Insurance Population Research Articles

Chemotherapy Utilization in Men with Advanced Penile Cancer.

Although studies using mixed insurance populations suggest that chemotherapy use in men with advanced penile cancer (PC) is low, it is unclear what regimens are being utilized. In this study, we use a database of insured patients to better understand specific chemotherapy utilization in men with PC. This is a retrospective cohort study of patients with stage IIIB or IV PC in the Surveillance, Epidemiology, and End Results-Medicare database (2004-2015). Standard of care (SOC) chemotherapy was defined by the National Comprehensive Cancer Network® guidelines: 4 cycles of paclitaxel, ifosfamide and cisplatin or 5-fluorouracil with cisplatin in the neoadjuvant, adjuvant or primary setting. We calculated what proportion of patients receive SOC or any chemotherapy within 2 years of diagnosis and analyzed what factors were associated with receiving chemotherapy. Our study included 147 patients-48 stage IIIB and 99 stage IV. Of these patients, 49 (33%) received chemotherapy. Less than 5% of men received SOC. About 10% received SOC chemotherapy but an insufficient number of cycles. Married men were more likely to undergo chemotherapy (OR 3.4, 95% CI 1.5-7.8). Less than 5% of the 24 Black or Hispanic patients received chemotherapy compared to 37% of white patients (p <0.001). Only a third of men with stage IIIB/IV PC underwent chemotherapy. Less than 5% of men received complete guideline-based regimens. Whether this is driven primarily by patient or provider factors is unknown, although social determinants of health may play a role. These data highlight the difficulty for patients with PC to get chemotherapy.

Health-economic burden of dementia in South Korea

BackgroundThis population-based study estimated the health-economic costs of dementia from a societal perspective using nationally representative data from 2015 to 2019 and analysed recent trends in Korea.MethodsThe prevalence of and mortality due to dementia were calculated using the National Health Insurance claims data and population census. The health-economic burden due to dementia was estimated using a prevalence-based approach, including the number of dementia patients and the number of deaths resulting from dementia during 2015–2019. The health-economic burden was presented separately as the national burden and the burden per capita by summing the direct and indirect costs.ResultsBetween 2015 and 2019, the prevalence of dementia among the elderly aged 65 years or older based on clinical diagnosis increased from 5.9 to 7.3%, with approximately 588000 elderly dementia patients in Korea. The total health-economic cost of dementia increased by about 1.5 times in the last 5 years and was estimated to be about USD 4218 million. Direct costs were 52.0% in 2019, and the proportion has been steadily increasing over the past 5 years; indirect costs accounted for 48.0% of the total burden, mainly from family members and caregivers. The health-economic cost per capita due to dementia was approximately USD 6957.ConclusionsThe burden of dementia in Korea is expected to considerably increase alongside the elderly population in the future. Health policies addressing the prevention and management of dementia should be prioritised.

MP40-07 CHEMOTHERAPY IN PENILE CANCER: ARE GUIDELINE-BASED REGIMENS BEING USED?

INTRODUCTION AND OBJECTIVE:Although studies using mixed insurance populations suggest that chemotherapy use in men with advanced penile cancer (PC) is low, it is unclear what regimens are actually ...

Treatment Patterns and Resource Utilization of Pregnant Women with Inflammatory Rheumatic Diseases or Psoriasis in Germany: A Claims Database Analysis

