Medical Costs For Patients Research Articles

Cost-effectiveness of routine screening for critical congenital heart disease in US newborns.

Clinical evidence indicates newborn critical congenital heart disease (CCHD) screening through pulse oximetry is lifesaving. In 2011, CCHD was added to the US Recommended Uniform Screening Panel for newborns. Several states have implemented or are considering screening mandates. This study aimed to estimate the cost-effectiveness of routine screening among US newborns unsuspected of having CCHD. We developed a cohort model with a time horizon of infancy to estimate the inpatient medical costs and health benefits of CCHD screening. Model inputs were derived from new estimates of hospital screening costs and inpatient care for infants with late-detected CCHD, defined as no diagnosis at the birth hospital. We estimated the number of newborns with CCHD detected at birth hospitals and life-years saved with routine screening compared with no screening. Screening was estimated to incur an additional cost of $6.28 per newborn, with incremental costs of $20 862 per newborn with CCHD detected at birth hospitals and $40 385 per life-year gained (2011 US dollars). We estimated 1189 more newborns with CCHD would be identified at birth hospitals and 20 infant deaths averted annually with screening. Another 1975 false-positive results not associated with CCHD were estimated to occur, although these results had a minimal impact on total estimated costs. This study provides the first US cost-effectiveness analysis of CCHD screening in the United States could be reasonably cost-effective. We anticipate data from states that have recently approved or initiated CCHD screening will become available over the next few years to refine these projections.

Effect of the self-management intervention on the medical costs of patients with chronic obstructive pulmonary disease

Objective To explore the effect of self-management intervention on chronic obstructive pulmonary disease (COPD) patients' medical costs.Methods Convenience sampling of 84 COPD patients at stable stage or discharged from hospital after treatment in Beijing Hospital and PUMC Hospital were recruited from April 2011 to January 2012.The samples were divided into two subgroups.Intervention group (n =42)performed self-management intervention,patients in control group (n =42) only received usual care.All patients were followed up and collected regarding times of exacerbations or emergency,times or length of hospitalization at 3 months and 6 months respectively.Results There was significant difference between group at both 3 and 6 months,but no difference in times of emergency,times or length of hospitalization were found between groups.And at the 3th months in intervention group,times of emergency and hospitalization times respectively were (4 cases 5times)and (3cases 5times) and that in control group respectively were (5cases11times),(5cases 8times),no significant difference was found between them (P ＞ 0.05),while significant difference was found in exacerbations times (12cases 17times vs 27cases 54times ;Z =-3.361,P ＜ 0.01).No significant difference was found at the 6th months between intervention group and control group in times of emergency (6cases 8times vs 5cases18times) and hospitalization times (4cases 6times vs 6cases 9times),while significant difference was found in exacerbations times (18cases 23times vs 27cases 65times;Z =-3.018,P ＜0.01).Conclusions Self-management intervention can decrease COPD patients' times of exacerbations,and whether can decrease times of emergency,times or length of hospitalization should be study in further. Key words: Lung disease; Chronic obstructive; Acute times; Medical costs

Prevalence and out-patient medical costs of comorbid conditions in patients with rheumatoid arthritis

ObjectivesTo evaluate the prevalence, types, and out-patient direct medical costs of comorbid conditions in patients with RA in Thailand. MethodsInformation of the patients with RA treated by rheumatologists with at least one disease modifying antirheumatic drugs (DMARDs), including demographic data, RA-related medication types and treatment costs, comorbidity-related medication types and treatment costs, and total direct medical costs, was captured from King Chulalongkorn Memorial Hospital databases. ResultsThe data from 684 patients with RA were included for analysis. The majority of the patients were prescribed combined DMARDs, while only 2.5% received biologics. Comorbid conditions were reported in 434 patients (63.5%). The most common comorbid condition was hypertension (51.2%). Advanced age and presence of healthcare coverage was associated with comorbid conditions. The average annual cost of non-RA-related treatments in patients with comorbid diseases was 15 times the cost in those without comorbidities (1546 vs. 104USD; P<0.001) while the total direct medical cost in patients with comorbid conditions was twice that in patients without comorbid diseases (4118 vs. 2045USD; P<0.001). Parameters that influenced total direct medical costs were RA medications costs, comorbidity, healthcare coverage, patient's age, and types of DMARDs. ConclusionsComorbid conditions were common in this study. However, the major cost component incurred in RA patients was the costs of RA medications and services, while the out-patient costs of comorbid conditions accounted for approximately 38% of the total costs.

