs) to assess the additional cost of achieving an additional life‐year for each management strategy.ResultsIn the analysis of the four strategies, current selective histology was ruled out due to a higher ICER compared with macroscopic selective histology, which showed better health outcomes (extended dominance). Comparison of routine histology with macroscopic selective histology resulted in a gain of 12 life‐years and an incremental healthcare cost of approximately €1 000 000 in a cohort of 10 000 patients, yielding an estimated ICER of €76 508. When comparing a macroscopic selective strategy with no histological assessment, 50 life‐years would be saved and the ICER was estimated to be €20 708 in a cohort of 10 000 patients undergoing cholecystectomy.ConclusionA macroscopic selective strategy appears to be the most cost‐effective approach.

Value-based Healthcare: Health Literacy's Impact on Orthopaedic Care Delivery and Community Viability.

Value-based Healthcare: Health Literacy's Impact on Orthopaedic Care Delivery and Community Viability.

Health care resource utilization among patients with T2D and cardiovascular-, heart failure-, or renal-related hospitalizations.

In patients with type 2 diabetes (T2D), comorbidity-related hospitalizations can have significant impact on longitudinal care. This study aimed to estimate incremental all-cause health care resource utilization (HCRU) and costs between patients with T2D who experienced cardiovascular (CV)-, heart failure (HF)-, or renal-related hospitalizations vs those who did not. This was a retrospective cohort study using data from a large national health plan. Patients with T2D aged 18 to 90 years with CV, HF, or renal hospitalizations were identified from the Humana claims database from October 1, 2009, to September 30, 2015, and separated into CV, HF, and renal cohorts. Patients had 12 months of continuous enrollment prior to the date of first hospitalization (index) and were followed for up to 12 months. Per-patient per-month (PPPM) all-cause HCRU and costs for hospitalized patients were compared with those of no-CV, no-HF, and no-renal cohorts. Differences in baseline characteristics between cohorts were controlled for using generalized linear models. A total of 221,229, 68,126, and 120,105 patients were included in the CV, HF, and renal cohorts, respectively; these patients were older and had higher Deyo-Charlson Comorbidity Index scores than patients in the no-CV, no-HF, and no-renal cohorts. Adjusted for baseline covariates, they had higher mean PPPM inpatient stays, outpatient visits, emergency department visits, and total health care costs. Among patients with T2D, concurrent CV, HF, or renal events present significant disease burden leading to poor quality of life. This information can be used to guide disease management strategies and interventions aimed at reducing comorbidity-related hospitalizations and health care costs, thus providing improved quality of life for these patients.

Modeling Healthcare Costs Attributable to Secondhand Smoke Exposure at Home among South Korean Children.

Children exposed to secondhand smoke (SHS) are at increased risk for disease. We sought to estimate the medical costs among Korean children who were exposed to SHS at home. A Markov model was developed, including five diseases (asthma, acute otitis media, acute bronchitis, pneumonia and sudden infant death syndrome) that were significantly associated with SHS in children based on a systematic review. The time horizon of the analysis was 20 years (from birth to adulthood), and the cycle length was 1 week. The direct healthcare costs were discounted annually at 5%. Univariate and probabilistic sensitivity analyses were conducted. The Markov model estimated the healthcare costs for 20 years as 659.61 USD per exposed child, an increase of approximately 30% compared to the cost per unexposed child (507.32 USD). Sensitivity analysis suggested that the younger the age of the exposure, the greater the incremental healthcare costs incurred, implying that infants and young children were especially vulnerable to the SHS exposure. Findings of this study could provide key baseline data for future economic evaluations on SHS control policies in South Korea.