BackgroundUncontrolled inflammatory disease activity can impact pregnancy outcomes and the health of the mother and child. This retrospective claims database analysis assessed treatment patterns before, during, and after pregnancy among women with inflammatory rheumatic disease (IRD; axial spondyloarthritis [axSpA], psoriatic arthritis [PsA], and rheumatoid arthritis [RA]) or psoriasis (PSO) in Germany.MethodsData were extracted from the BARMER sickness fund (2013–2017). Pregnant women (18–45 years) with documented IRD or PSO diagnoses were compared with age-matched controls from the same database for the analysis of patient characteristics, healthcare resource utilization, and pharmacological treatment during pregnancy. Reported measures included the proportion of women with pharmacological prescriptions or hospitalization/new prescription of corticosteroids or biologics in the 180 days before pregnancy, during pregnancy, and 180 days after delivery. Pre-specified prescription categories (such as disease-specific drugs [not including biologics]) were identified by anatomical therapeutic chemical classification codes. Extrapolated values to the German statutory health insurance population are reported.ResultsOverall, 2702 pregnant women with IRD (axSpA: 1063; PsA: 660; RA: 979) and 6527 with PSO were identified. The proportion of women with IRD receiving prescriptions for disease-specific drugs reduced during pregnancy and remained stable after delivery (before: 15.0%; during: 9.0%; after: 9.7%). The proportion of women with PSO receiving prescriptions for disease-specific drugs was low (before: 0.6%; during: 0.3%; after: 0.1%). The proportion of women with hospitalization/new prescription of corticosteroids or biologics decreased during pregnancy, compared with pre-pregnancy, and increased after delivery in women with IRD (before: 9.0%; during: 5.1%; after: 11.1%) and PSO (before: 3.5%; during: 1.9%; after: 2.7%).ConclusionsA reduction in pharmacological treatment during pregnancy was observed for women with IRD in Germany. Many women with IRD did not return to pre-pregnancy treatments after delivery, despite signs of disease exacerbation, such as hospitalization and initiation of treatment with corticosteroids/biologics, in this period.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00347-3.

Uptake of evidence by physicians: De-adoption of erythropoiesis-stimulating agents after the TREAT trial

BackgroundVariation in de-adoption of ineffective or unsafe treatments is not well-understood. We examined de-adoption of erythropoiesis-stimulating agents (ESA) in anemia treatment among patients with chronic kidney disease (CKD) following new clinical evidence of harm and ineffectiveness (the TREAT trial) and the FDA’s revision of its safety warning.MethodWe used a segmented regression approach to estimate changes in use of epoetin alfa (EPO) and darbepoetin alfa (DPO) in the commercial, Medicare Advantage (MA) and Medicare fee-for-service (FFS) populations. We also examined how changes in both trends and levels of use were associated with physicians’ characteristics.ResultsUse of DPO and EPO declined over the study period. There were no consistent changes in DPO trend across insurance groups, but the level of DPO use decreased right after the FDA revision in all groups. The decline in EPO use trend was faster after the TREAT trial for all groups. Nephrologists were largely more responsive to evidence than primary care physicians. Differences by physician’s gender, and age were not consistent across insurance populations and types of ESA.ConclusionsPhysician specialty has a dominant role in prescribing decision, and that specializations with higher use of treatment (nephrologists) were more responsive to new evidence of unsafety and ineffectiveness.

Wearing the devil down: Rate of tooth wear varies between wild and captive Tasmanian devils.

Mammalian carnivores rely on their sharp teeth to effectively kill and consume prey. However, over time this causes wear and breakage that alters tooth shape, reducing their effectiveness. Extreme tooth wear and damage is especially prevalent in species that scavenge carcasses, like the Tasmanian devil (Sarcophilus harrisii), which are well known for their voracious appetites and ability to consume almost all of a carcass, including bone. In this study, we comprehensively describe tooth wear in captive and wild devils to look for differences in the patterns and rate of wear between these environments. To do this we surveyed tooth condition in skulls from 182 wild and 114 captive devils for which age was estimated using canine over-eruption. We found the types of tooth wear documented were the same in captive and wild devils, but captive animals have less severe wear than wild devils of the same estimated age. There was no difference in the proportion of captive or wild individuals with broken canine or molar teeth; however, breakage occurred at a younger age in wild devils. Although not considered anomalous or harmful, this indicates a difference in the way teeth are being used and/or the foods consumed between captive and wild devils. We hypothesize how these results relate to differences in diet or behavior that may stem from their various feeding environments, for example, higher quality food (fresh, whole, and yet to be scavenged carcasses) provided to captive devils likely causes less wear. Further, we support management options that closely replicate wild diet items and behaviors suitable for a long-term insurance population.

Predictors of early readmission to hospital and mortality in patients with malignant ascites: Analysis of the nationwide readmissions database.