Time trend of medical economic outcomes of endoscopic submucosal dissection for gastric cancer in Japan: a national database analysis

Little information is available on the analysis of chronological changes in medical economic outcomes of endoscopic submucosal dissection (ESD) for gastric cancer. This study aimed to investigate the recent time trend of medical economic outcomes of ESD for gastric cancer based on the Japanese administrative database. A total of 32,943 patients treated with ESD for gastric cancer were referred to 907 hospitals from 2009 to 2011 in Japan. We collected patients' data from the administrative database to compare ESD-related complications, risk-adjusted length of stay (LOS), and medical costs during hospitalization. The study periods were categorized into three groups: 2009 (n = 9,727), 2010 (n = 11,052), and 2011 (n = 12,164). No significant difference was observed in ESD-related complications between three study periods (p = 0.496). However, mean LOS and medical costs during hospitalization of patients with ESD were significantly lower in 2011 than in 2009 and 2010 (p < 0.001). Multiple linear regression analysis showed that patients who received ESD in 2011 had a significantly shorter LOS and lower medical costs during hospitalization compared with those in 2009. The unstandardized coefficient of patients with ESD in 2011 for LOS was -0.78 days [95 % confidence interval (CI), -0.89 to -0.65; p ≤ 0.001], while that of those for medical costs during hospitalization was -290.5 US dollars (95 % CI, -392.3 to -188.8; p ≤ 0.001). This study showed that the complication rate of ESD was stable, whereas the LOS and medical costs of patients were significantly reduced from 2009 to 2011.

Assessment of viral genotype impact to the cost-effectiveness and overall costs of care for PEG-interferon-2α + ribavirine treated chronic hepatitis C patients.

BackgroundPegylated interferon alfa plus ribavirin protocol is currently considered the most efficient hepatitis C treatment. However, no evidence of costs comparison among common viral genotypes has been published.ObjectivesWe aimed to assess core drivers of hepatitis C medical care costs and compare cost effectiveness of this treatment among patients infected by hepatitis C virus with genotypes 1 or 4 (group I), and 2 or 3 (group II).Patients and MaterialsProspective bottom-up cost-effectiveness analysis from societal perspective was conducted at Infectious Diseases Clinic, University Clinic Kragujevac, Serbia, from 2007 to 2010. There were 81 participants with hepatitis C infection, treated with peg alpha-2a interferon plus ribavirin for 48 or 24 weeks. Economic data acquired were direct inpatient medical costs, outpatient drug acquisition costs, and indirect costs calculated through human capital approach.ResultsTotal costs were significantly higher (P = 0.035) in group I (mean ± SD: 12,751.54 ± 5,588.06) compared to group II (mean ± SD: 10,580.57 ± 3,973.02). In addition, both direct (P = 0.039) and indirect (P < 0.001) costs separately were significantly higher in group I compared to group II. Separate comparison within direct costs revealed higher total cost of medical care (P = 0.024) in first compared to second genotype group, while the similar tendency was observed for total drug acquisition (P = 0.072).ConclusionHCV genotypes 1 and 4 cause more severe clinical course require more care and thus incur higher expenses compared to HCV 2 and 3 genotypes. Policy makers should consider willingness to pay threshold differentially depending upon HCV viral genotype detected.

Economic benefits of adequate molecular monitoring in patients with chronic myelogenous leukemia (CML).