Sa1429 THE IMPACT OF ENDOSCOPIC ULTRASOUND GUIDED GALLBLADDER DRAINAGE (EUS-GBD) ON REDUCING COSTS OF REINTERVENTION AND UNPLANNED READMISSION: A BUDGET IMPACT ANALYSIS

Endoscopic ultrasound guided gallbladder drainage (EUS-GBD) was introduced as an alternative approach for internally draining the gallbladder in patients with acute cholecystitis at high-risk for surgery. A recent randomized controlled trial showed that EUS-GBD could improve the outcomes when compared with percutaneous cholecystostomy (PT-GBD) in patients with acute cholecystitis who are at high-risk for cholecystectomy (DRAC Trial)( ClinicalTrials.gov Identifier: NCT02212717). We evaluated the economic impact of using EUS-GBD in the public hospitals in Hong Kong via a pilot budget impact analysis. A Microsoft Excel-based budget impact model was developed to estimate the cost of EUS-GBD versus PT-GBD. The model was used to measure the costs in terms of total cost in a year for all the patients admitted to all public hospitals in Hong Kong. The admission data from the patients were collected from the records in the previous randomized controlled trial (DRAC Trial). The cost information including screening cost (cost before interventions), procedural costs, potential re-intervention costs, costs for regular follow-up, costs of unplanned readmissions, and total costs of medications was collected from published literature, the Clinical Data Analysis and Reporting System (CDARS) of the Hospital Authority, and price lists from different local hospitals/clinics. According to the statistics of patients having acute cholecystitis with PT inserted in 2018 in Hong Kong, a hypothetical population size of 400 was assumed. As it is a budget impact analysis for a short time horizon of one year, there was no discounting of costs. According to the budget impact analysis, the total average cost per patient receiving EUS-GBD was around HK$127,096, while the total average cost per patient receiving PT-GBD [MW1] was around HK$88,576, representing an incremental healthcare costs of HK$15.4M for all local patients in a year. The EUS-GBD would reduce the expected cost for re-intervention (HK$1,406 vs HK$12,492), whereas it would also decrease the expected cost from unplanned readmissions (HK$3,510 vs HK$13,397) when compared with PT-GBD. Nevertheless, the procedural cost of EUS-GBD is higher than that of PT-GBD. The findings of this study demonstrated that EUS-GBD could save the cost for re-intervention and unplanned readmissions. This could potentially enhance patients' quality of life after EUS-GBD. Future prospective studies are warranted to compare the quality adjusted life years between patients who received EUS-GBD and PT-GBD.

How expensive are post-traumatic stress disorders? Estimating incremental health care and economic costs on anonymised claims data

BackgroundPost-traumatic stress disorders (PTSD) pose a high burden for individuals and societies. Although prevalence rates are rather low, high co-occurrence rates and overall impairments cause deleterious suffering and significant costs. Still, no long-term data on costs and trends in cost developments are available.MethodsClaims data from a German research database were analysed regarding direct and indirect costs occurring for individuals with incident diagnoses of PTSD. Results were compared to non-exposed average insurants matched on age and gender. Costs were analysed over a 5-year period from 2 years preceding until 3 years following an incident diagnosis of PTSD.ResultsOverall costs for PTSD account for approximately 43,000 EUR per individual, which is three times higher than costs for non-exposed controls. Of these costs, 59% are caused by mental disorders, 18% specifically by PTSD. In the control group, costs for mental disorders account for 19% of total costs. Costs increase by 142% in the year after an incident diagnosis of PTSD but return to the initial level 2 years later. Still, costs are at least twice as high in every year as in those for the comparison group.ConclusionsIndividuals with PTSD seem to suffer from far more impairments in their general health conditions and incur many more costs than average insurants. Most of these seem to be caused by co-occurring mental disorders and show their maximum in the index year. Nevertheless, as costs decrease to their initial level, treatments seem to have counterbalanced the impairments due to PTSD. Thus, treatments for PTSD can be considered as beneficial and their cost-effectiveness should be further investigated.

PMH17 ECONOMIC BURDEN OF MEDICAID BENEFICIARIES WITH SCHIZOPHRENIA NOT ADHERENT TO ANTIPSYCHOTICS AND WITH SCHIZOPHRENIA RELAPSES