12057 Background: Malignant ascites accounts for 7 percent of ascites cases in the United States. It is a common manifestation of several solid tumors and is associated with poor prognosis with median survival of 3 months. Moreover, patients with malignant ascites are at risk of recurrent hospitalizations. Hospital readmissions are costly for health-care system and are regarded as a quality of care index. Nevertheless, predictive factors for hospital readmissions and mortality in patients with malignant ascites are limited. Understanding these factors can expedite development of strategies to reduce the readmission and health-care costs. Methods: Utilizing the Nationwide Readmissions Database (NRD), we conducted a retrospective cohort study on patients admitted with malignant ascites between 2016 and 2018 across the United States. We used multivariable logistic regression to determine the predictors of unplanned 30-days readmissions and mortality among patients with malignant ascites. Results: Out of 130,648 patients hospitalized with malignant ascites, 15,756 individuals (12.1%) were readmitted within next 30 days. Predictors of early readmission included pulmonary embolism (OR 2.40; 95% CI 1.55-3.74), complicated diabetes (OR 1.28; 95% CI 1.05-1.56) and having Medicaid insurance (OR 1.34; 95% CI 1.11-1.62). In-hospital mortality for patients with malignant ascites was 14.1%. The comorbidities associated with increased mortality were liver disease (OR 1.87; 95% CI 1.77-1.97), pulmonary embolism (OR 1.60; 95% CI 1.34-1.90), renal failure (OR 1.39; 95% CI 1.27-1.52), and congestive heart failure (OR 1.27; 95% CI 1.16-1.38). Patients with Medicaid insurance also had higher mortality (OR 1.21; 95% CI 1.12-1.32) among the payers. Conclusions: One in eight patients with malignant ascites was readmitted to the hospital within 30 days of discharge. By examining the risk factors leading to readmission, this study helped to identify the subpopulations of patients likely to become more ill. The strong association of pulmonary embolism with readmission and in hospital mortality suggests the benefit of prophylactic anticoagulation. Furthermore, higher readmission and mortality rate within Medicaid insurance population can open a new window in studying health care disparities.

Burden of Herpes Zoster in Adult Patients with Underlying Conditions: Analysis of German Claims Data, 2007–2018

IntroductionSeveral chronic underlying conditions (UCs) are known to be risk factors for developing herpes zoster (HZ) and to increase the severity of HZ and its risk of recurrence. The aim of this study was to investigate the incidence and recurrence of HZ in adult patients with one or multiple UCs.MethodsA retrospective cohort study based on claims data representing 13% of the statutory health insurance population from 2007 to 2018 in Germany was performed. Patients aged ≥ 18 years were included when at least one of the following UCs was diagnosed: asthma, chronic heart failure, chronic obstructive pulmonary disease (COPD), coronary heart disease (CHD), depression, diabetes mellitus type 1 or 2, and rheumatoid arthritis (RA). Exact matching was used to account for differences in the distribution of age and sex between the case and matched control cohorts. Multi-morbidity was considered in sensitivity analyses by analyzing patients with only one UC.ResultsPatients with asthma, CHD, COPD, depression, and RA had, on average, a 30% increased risk of developing acute HZ compared to patients without any UC. RA was found to have the highest odds ratio among these conditions, varying from 1.37 to 1.57 for all age groups. Patients with depression also showed a high risk of developing HZ. Analysis of recurrence indicated that patients with at least one UC in the age groups 18–49 years and 50–59 years had the highest risk for a recurrent HZ. After experiencing a first recurrence, patients, regardless of age group, had a two- to threefold higher risk for a second recurrence.ConclusionThis study of representative claims data shows a higher HZ incidence and recurrence frequency in patients with UCs. These results provide relevant information for national health care guidelines and disease management programs.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00535-7.