7093 Background: Molecular monitoring every 3 months using quantitative polymerase chain reaction (qPCR) of BCR-ABL mRNA transcripts on International Scale is recommended by the National Comprehensive Cancer Network and the European LeukemiaNet for patients (pts) in chronic phase of CML. A previous study has shown an underutilization of qPCR in the community setting. This study assessed the impact of the frequency of molecular monitoring on hospitalization and medical costs among CML pts receiving 1st-line tyrosine kinase inhibitor (TKI) therapies. Methods: Two U.S. administrative claims databases were combined (01/2000-06/2012) to identify adult CML pts initiated on TKIs (imatinib, dasatinib, nilotinib). Pts were followed for 12 months from their first TKI prescription and categorized into 3 cohorts based on frequency of qPCR tests (i.e., 0, 1-2, and 3-4). Number of inpatient admissions and medical service costs (measured from a US payer perspective; adjusted to 2012 U.S. dollars) were compared between cohorts. Multivariate regression models adjusted for confounding factors (e.g., age, gender, CML complexity, TKI). Results: The study included 1,205 CML pts. Over the 12-month study period, 41.0% of the pts had no qPCR test, 31.9% had 1-2 tests, and 27.1 % had 3-4 tests. Compared to pts with no qPCR monitoring, those with 3-4 tests incurred 37% fewer CML-related (i.e., a primary CML diagnosis) inpatient admissions (p=.017) during the study period, leading to a $4,000 (p=.009) reduction in CML-related inpatient costs and $5,663 (p=.005) reduction in all-cause inpatient costs, accounting for the majority of the $5,997 reduction in total medical service costs (p=.049). Pts with 1-2 tests a year showed smaller and statistically insignificant reductions from those with no test in the frequency of hospitalization and medical costs. Conclusions: Among CML pts who initiated 1st-line TKIs, pts with 3-4 qPCR tests a year incurred fewer inpatient admissions and lower medical service costs compared to pts with no test. These findings suggest that pts would benefit from regular qPCR testing and underscore the value of molecular monitoring in the delivery of quality care for Ph+ CML-CP pts on TKI therapies.

PMS24 - Medical Costs Of Patients With Rheumatoid Arthritis And Its Association With Global Disease Activity In Turkey

PMS24 - Medical Costs Of Patients With Rheumatoid Arthritis And Its Association With Global Disease Activity In Turkey

Association between teriparatide adherence and healthcare utilization and costs in real-world US kyphoplasty/vertebroplasty patients

The objective of this study was to examine the association between teriparatide adherence and healthcare utilization and costs in real-world US kyphoplasty/vertebroplasty (KV) patients. Among KV patients newly initiating teriparatide, significantly increased pharmacy costs associated with high teriparatide adherence were offset by significantly lower inpatient utilization and medical costs. This study seeks to examine the association between teriparatide adherence and healthcare utilization/costs in real-world US KV patients. Identified patients from a large US administrative claims database were aged 50+ with KV from 1/1/2002-12/31/2010 (first observed KV = index). Included individuals had 6+ months of pre-index continuous enrollment and no pre-index teriparatide, cancer, or Paget's disease. Follow-up period for patients initiating teriparatide was ≤36 months post-index. Three teriparatide adherence cohorts were constructed using the proportion of days covered (PDC) during the follow-up period: low (PDC ≤ 0.5), medium (PDC >0.5-≤ 0.8), and high (PDC >0.8). Repeated KV admissions, any inpatient admission, number of inpatient admissions, and per-patient-per-month (PPPM) inpatient, outpatient, pharmacy, and total costs were compared between cohorts. The associations between teriparatide adherence and healthcare utilization/costs were examined using multivariable regression models, adjusting for patient demographics and clinical characteristics. Included were 1,568 patients (mean age, 75 years; 82% female): 403 (26%) had low adherence, 382 (24%) medium, and 783 (50%) high. After multivariable adjustment, high adherence was significantly associated with the lowest PPPM inpatient (low = $1,287; medium = $1,005; high = $678) and outpatient (low = $1,464; medium = $1,244; high = $1,077) medical costs, but with increased pharmacy costs (low = $752; medium = $1,159; high = $1,616; all P < 0.05), leading to similar total costs (low = $3,344; medium = $3,376; high = $3,351) between cohorts; high adherence was also significantly associated with the lowest odds of repeated KV admission, any inpatient admission, and number of inpatient admissions (all P < 0.05). Among KV patients initiating teriparatide, significantly increased pharmacy costs associated with high teriparatide adherence were offset by significantly lower inpatient utilization and medical costs.