Patients with schizophrenia struggle with long-term adherence to antipsychotics (AP). This study evaluated incremental healthcare resource utilization (HRU) and costs among patients not adherent to APs with repeated schizophrenia relapses relative to controls without schizophrenia. Adults with ≥2 schizophrenia diagnoses and controls without schizophrenia were identified in Medicaid data (Q1/1998-Q1/2018) from six states. The index date was the last observed schizophrenia diagnosis (cohort with schizophrenia) or the last service claim (control cohort) with ≥12 months of continuous Medicaid enrollment before and after it. Cohorts were matched 1:1 using propensity scores. Analyses were then restricted to patients with schizophrenia not adherent to APs (proportion of days covered ≤80%) and with ≥2 schizophrenia-related hospitalizations (relapses) in the 12-month pre-index period and their matched controls. Per-patient-per-year HRU and costs ($2018 USD) in the 12-month post-index period were compared between matched pairs using regression models adjusted for unbalanced baseline characteristics. P-values were estimated using non-parametric bootstrap procedures. Among all patients with schizophrenia, 13,779 (8.7%) were non-adherent with repeated relapses (mean age 47.1 years; 52.0% male). Non-adherent patients with relapses had 3.1 times more inpatient stays, 2.1 times more long-term care stays, 2.6 times more emergency room visits, and 1.5 times more outpatient visits relative to controls (all p<0.01); they incurred adjusted incremental healthcare costs of $21,688 versus controls (mean: $38,368 vs $15,271; p<0.01). Incremental costs were predominantly driven by inpatient ($8,417) and long-term care ($5,427) costs (all p<0.01). Incremental costs incurred by non-adherent patients with relapses were 54.0% higher than those of all patients with schizophrenia ($14,087). Medicaid beneficiaries with schizophrenia not adherent to APs and with repeated relapses incurred substantial incremental HRU and costs relative to controls without schizophrenia. Incremental costs of non-adherent patients with schizophrenia and relapses appeared higher compared to those of all patients with schizophrenia.

Direct incremental healthcare costs associated with mood disorders in the United States, 2007–2017

BackgroundThis study provides nationally representative estimates of the direct incremental economic burden of mood disorders in the United States between 2007–2017, and examines trends in spending on mood disorders by healthcare setting over time. MethodsThe Medical Expenditure Panel Survey (MEPS) was used to analyze nationally-representative data related to healthcare expenditures between 2007–2017. A two-part regression model was used to estimate healthcare expenditures for patients with mood disorders compared to those without, adjusting for several sociodemographic and health-related factors. ResultsTotal annual healthcare costs for patients with mood disorders were over twice as high as for those without, even after adjusting for potential confounders. A mood disorder diagnosis independently accounted for $6,591.60 in additional annual healthcare spending over this period. While healthcare spending on mood disorders increased significantly in the outpatient setting (14%), home health setting (84%), and on prescription medications (17%), it decreased in the inpatient setting and remained stable for emergency care. LimitationsStudy limitations include an inability to determine specific components of cost in each setting, analyze costs for distinct depressive and bipolar disorders by four- or five-digit diagnosis code, and the potential for recall bias during data collection. ConclusionsSpending on outpatient care, prescription medications, and home health care for mood disorder patients grew significantly between 2007 and 2017, but decreased for inpatient care and remained stable in the emergency care setting. Future research should examine drivers of spending in these settings and explore ways to improve patient outcomes and stabilize growing healthcare expenditures.

The socioeconomic cost of chronic rhinosinusitis study.

Chronic rhinosinusitis (CRS) is highly prevalent, affecting 11% of the population. Studies evaluating the socio-economic impact of CRS are mostly limited to the US population. Currently there is no study that has evaluated the socio-economic costs of CRS in the UK. A case-control study of patients with CRS and healthy controls was conducted to investigate the wider socio-economic impact of the disease. Data on demographic and socioeconomic characteristics, out-of-pocket expenditure (OOPE), health resource utilisation, productivity losses and health-related quality of life (HRQoL) via the EQ-5D and SNOT-22 instruments, were collected from questionnaires. A total of 139 CRS participants and 67 control participants completed the questionnaires. The average total OOPE per patient extrapolated to a 12-month period was £304.84. Other important findings include significantly higher reported primary care interactions (4.14 vs. 1.16) as well as secondary care interactions (2.61 vs 0.4) in CRS group as compared to controls over three-months. The average total missed workdays was estimated to be 18.7 per patient per year. The estimated incremental healthcare cost of CRS per year is £16.8 billion or £2.8 billion per million inhabitants. Factors predictive of a higher OOPE include higher household occupancy and income and these accounted for only 9.7% of the total variance in total OOPEs. Other socioeconomic, demographic and HRQoL variables were not found to be predictive factors of OOPE. This study showed that CRS has a significant wider economic burden beyond the immediate direct healthcare costs. CRS participants had a high level of healthcare service use, OOPE and productivity loss. Results from this study will add to the existing limited data both for the UK and abroad and emphasises the need for effective treatments for these patients to reduce the disease impact.