Socioeconomic inequalities in lung cancer \u2013 a time trend analysis with German health insurance data

BackgroundLung Cancer (LC) is one of the most prevalent cancer diseases. Due to the lack of databases which allow the combination of information on individual socioeconomic status (SES) and cancer incidence, research on social inequalities in LC among the German population is rare. The aim of the study is to analyse time trends in social inequalities in LC in Germany.MethodsThe analyses are based on data of a large statutory health insurance provider. The data contain information on diagnoses, occupation and education (working age), and income (full age range) of the insurance population. Trends were analysed for two subpopulations (retirement age and working age) and stratified by sex. The analyses are based on incidence rates and proportional hazard models spanning the periods 2006–2009, 2010–2013 and 2014–2017.ResultsIncidence rates declined in men but increased in women. For men, inequalities were strongest in terms of income and the decline in incidence was most pronounced in middle- and higher-income men. Among women at retirement age, a reversed income gradient was found which disappeared in the second period. The educational gradient among the working-age population decreased over time due to the trend towards increasing incidence among individuals with higher education. Declining gradients were also found for occupational position.ConclusionThe findings reveal considerable inequalities in LC and that trends vary with respect to SES, sex and age. Widening income inequalities were found in the retired population, while educational and occupational inequalities tend to narrow among the working-age population.

The past, present and future of hormonal contraceptive use in managed captive female tiger populations with a focus on the current use of deslorelin acetate.

Tigers (Panthera tigris spp.) are endangered in the wild; ensuring sustainable insurance populations requires careful planning within zoological collections. In captive situations, contraceptives are often used to control breeding and ensure genetically viable populations that contain manageable numbers of animals; reversible contraceptives are ideal because they offer flexibility for breeding management. Historically, synthetic progestins, such as melengestrol acetate implants, were used in female tigers, but these are associated with an increased risk of reproductive pathology and subsequent infertility. Recent management advice to ex-situ collections has been to transition to the use of gonadotropin-releasing hormone agonists, such as deslorelin acetate implants, which do not appear to have a similar risk of reproductive pathology but are associated with highly variable reversal times in exotic felids. Using data from 917 contraceptive records in female tigers captured by the Association of Zoos and Aquariums Reproductive Management Center and the European Association of Zoos and Aquaria Reproductive Management Group's joint Contraception Database and from supplementary surveys, this study reviews the changing use of contraceptives in captive female tigers. The aim was to describe the historical and current use of contraceptives and provide a comprehensive assessment on the use of deslorelin implants, including data on product protocols, efficacy, pathology, and reversibility. This study determined that current dose, frequency, reversibility, and anatomical placement sites of deslorelin implants are highly variable, indicating that specific, readily available, unified, evidence-based recommendations on the use of deslorelin would be useful for future contraceptive use in managed tiger populations.

Can Health Insurance Protect Against Catastrophic Health Expenditures in Iran? A Systematic Review and Meta‐Analysis

The results of previous Iranian studies on the protective effect of health insurance on catastrophic health expenditures (CHE) are inconsistent. Therefore, the aim of this meta‐analysis was to summarize all existent evidence. We searched international and Iranian scientific databases for relevant literature. Using a Mantel–Haenszel random‐effects model, the pooled odds ratios (OR) were calculated. Subgroup meta‐analyses were performed considering the type of insurance and study population. The pooled OR for the protective effect of health insurance risk on facing CHE was 0.93 (95% confidence interval [CI], 0.68–1.28). The protective effect of the two types of insurance was statistically insignificant. Health insurance does not effectively provide financial protection against CHE in Iran. Expanding the prepayment mechanism and integrating health insurance funds can be good strategies in protecting people from CHE. More attention should be paid to the design of health insurance benefit package to cover chronic diseases.

Assessing evolutionary processes over time in a conservation breeding program: a combined approach using molecular data, simulations and pedigree analysis

Captive breeding for conservation is widely used to prevent extinction, however these programs face many challenges due to small population size, founder effects, lack of migration and potential adaptation to captivity. Together these influence how selection, genetic drift and gene flow shape the genetic makeup of small populations, so examining these in a captive setting is valuable for appropriate biodiversity management. We have quantified the effects of selection, drift and gene flow in 503 individuals across five generations from the Tasmanian devil insurance population. To determine whether different processes were acting in different settings, we separately analysed animals housed under individual-based management, versus those that were released to an island site. We found that a greater proportion of alleles were lost over time in the smaller island population than in captivity and propose that genetic drift is the most likely process influencing this result. We found that the captive population became more heterozygous over time, while the island population stayed constant. Our molecular measure of inbreeding found a decrease over generations in captivity that is not captured by pedigree-based analysis. As management of breeding interactions only takes place in the captive population, our results are consistent with gene flow through managed breeding in captivity minimising inbreeding over time. Gene flow was also evident through changes to population structure in the captive population. Our findings serve as an example of how conservation managers can assess the impact of evolutionary processes on managed populations and adapt management practices if required.