Direct Medical Costs and Medication Compliance among Fibromyalgia Patients: Duloxetine Initiators vs. Pregabalin Initiators

To assess and compare direct medical costs and medication compliance between patients with fibromyalgia who initiated duloxetine and patients with fibromyalgia who initiated pregabalin in 2008. A retrospective cohort study design was used based on a large US national commercial claims database (2006 to 2009). Patients with fibromyalgia aged 18 to 64 who initiated duloxetine or pregabalin in 2008 and who had continuous health insurance 1year preceding and 1year following the initiation were selected into duloxetine cohort or pregabalin cohort based on their initiated agent. Medication compliance was measured by total supply days, medication possession ratio (MPR), and proportion of patients with MPR≥0.8. Direct medical costs were measured by annual costs per patient and compared between the cohorts in the year following the initiation. Propensity score stratification and bootstrapping methods were used to adjust for distribution bias, as well as cross-cohort differences in demographic, clinical and economic characteristics, and medication history prior to the initiation. Both the duloxetine (n=3,033) and pregabalin (n=4,838) cohorts had a mean initiation age around 49years, 89% were women. During the postindex year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, P<0.05), higher MPR (0.7 vs. 0.5, P<0.05), and more patients with MPR≥0.8 (45.1% vs. 29.4%, P<0.05). Further, relative to pregabalin cohort, duloxetine cohort had lower inpatient costs ($2,994.9 vs. $4,949.6, P<0.05), lower outpatient costs ($8,259.6 vs. $10,312.2, P<0.05), similar medication costs ($5,214.6 vs. $5,290.8, P>0.05), and lower total medical costs ($16,469.1 vs. $20,552.6, P<0.05) in the postinitiation year. In a real-world setting, patients with fibromyalgia who initiated duloxetine in 2008 had better medication compliance and consumed less inpatient, outpatient, and total medical costs than those who initiated pregabalin.

P157 Reasons for a delayed diagnosis in inflammatory bowel disease

to follow-up, ADA-treated patients had significant reductions whereas IMS-treated patients had increases in UC-related hospitalizations and LOS (table). UC-related outpatient service utilization and costs, as well as total inpatient and outpatient service costs, decreased significantly for ADA-treated patients vs. a small increase for IMS-treated patients. ADA-treated patients also had a significantly greater reduction in hospital LOS for colectomy. Conclusions: In this retrospective claims database analysis, ADA therapy was associated with greater reductions in UCrelated hospitalization rates, length of hospitalization for colectomy, and total inpatient and outpatient medical service costs compared with IMS therapy.

Impact of acute kidney injury on mortality and medical costs in patients with meticillin-resistant Staphylococcus aureus bacteraemia: a retrospective, multicentre observational study

Despite the frequent occurrence of acute kidney injury (AKI) associated with meticillin-resistant Staphylococcus aureus (MRSA) infection during treatment, the adverse impact of renal injury on clinical and economic outcomes has not been evaluated. To study the clinical and economic burdens of MRSA bacteraemia and the impact of AKI occurring during treatment on outcomes. Medical records of patients hospitalized for MRSA bacteraemia between March 2010 and February 2011 in eight hospitals in Korea were reviewed retrospectively to evaluate the risk factors for AKI and mortality. Direct medical costs per patient of MRSA bacteraemia during treatment were estimated from the medical resources consumed. In all, 335 patients were identified to have MRSA bacteraemia. AKI occurred in 135 patients (40.3%) during first-line antibiotic therapy. Independent risk factors for AKI were male sex, underlying renal disease, intra-abdominal and central venous catheter infection, and increase in Pitt bacteraemia score. Seventy-seven (23.0%) patients died during the study period. Underlying solid tumour, high Pitt bacteraemia score, and occurrence of AKI were independent risk factors for mortality. The mean total medical cost per MRSA patient was estimated as South Korean Won 5,435,361 (US$4,906), and occurrence of AKI and ICU admission were identified as independent predictors of increased direct medical costs. Compared with patients who retained their baseline renal function, patients with AKI had a 45% increase in medical costs. Patients who developed AKI showed significantly higher mortality rate andgreater direct medical costs compared with patients who retained baseline renal function.