Estimation of the Incremental Cumulative Cost of HIV Compared with a Non-HIV Population

ObjectiveThere are limited real-world data comparing cumulative incremental healthcare costs in people living with HIV (PLWH) and those without HIV. This study evaluated all-cause cumulative and incremental costs in PLWH in the US using a matched-cohort design.Materials and MethodsThis retrospective, multi-year, cross-sectional analysis evaluated annual costs from 2013 to 2017, and projected cumulative costs of HIV from age 25 to 69 years. IQVIA’s commercial adjudicated claims database was used to identify patients with HIV and match them with patients without HIV (controls). Cumulative all-cause costs were derived from the health plan-allowed costs incurred from ages 25–69 years. Undiscounted, discounted, and incremental costs between PLWH and non-HIV populations were reported in 2017 US dollars (US$), and annual all-cause costs were estimated for each year by 10-year age bands.ResultsA total of 25,261, 24,134, 31,654, 35,374, and 29,039 PLWH and 75,783, 72,402, 94,962, 106,122, and 87,117 matched controls were identified in the years 2013 through 2017, respectively. The mean undiscounted cumulative costs were $1,840,554 for PLWH and $285,065 for controls, an incremental cost difference of $1,555,489, while the mean discounted cumulative cost for PLWH was $983,897 compared with $133,340 for controls, an incremental cost difference of $850,557. Mean all-cause annual and cumulative costs were up to seven times higher for PLWH compared with controls. There was a trend for costs to increase each year with increasing age.Limitations and ConclusionsWhile cumulative all-cause cost estimates only approximate total cost burden for any given patient, and the results of this study may not be generalizable to all population subgroups, this is one of the first US studies to examine annual and cumulative costs in a real-world cohort of commercially insured PLWH compared with a population without HIV. In this large, representative sample of commercially insured US adults with HIV, PLWH had substantially higher all-cause cumulative costs than individuals without HIV.Electronic supplementary materialThe online version of this article (10.1007/s41669-020-00209-8) contains supplementary material, which is available to authorized users.

Cost-effectiveness of total knee replacement in addition to non-surgical treatment: a 2-year outcome from a randomised trial in secondary care in Denmark

ObjectiveTo assess the 24-month cost-effectiveness of total knee replacement (TKR) plus non-surgical treatment compared with non-surgical treatment with the option of later TKR if needed.Methods100 adults with moderate-to-severe knee osteoarthritis...

Economic burden of multimorbidity in patients with severe asthma: a 20-year population-based study

BackgroundThe economic impact of multimorbidity in severe or difficult-to-treat asthma has not been comprehensively investigated.AimsTo estimate the incremental healthcare costs of coexisting chronic conditions (comorbidities) in patients with severe asthma,...

Quantifying the Economic Burden of Myelodysplastic Syndromes Among Elderly US Patients