Thoughts about health and patient-reported outcomes among people with diabetes mellitus: results from the DiaDec-study

BackgroundThere is considerable evidence that repetitive negative thoughts are often associated with adverse health outcomes. The study aims are (i) to identify the frequency and valence of thoughts about health in people with diabetes mellitus using questions based on the day reconstruction method (DRM) and (ii) to analyse associations between thoughts about health and health-related quality of life (HRQoL), diabetes-related distress and depressive symptoms.MethodsCross-sectional study of a random sample of a German statutory health insurance population with diabetes aged between 18 and 80 linking questionnaire and claims data. Associations between frequency and valence of thoughts about health on a previous day and HRQoL assessed by a 12-Item Short-Form Health Survey, diabetes-related distress assessed using the Problem Areas in Diabetes scale and depressive symptoms assessed by Patient Health Questionnaire-9 were analysed using linear and logistic regression analysis, adjusting for sociodemographic and clinical characteristics.ResultsThoughts about health were analysed in 726 participants (86% type 2 diabetes, 62% male, mean age 67.6 ± 9.7 years). A total of 46% had not thought about their health the day before, 17.1% reported low frequency and negative thoughts, 21.4% low frequency and positive thoughts, 12.1% high frequency and negative thoughts and 3.4% high frequency and positive thoughts. The presence of thoughts about health irrespective of their frequency and valence is associated with a lower physical and mental component summary score of the 12-Item Short-Form Health Survey. Negative thoughts are associated with high diabetes-related distress. Frequent or negative thoughts are associated with depressive symptoms.ConclusionsThoughts about health are a part of everyday life for a substantial number of people with diabetes. Surprisingly, even positive thoughts are associated with poorer HRQoL in our study. Further research within the DRM paradigm is needed to understand how thoughts about health may affect people’s (assessment of) state of health. Thoughts about health should be considered in diabetes education and patient counselling with a view to preventing and treating emotional disorders. More attention should be paid to the outcomes of interventions that may themselves lead to an increase in the frequency of thoughts about health.

White-naped mangabeys\u2019 viable insurance population within European Zoo Network

The success and viability of an ex-situ conservation program lie in the establishment and potential maintenance of a demographically and genetically viable insurance population. Such population reserve may support reintroduction and reinforcement activities of wild populations. White-naped mangabeys are endangered restricted-range African primates which have experienced a dramatic population decrease in their natural habitats over the last few decades. Since 2001, some European zoos singularly monitor an ex-situ population aiming to seek the recovery of the current wild population. The aim of the present paper is to evaluate the genetic status and population demographics of European zoo-captive white-naped mangabeys based on pedigree data. The captive population is gradually growing and preserves specific reproductive and demographic parameters linked to the species. The intensive management program that is implemented has brought about the minimization of inbreeding and average relatedness levels, thus maintaining high levels of genetic diversity despite the existence of fragmented populations. This finding suggests white-naped mangabey ex-situ preservation actions may be a good example of multifaceted conservation throughout studbook management which could be used as a model for other ex-situ live-animal populations.

Post-release immune responses of Tasmanian devils vaccinated with an experimental devil facial tumour disease vaccine