Multivariate Analysis of Factors Influencing Length of Hospitalization and Medical Costs of Cholecystectomy for Acute Cholecystitis in Japan: A National Database Analysis

Little information is available on the factors influencing length of stay (LOS) in hospital and medical costs during hospitalization associated with cholecystectomy for acute cholecystitis. We determined the independent factors affecting LOS and medical costs of patients who underwent cholecystectomy for acute cholecystitis based on data from the Diagnosis Procedure Combination (DPC) database. In 2008, a total of 2176 patients with acute cholecystitis were referred for cholecystectomy to 624 hospitals in Japan. We collected patient characteristics and data on treatments for acute cholecystitis using the DPC database and identified independent factors affecting LOS and medical costs during hospitalization using multiple linear regression models. Analysis revealed that early cholecystectomy was significantly associated with a decrease in LOS, whereas longer preoperative antimicrobial therapy was significantly associated with an increase of LOS: the standardized coefficient for early cholecystectomy was -0.372 and that for preoperative antimicrobial therapy was 0.353 (P < 0.001). These procedures were also significant independent factors with regard to medical costs during hospitalization: the standardized coefficient for early cholecystectomy was -0.391 and that for preoperative antimicrobial therapy was 0.335 (P < 0.001). Early cholecystectomy significantly reduces the LOS and medical costs of cholecystectomy for acute cholecystitis, while preoperative antimicrobial therapy increases LOS and medical costs during hospitalization. These results highlight the need for health care implementations such as promotion of early cholecystectomy, appropriate use of antimicrobial drugs, and centralization of patients with cholecystectomy for acute cholecystitis in Japan.

Abstract P5-18-12: Comparison of treatment patterns and outcomes in metastatic breast cancer patients initiated on trastuzumab vs. lapatinib; a retrospective analysis

Abstract Background: Trastuzumab-or lapatinib-based therapies are recommended by the National Comprehensive Cancer Network (NCCN) guidelines as preferred agents for metastatic HER2-positive breast cancer. Few studies have compared treatment patterns, healthcare resource utilization (HRU), and costs in metastatic breast cancer (MBC) patients receiving trastuzumab vs. lapatinib. The objective of this study was to compare discontinuation rates, HRU, and costs in MBC patients (pts) initiated on trastuzumab vs. lapatinib. Methods: MBC adult women initiated on trastuzumab or lapatinib on/after 03/13/2007 (lapatinib FDA-approval date) were selected from the US-based PharMetrics® Integrated Database (2000–2011). Selected pts were required to be continuously eligible in their healthcare plan ≥6 months prior to and ≥30 days following trastuzumab or lapatinib initiation date. Pts were observed over the period spanning from trastuzumab or lapatinib initiation date (without restriction on line of therapy) up to the end of continuous health plan enrollment or data availability, whichever occurred first. Trastuzumab or lapatinib discontinuation rates (gap ≥45 consecutive days) were compared using multivariate Cox proportional-hazards models and reported as hazard ratios (HRs). Incremental HRU was estimated using negative binomial regression models and reported as incidence rate ratios (IRRs). Monthly cost difference (2010 USD; measured from a payer perspective) were estimated using multivariate generalized linear or two-part models. Since a large proportion of lapatinib users were previously treated with trastuzumab, a sensitivity analysis was conducted to control for the impact of prior trastuzumab use. Results: Among the 643 pts selected, 381 and 262 pts were initiated on trastuzumab and lapatinib, respectively. Of the 262 pts initiated on lapatinib, 171 (65%) were previously treated with trastuzumab. After adjustment for confounders (demographics, index year, prior MBC therapies, comorbidities, baseline HRU, and MBC duration), compared to trastuzumab users, lapatinib users had a higher rate of treatment discontinuation (HR = 1.57; p &amp;lt; .001). While lapatinib users had a higher rate of outpatient visits (not treatment administration related) compared to trastuzumab users (HR = 1.19; p &amp;lt; 0.004), there were no observed significant differences of other HRU and total monthly healthcare costs between the two groups ($11,138±8,751 vs. $11,159 ±8,674, respectively; adjusted difference=$637 p = .397). Sensitivity analyses showed that pts who were initiated on lapatinib without prior trastuzumab use had a higher incidence of inpatient admissions (IRR = 1.74; p = .002) and greater overall medical service costs compared to pts who were initiated on trastuzumab (adjusted difference=$3,059; p &amp;lt; .001). Conclusion: Overall, while MBC pts initiated on trastuzumab or lapatinib had similar healthcare costs, pts initiated on lapatinib had higher rates of treatment discontinuation and outpatient visits (not treatment administration related). Medical costs were significantly higher among pts initiated on lapatinib without prior trastuzumab use. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-18-12.