Introduction: Myelodysplastic syndromes (MDS) include a diverse group of bone marrow disorders associated with high mortality and morbidity. In individuals with MDS, the bone marrow produces dysfunctional blood cells with about one-third of patients progressing to acute myeloid leukemia (AML). Previous estimates of the economic burden of MDS are highly variable, with the existing clinical literature deficient of detailed economic data and existing economic studies lacking accurate information on MDS diagnostics. To address the issue, this study uses registry-linked claims data from SEER-Medicare to estimate the economic burden of MDS among elderly individuals in the US. Methods: We conducted a retrospective case-control study using SEER-Medicare data from January 1, 2010 to December 31, 2016. The study included two cohorts, both aged ≥66 years: (i) patients diagnosed with MDS between January 1, 2011 and December 31, 2015, and (ii) cancer-free controls from a 5% random sample of Medicare beneficiaries. Patients with MDS were followed from index date, defined as the date of initial MDS diagnosis, to death, study end date, or 24 months post-index, whichever occurred first. A 1-year pre-index lookback period was used to identify comorbidities. Except in the instance of death, all individuals had a minimum of 1-year post-index follow-up. We propensity score-matched MDS cases and controls using demographic factors and comorbidities. After examining standardized differences between the MDS and control groups under various caliper widths and allowed numbers of matches, a caliper width of 0.05 of the standard deviation of the propensity score with 25 matched neighbors with replacement was chosen, as this minimized standardized differences across covariates. We calculated average 30-day cost burden for each matched patient based on costs incurred over the number of days in their individual follow-up period. We then estimated incremental healthcare cost burden for patients with MDS relative to the matched controls, including inpatient, outpatient, and pharmaceutical drug costs. We used a generalized linear model (GLM) with a log link and adjusted for demographics and comorbidities. Results: Of the 18,780 patients diagnosed with MDS during the study period, 9,524 met the inclusion criteria. Prior to matching, the control group of 288,877 cancer-free patients was 40% male with a mean age of 75.8 years (SD=8.3), while the MDS group was 57% male with a mean age of 80.1 years (SD=7.4). In addition, standardized differences between the groups were &gt;0.2 for 50% (8/16) of comorbidities considered. After matching, the number of matched controls fell to 109,075 individuals that were 57% male with a mean age of 80.6 (SD=8.4), and standardized differences were &lt;0.04 for all 16 comorbidities. Unadjusted analyses revealed that, in the first two years following diagnosis, patients with MDS had a $6,599/month total cost, $4,005 of which was MDS-related, compared with $2,122/month for matched controls, a difference of $4,478 in total monthly cost (nominal P&lt;.001). After adjusting for patient characteristics using GLM, estimated monthly cost was $7,400/month for patients with MDS and $2,005/month for controls, a difference of $5,395/month (nominal P&lt;.001). This translates to an estimated two-year cost of $177,601 for patients with MDS compared to $48,125 for cancer-free controls, a difference of $129,476. Approximately 58% of this difference was due to higher medical costs, with the remaining 42% due to higher pharmaceutical costs. Higher inpatient hospitalization costs ($2,319/month for patients with MDS; $851/month for controls; $1,468 cost difference, nominal P&lt;.001) and Part B drug costs ($1,434/month for patients with MDS; $71/month for controls; $1,363 cost difference, nominal P&lt;.001) were key drivers of the incremental cost burden. Conclusion: The economic burden of MDS is higher than that of the cancer-free Medicare population, with an estimated incremental adjusted cost burden of nearly $130,000 in the two years following MDS diagnosis. Medical costs make up the majority of this cost difference. Our results provide an updated estimate of the economic burden of MDS using the most recent data and MDS coding methodology, with detailed estimates of cost by component. Our results fall within the range of estimates of previous studies using SEER-Medicare data. Figure Disclosures Shafrin: Precision Medicine Group: Employment, Equity Ownership. Green:Precision Health Economics: Employment, Other: Employee of Precision Health Economics (PHE). PHE received funding from Breath Therapeutics for this research. . Murphy:Precision Medicine Group: Employment. Everson:Precision Medicine Group: Employment. Dennen:Precision Medicine Group: Employment. Price:Jazz Pharmaceuticals: Employment, Equity Ownership. Batt:Precision Medicine Group: Consultancy.

Incremental economic burden associated with exudative age-related macular degeneration: a population-based study

BackgroundThe exudative age-related macular degeneration (AMD) causes considerable healthcare costs for patients and healthcare system, which are expected to grow as the population ages. The objective of this study was to assess the incremental economic burden of exudative AMD by comparing total healthcare costs between the exudative AMD group and non-AMD group to understand economic burden related to exudative AMD.MethodsThis retrospective cohort study used the National Health Insurance Service database including the entire Korean population. Exudative AMD group included individuals with at least one claim for ranibizumab and one claim using the registration code for exudative AMD (V201). Non-AMD group was defined as individuals without any claims regarding the diagnostic code of H35.3 or ranibizumab. The exudative AMD group and non-AMD group were matched using a propensity-score model. Incremental healthcare resource utilization and healthcare costs were measured during a one-year follow-up by employing econometric models: ordinary least squares (OLS) with log transformation and heteroscedastic retransformation; and generalized linear model (GLM) with a log link function and gamma distribution.ResultsA total of 7119 exudative AMD patients were matched to 7119 non-AMD patients. The number of outpatient visits was higher in the exudative AMD group (P-value < 0.0001), while the length of hospitalization was shorter in exudative AMD group (P-value < 0.0001). Exudative AMD patients had total costs 2.13 times (95%CI, 2.08–2.17) greater than non-AMD group using OLS, and total costs 4.06 times (95%CI, 3.82–4.31) greater than non-AMD group using GLM. Annual incremental total costs were estimated as $5519 (OLS) and $3699 (GLM).ConclusionsExudative AMD was associated with significantly increased healthcare costs compared to the non-AMD group. Attention is needed to manage the socioeconomic burden of exudative AMD.