Educational Intervention in CKD Retards Disease Progression and Reduces Medical Costs for Patients with Stage 5 CKD

Background: Nephrologist-based multidisciplinary care (MDC) has a positive impact on slowing chronic kidney disease (CKD) progression. However, the benefits of MDC in patients with stage 5 CKD remain unclear. Methods: Stage 5 CKD patients who visited the Chang Gung Memorial Hospital, Chiayi, Taiwan during the period of 2002–2008 were enrolled. The incident dialysis and medical cost were compared between MDC recipients and nonrecipients. The MDC recipients were divided into two groups by educational duration to observe the clinical renal outcome and medical care expenses. The effect of MDC on renal disease progression was also compared in MDC recipients with and without diabetes. Results: Out of 307 patients, 171 received MDC. For MDC recipients, the temporary usage of catheter was reduced (54.7% vs. 79.4%, p < 0.001), the hospital stay was shorter (18.64 ± 1.20 vs. 24.63 ± 1.22 months, p = 0.001), and the total medical cost was lower [New Taiwan dollars (NTD) 105,948.54 ± 9,967.22 vs. NTD 160,388.61 ± 16,373.97, p = 0.005] than for nonrecipients. Out of the 171 MDC recipients, those with MDC for more than 1 year had slower renal disease progression (0.76 ± 0.27 mL/min per 1.73 m2 per year) and had an estimated per- capita annual cost savings of about NTD 336,500.66. MDC recipients with diabetes had a higher risk of requiring dialysis than those without diabetes. Conclusions: MDC could significantly reduce temporary use of the catheter, hospital stay, and total medical costs in patients with stage 5 CKD. Furthermore, longer (>1 year) MDC could preserve renal function and deliver annual medical cost savings.

Associations Between Hemoglobin Level, Resource Use, and Medical Costs in Patients With Heart Failure: Findings From HF-ACTION

BackgroundReports that patients with heart failure and anemia incur greater costs and medical resource use have relied largely on data with limited clinical detail. MethodsHF-ACTION, a large trial of exercise training in heart failure, recorded hemoglobin at baseline. Medical resource use and hospital bills for inpatient and emergency department visits were collected throughout the study. We analyzed hemoglobin as a continuous variable to evaluate relationships with medical resource use and costs over 1 year. ResultsAmong 1,763 patients with baseline hemoglobin levels, those with lower hemoglobin levels tended to be older, African American, and women and to have more severe heart failure. Lower hemoglobin was significantly associated with more hospital admissions, inpatient days, outpatient visits, and urgent care or emergency department visits (all P < .005, unadjusted). Although cost outliers influenced estimates, these observations were distributed across hemoglobin levels. Mean 1-year costs across hemoglobin levels defined as ≤11, >11–12, >12–13, >13–14, >14–15, and >15 g/dL were $21,106, $20,189, $16,249, $17,989, $13,216, and $12,492, respectively (P < .001, unadjusted). Significant associations remained after multivariable adjustment. ConclusionsPatients with lower baseline hemoglobin levels experienced progressively greater resource use and higher costs.

Costs of autologous and allogeneic hematopoietic cell transplantation in the United States: a study using a large National Private Claims Database

There is a lack of multi-center cost-identification studies for hematopoietic cell transplantation (HCT). We used a single longitudinal administrative claims database representing a national, commercially insured population to evaluate the feasibility of identifying HCT recipients and to establish a cohort of autologous and allogeneic HCT recipients to study inpatient and outpatient direct medical costs from transplant hospitalization through first 100 days post-transplantation. Using ICD-9 procedure and diagnosis codes, we identified 3,365 patients who had received their first transplant in the United States between 2007 and 2009 (autologous-1,678, allogeneic-1,320, graft source not specified-367). The median 100-day total costs for autologous HCT were $99,899 (interquartile range [IQR], $73,914–140,555) and for allogeneic HCT were $203,026 (IQR, $141,742–316,426). The majority of costs (>75%) occurred during the initial transplant hospitalization for both autologous and allogeneic HCT recipients. Costs were greater among pediatric (≤ 20 years) compared to adult (>20 years) recipients and this difference was more pronounced with allogeneic HCT. Using a claims database representing a national HCT population, we highlight the high costs associated with autologous and allogeneic HCT. Our study lays the foundation for using claims data for future research on economic aspects of HCT.

Economic burden of osteoporotic fractures in Austria

ObjectiveOsteoporotic fractures impose a huge economic burden on society. Though several cost of illness studies from other countries exist, no equivalent study has been conducted in Austria. Our study aims at assessing costs resulting from osteoporotic fractures in Austria in the year 2008 from a societal perspective.MethodsWe took both direct and indirect costs into consideration. Direct costs encompass medical costs such as expenses for pharmaceuticals, inpatient and outpatient medical care costs, as well as other medical services (e.g., occupational therapies). Non-medical direct costs include transportation costs and medical devices (e.g., wheel chairs or crutches). Indirect costs refer to costs of productivity losses due to absence of work. Moreover, we included costs for early retirement and opportunity costs of informal care provided by family members. For our analysis, we combined data of official statistics, expert estimates as well as unique patient surveys that are currently conducted in the course of an international osteoporotic fracture study in Austria.ResultsFor the year 2008, the total annual financial burden incurred by osteoporotic fractures in Austria amounted to approx. €685.2 million, the largest fraction of which was due to the opportunity cost of family care (30.2%), followed by costs for hospitalization (26.6%).ConclusionsThe financial burden of osteoporotic fractures in Austria is substantial. Our findings may have implications for future economic analyses, and also support health care authorities in their decision making.

MA3 Comparative Outcomes of Fibromyalgia Patients Who Initiated Duloxetine or Pregabalin: Medication Adherence and Direct Medical Costs

COMPARATIVE OUTCOMES OF FIBROMYALGIA PATIENTS WHO INITIATED DULOXETINE OR PREGABALIN: MEDICATION ADHERENCE AND DIRECT MEDICAL COSTS Sun P1, Peng X2, Sun S3, Novick D4, Faries D2, Andrews J2, Wu A5, Wohlreich M2 1Kailo Research Group, Fishers, IN, USA, 2Eli Lilly and Company, Inc., Indianapolis, IN, USA, 3Kailo Research Group, Fremont, CA, USA, 4Eli Lilly and Company, Inc., Windlesham, Surrey, UK, 5Kailo Research Group, Los Angeles, CA, USA OBJECTIVES: To compare medication adherence and direct medical costs between duloxetine and pregabalin among fibromyalgia patients. METHODS: A retrospective cohort study design was used along with a large US national commercial claims database (2006 2009). Fibromyalgia patients who initiated duloxetine or pregabalin in 2008 at age between 18 and 64, and with continuous health insurance 1 year before and 1 year after initiation were assigned to a duloxetine initiator cohort or a pregabalin initiator cohort based on their initiated agent. Medication adherence of duloxetine or pregabalin, measured by total supply days, medication possession ratio (MPR) and proportion of patients with MPR 0.8, and direct medical costs, measured by annual costs per patient, were assessed and compared between the cohorts in the year following the initiation. Bootstrapping and propensity score stratification methods were used to adjust for distribution bias, as well as cross-cohort differences in demographics, clinical and economic characteristics, and medication history prior to the initiation. RESULTS: Both the duloxetine (n 3,033) and pregabalin (n 4,838) cohorts had a mean initiation age around 49 years, 89% were female. In the post-initiation year, compared to the pregabalin cohort, the duloxetine cohort had higher totally annual supply days (273.5 vs. 176.6, p 0.05), higher MPR (0.7 vs. 0.5, p 0.05) and more patients with MPR 0.8 (45.1% vs. 29.4%, p 0.05). Further, relative to pregabalin initiators, duloxetine initiators had lower inpatient costs ($2,994.9 vs. $4,949.6, p 0.05), low outpatient costs ($8,259.6 vs. $10,312.2, p 0.05), similar medication costs ($5,214.6 vs. $5,290.8, p 0.05), and lower total costs ($16,469.1 vs. $20,552.6, p 0.05) in the post-initiation year. CONCLUSIONS: In a real-world setting, fibromyalgia patients who initiated duloxetine in 2008 were associated with higher adherence and lower inpatient, outpatient and total medical costs than those who initiated pregabalin.