Treatment Patterns and Medication Use in Patients with Postherpetic Neuralgia.

Postherpetic neuralgia (PHN) is a chronic, painful condition characterized by persistent pain following resolution of a herpes zoster (HZ) infection. Epidemiologic data demonstrate that the risks for HZ infections and the development of PHN increase with age. To characterize prescribing patterns, health care utilization, and treatment costs for adults with PHN based on real-world data. This study analyzed medical and pharmacy claims from 2010 to 2014 in the MarketScan Commercial and Medicare Supplemental databases. PHN patients were identified based on criteria from a published algorithm. PHN treatment patterns were analyzed by age and reported descriptively for patients aged < 65 or ≥ 65 years. Excess incremental health care costs were calculated for PHN patients by comparing expenditures for a cohort of PHN patients to expenditures of a propensity score-matched control group of patients with HZ alone. Approximately 0.4% of patients aged < 65 years were diagnosed with HZ versus 1.3% of patients aged ≥ 65 years; approximately 15.3% of HZ patients aged < 65 years and 26.4% of patients aged ≥ 65 years were diagnosed with PHN. Overall, opioids remained the most frequently prescribed initial treatment. Approximately 21.6% of PHN patients received an opioid as an initial treatment for PHN, 15.1% received gabapentin; 8.9% received a prescription nonsteroidal anti-inflammatory drug (NSAID); 8.3% received a lidocaine patch; 3.3% received pregabalin; 2.5% received a tricyclic antidepressants (TCAs); 0.8% received other topical lidocaine; and < 1% received capsaicin. Observed first-line use of the lidocaine patch and gabapentin was higher in patients aged ≥ 65 years relative to patients aged < 65 years. When separated by age group, only 24.6% of patients aged < 65 years and 38.5% of patients aged ≥ 65 years were prescribed a recommended first-line treatment for initial PHN therapy (gabapentin, lidocaine patch, pregabalin, and TCAs). Comparisons of treatment costs of PHN patients to matched HZ patients without PHN indicated that PHN patients initiated on opioids had the highest mean additional health care expenditure compared with PHN patients initiated on other medications. On average, PHN patients initiated on opioids had $7,601 additional health care expenditure compared with HZ patients with no PHN; additional expenditures were $6,428 for pregabalin, $4,213 for lidocaine patches, $3,478 for gabapentin, $3,304 for NSAIDs, and $2,797 for TCAs, respectively. Management of PHN is associated with substantial utilization of opioid-based therapies across all ages. Medications supported by evidence either as first-line therapies or as part of a multimodal regimen for the management of PHN are underused relative to opioid-based PHN therapies. Improving adherence to evidence-based PHN treatment regimens offers the potential to reduce opioid prescribing first line and reduce overall treatment costs. Given the emphasis to reduce opioid prescribing to minimize the risk of dependence, abuse, and diversion, multimodal analgesic treatments that can avoid or reduce opioid use should be considered. Research funding was provided by SCILEX Pharmaceuticals. The sponsor reviewed and approved the research plan and provided support for manuscript preparation through Patel's role as a coauthor of this manuscript. The sponsor's product (lidocaine patch) was not used in this study. Patel is a paid employee of SCILEX Pharmaceuticals. Goss is an employee and minority owner of Boston Healthcare Associates, which received a research grant from SCILEX Pharmaceuticals to conduct this study. Gudin reports advisory board fees from AcelRx Pharmaceuticals and BioDelivery Sciences International and consulting fees from Averitas, Daiichi, Hisumitsu, Nektar, Purdue, Quest Diagnostics, SCILEX Pharmaceuticals, and US WorldMeds, unrelated to this study. Fudin reports advisory board fees from AcelRx Pharmaceuticals, Human Half-Cell, Quest Diagnostics, GlaxoSmithKline, SCILEX Pharmaceuticals, BioDelivery Sciences, Daiichi Sankyo, and Salix Pharmaceuticals; speaker fees from Daiichi Sankyo, Salix Pharmaceuticals, Abbott Laboratories, Acutis Diagnostics, and AstraZeneca; and consulting fees from Firstox Laboratories, unrelated to this study. The other authors have nothing to disclose. Parts of this research were presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting; April 22, 2016; San Francisco, CA, and at the 35th Annual Scientific Meeting of the American Pain Society; May 11-14, 2016; Austin, TX.

Incremental healthcare utilisation and costs among new senior high-cost users in Ontario, Canada: a retrospective matched cohort study

ObjectivesTo describe healthcare use and spending before and on becoming a new (incident) senior high-cost user (HCU) compared with senior non-HCUs; to estimate the incremental costs, overall and by service...

Epidemiology and disease burden of pertussis in the United States among individuals aged 0–64 over a 10-year period (2006–2015)

Background: Pertussis incidence has increased in recent decades despite childhood vaccination programs and high vaccination rates. To quantify the burden of pertussis, incidence, healthcare resource utilization, and costs among pertussis patients were estimated in a US managed care setting.Methods: Patients aged 0–64 years with evidence of pertussis (ICD-9-CM codes 033.0, 033.9, 484.3, ICD-10-CM codes A37.0, A37.9) and commercial insurance from 1 January 2006–12 December 2015 were identified. Incidence rates were calculated and standardized to the 2010 US Census on age, sex, and geographic region. Healthcare costs and resource utilization were compared between patients and matched comparators (health plan members without pertussis).Results: From 2006 to 2015, 11,378 pertussis cases were identified. Adjusted pertussis incidence was 15.55 cases per 100,000 person-years. Incidence was highest among infants and children; however, 59.0% of total cases were among adolescents or adults. Average adjusted healthcare costs per episode were 3.17 times higher among pertussis patients versus comparators ($5195 versus $1637, p < .001). Stratifying by age group, adjusted incremental healthcare costs per episode were $5581, $827, $700, $1429, $2530, and $4849 for patients aged <1 year, 1–6 years, 7–10 years, 11–19 years, 20–49 years, and 50–64 years, respectively.Conclusions: Managing pertussis is associated with substantial economic burden. Incidence rate estimates from this study were higher than CDC-reported rates; however, similar overall trends were observed. Although pertussis incidence has been declining since CDC-recommended vaccination for all adults in 2012, this study highlights the importance of continued management and prevention strategies, especially among adolescents and adults as they represent an important source of transmission to infants.

The association of pain interference and opioid use with healthcare utilization and costs, and wage loss among adults with osteoarthritis in the United States

Aim: To examine associations of opioid use and pain interference with activities (PIA), healthcare resource utilization (HRU) and costs, and wage loss in noninstitutionalized adults with osteoarthritis in the United States (US).Methods: Adults with osteoarthritis identified from the Medical Expenditure Panel Survey for 2011/2013/2015 were stratified by no-opioid use with no/mild PIA, no-opioid use with moderate/severe PIA, opioid use with no/mild PIA, and opioid use with moderate/severe PIA. Outcomes included annualized total HRU, direct healthcare costs, and wage loss. Multivariable regression analyses were used for comparisons versus no-opioid use with no/mild PIA (referent). The counterfactual recycled prediction method estimated incremental costs. Results reflect weighted nationally representative data.Results: Of 4,921 participants (weighted n = 20,785,007), 46.5% had no-opioid use with no/mild PIA; 23.2% had no-opioid use with moderate/severe PIA; 9.6% had opioid use with no/mild PIA; and 20.7% had opioid use with moderate/severe PIA. Moderate/severe PIA and/or opioid use were associated with significantly higher HRU and associated costs, and wage loss. Relative to adults with no/mild PIA, opioid users with moderate/severe PIA were more likely to have hospitalizations, specialist visits, and emergency room visits (all p < .001). Relative to the referent, opioid use with no/mild PIA had higher per-patient incremental annual total healthcare costs ($11,672, 95% confidence interval [CI] = $11,435–$11,909) and wage loss ($1,395, 95% CI = $1,376–$1,414) as did opioid use with moderate/severe PIA ($13,595, 95% CI = $13,319–$13,871; and $2,331, 95% CI = $2,298–$2,363) (all p < .001). Compared with the referent, estimated excess national total healthcare costs/lost wages were $23.3 billion/$1.3 billion for opioid use with no/mild PIA, and $58.5 billion/$2.2 billion for opioid use with moderate/severe PIA.Limitations: Unobservable/unmeasured factors that could not be accounted for.Conclusions: Opioid use with moderate/severe PIA had significantly higher HRU, costs, and wage loss; opioid use was more relevant than PIA to the economic burden. These results suggest unmet needs for alternative pain management strategies.