Direct Medical Costs of Liquid Intravenous Immunoglobulins in Children, Adolescents, and Adults in Spain

The aim of this study was to determine health care resource utilization and direct medical costs in Spanish patients treated with intravenous immunoglobulins (IVIGs) in 2009. Cost-of-illness analyses were performed to estimate direct medical costs of patients treated with IVIGs. Prevalence data were obtained from the Spanish Primary Immunodeficiency registry. A semi-structured questionnaire was used to collect data on health care resource utilization and patient distribution. Drug, administration, and premedication costs were considered from the payer's perspective. Separate analyses were conducted for children and adolescents versus adults. The numbers of children and adolescents with replacement therapy were 724, with immunomodulation 243, and with allogeneic bone marrow transplantation 30. The numbers of adult patients were, respectively, 3450, 1134, and 172. Mean annual costs for children and adolescents were 6293 € with Privigen, 6292 € with Kiovig, 6939 € with Flebogamma, and 6559 € with Octagamocta. For adults, estimations were 17 106 € with Privigen, 17 103 € with Kiovig, 18 077 € with Flebogamma, and 17 423 € with Octagamocta. Direct medical costs for IVIGs were approximately 91.8 million €. Drug costs represented 94% of total costs. The choice for a certain IVIG treatment depends on individual patient characteristics and cost considerations.

Hospital use and medical care costs up to 5 years after triglyceride lowering among patients with severe hypertriglyceridemia

Severe hypertriglyceridemia is associated with resource-intensive conditions such as cardiovascular disease, diabetes, and pancreatitis. Whether triglyceride (TG) reduction reduces annual medical costs has not been studied. The objective was to compare medical care costs after changes in triglyceride levels for up to 5 years of follow-up. Using an observational cohort, we identified 808 individuals who had a baseline TG level ≥500 mg/dL in calendar year 2004 and had a second measure 6 to 24 weeks later. We collected all subsequent inpatient, outpatient, and pharmacy use and medical cost data through 2009. Percentage change from baseline TG level was used to create six categories: decreased ≥60%, 45%-59%, 30%-44%, 15%-29%, 0%-14%, and TG increase. We estimated and compared annualized medical care costs by adjusting for baseline costs, baseline TG, high-density lipoprotein, and low-density lipoprotein cholesterol levels, age, sex, smoking status, body mass index, blood pressure, and presence of comorbidities such as diabetes and cardiovascular disease. Mean age of the cohort was 55.9 ± 11.7 years and 66% were men. Patients who reduced their TG levels by ≥60% experienced a mean annualized reduction from baseline medical costs of $471, whereas costs increased in all other TG change categories. Between-group differences were most pronounced in the first three years, but none were statistically significant. This observational study was unable to establish that TG lowering among patients with severe hypertriglyceridemia produced statistically significantly lower hospital use or medical care costs. However, the nonsignificant trends observed suggest that a larger study conducted with controlled TG lowering may be warranted.