The rate of occurrence, healthcare resource use and costs of adverse events among metastatic non-small cell lung cancer patients treated with first- and second-generation epidermal growth factor receptor tyrosine kinase inhibitors

ObjectivesClinical trials with first- and second-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) reported severe adverse events (SAEs) in 6%–49% of patients with EGFR-mutated non-small cell lung cancer. This study describes incremental healthcare resource utilization (HRU) and costs associated with real-world management of AEs in this population, with a focus on SAEs. Materials and methodsPatients receiving erlotinib, gefitinib, or afatinib as first-line (1L) monotherapy were identified from IQVIA™ Real-World Data Adjudicated Claims–US database (04/01/2012–03/31/2017). Relevant AEs were selected from corresponding prescribing information; SAEs were identified from hospitalization claims. HRU and cost per-patient-per-month (PPPM) were assessed during 1L treatment and compared for patients with and without each AE using multivariate Poisson and linear regression, respectively, adjusting for baseline characteristics. ResultsOf 1646 patients, 86.9% were treated with erlotinib, 12.1% with afatinib, and 1.0% with gefitinib. In 1L, 12.2% of patients had ≥1 acute SAE (220.1/1000 patient-years). Patients with any SAE had higher PPPM costs than patients without SAEs (cost difference = $4700, p < 0.001). Incremental costs ranged from $2604 PPPM for diarrhea to $10,143 PPPM for microangiopathic hemolytic anemia (MAHA), and were statistically significant for all SAEs (all p < 0.001) except MAHA (p < 0.0528). Patients with any SAEs had higher rates of HRU relative to patients without SAEs (hospitalization rate ratio = 6.15; outpatient visits rate ratio = 1.21; all p < 0.001). ConclusionMore than one-tenth of patients experienced SAEs, resulting in sizeable economic burden with respect to HRU and costs. EGFR-TKIs with more favorable safety profiles may reduce the burden of managing this population.

The economic burden of hypertriglyceridemia among US adults with diabetes or atherosclerotic cardiovascular disease on statin therapy

Hypertriglyceridemia (HTG) is associated with increased cardiovascular disease (CVD) risk. However, the cost burden of HTG-related CVD in high-risk US adults on statins has not been well characterized. We estimated the HTG-related health care cost burden among US adults with CVD or diabetes taking statin therapy. We estimated population sizes and annual health care costs among US adults aged ≥45years with diabetes or CVD taking statin therapy with normal triglycerides (TGs) defined as TG<150mg/dL compared with those with HTG defined as TG ≥ 150mg/dL. Population sizes were estimated from the 2007-2014 National Health and Nutrition Examination Surveys. Adjusted mean total annual health care costs in 2015 US dollars were estimated using the Optum Research Database. The annual total health care cost burden was estimated by multiplying the population size by the mean annual total incremental health care costs overall and within subgroups. There were 6.2 (95% confidence interval [CI], 5.4 - 7.1) million and 12.0 (95% CI, 11.1- 12.9) million US adults aged ≥45years with diabetes and/or CVD on statin therapy with TG≥150mg/dL and TG<150mg/dL, respectively. The mean adjusted incremental total one-year health care costs in adults with TG≥150mg/dL compared with those with TG<150mg/dL was $1730 (95% CI, $1160 - $2320). This leads to a projected annual incremental cost burden associated with HTG in patients with diabetes or CVD on statins of $10.7 billion (95% CI, $6.8B - $14.6B). In US adults on statins and at high risk for CVD, the health care costs associated with HTG are substantial.