Abstract Context Disease is increasingly becoming a driver of wildlife population declines and an extinction risk. Vaccines are one of the most successful health interventions in human history, but few have been tested for mitigating wildlife disease. The transmissible cancer, devil facial tumour disease (DFTD), triggered the Tasmanian devil’s (Sarcophilus harrisii) inclusion on the international endangered species list. In 2016, 33 devils from a DFTD-free insurance population were given an experimental DFTD vaccination before their wild release on the Tasmanian northern coast. Aim To determine the efficacy of the vaccination protocol and the longevity of the induced responses. Method Six trapping trips took place over the 2.5 years following release, and both vaccinated and incumbent devils had blood samples and tumour biopsies collected. Key results In all, 8 of the 33 vaccinated devils were re-trapped, and six of those developed DFTD within the monitoring period. Despite the lack of protection provided by the vaccine, we observed signs of immune activation not usually found in unvaccinated devils. First, sera collected from the eight devils showed that anti-DFTD antibodies persisted for up to 2 years post-vaccination. Second, tumour-infiltrating lymphocytes were found in three of four biopsies collected from vaccinated devils, which contrasts with the ‘immune deserts’ typical of DFTs; only 1 of the 20 incumbent devils with DFTD had a tumour biopsy exhibiting immune-cell infiltrate. Third, immunohistochemical analysis of the vaccinated devils’ tumour biopsies identified the functional immune molecules associated with antigen-presenting cells (MHC-II) and T-cells (CD3), and the immune checkpoint molecule PD-1, all being associated with anti-tumour immunity in other species. Conclusions These results correlate with our previous study on captive devils in which a prophylactic vaccine primed the devil immune system and, following DFTD challenge and tumour growth, immunotherapy induced complete tumour regressions. The field trial results presented here provide further evidence that the devil immune system can be primed to recognise DFTD cells, but additional immune manipulation could be needed for complete protection or induction of tumour regressions. Implications A protective DFTD vaccine would provide a valuable management approach for conservation of the Tasmanian devil.

Observations on the behaviour of the northern hairy-nosed wombat (Lasiorhinus krefftii) in a translocated population

The natural distribution of the critically endangered northern hairy-nosed wombat (Lasiorhinus krefftii) is confined to Epping Forest National Park, Queensland; however, a small number of animals have been translocated to establish an insurance population at Richard Underwood Nature Refuge (RUNR), Queensland. Northern hairy-nosed wombat behaviour is poorly understood, mostly due to its cryptic behaviour. Thirty-two wildlife cameras set up at burrow mouths at RUNR were used to capture social and solitary behaviour. Over a six month period between December 2016 and May 2017, 0.3% (21 videos of 6607) of recordings captured social behaviour, suggesting that the northern hairy-nosed wombat actively avoids social interactions at the burrow mouth. Vocalisation was only observed during social interaction. The results were similar to data from Epping Forest National Park and studies on other wombat species. In this respect the translocated population appeared to behave in a manner typical of the wild population.

Underutilization of Surgical Standard of Care for Insured Men with Invasive Penile Cancer.

Prior studies of mixed insurance populations have demonstrated poor adherence to surgical standard of care (SOC) for penile cancer. We used data from the Surveillance, Epidemiology and End Results (SEER) cancer registry linked to Medicare to calculate SOC adherence to surgical treatment of penile cancer in insured men over the age of 65, focusing on potential social and racial disparities. This is an observational analysis of patients with T2-4 penile cancer of any histologic subtype without metastasis in the SEER-Medicare database (2004-2015). SOC was defined as penectomy (partial or radical) with bilateral inguinal lymph node dissection (ILND) based on the National Comprehensive Cancer Network guidelines. We calculated proportions of those receiving SOC and constructed multivariate models to identify factors associated with receiving SOC. A total of 447 men were included. Of these men, 22.1% (99/447) received SOC while 18.8% (84/447) received no treatment at all. Only 23.3% (104/447) had ILND while 80.9% (362/447) underwent total or partial penectomy. Race and socioeconomic status (SES) were not associated with decreased SOC. Increasing age (OR 0.93, 95%CI:0.89-0.96), Charlson Comorbidity Index score ≥ 2 (OR 0.53, 95%CI:0.29-0.97), and T3-T4 disease (OR 0.34, 95%CI:0.18-0.65) were associated with not receiving SOC on adjusted analysis. Rates of SOC are low among insured men 65 years of age or older with invasive penile cancer, regardless of race or SES. This finding is largely driven by low rates of ILND. Strategies are needed to overcome barriers to SOC treatment for men with invasive penile cancer.

PNS99 Personal Characteristics Associated with Subscription to Private Health Insurance in Greece − Results from the ″Health & Welfare″ Survey

To investigate the personal characteristics associated with subscription to private health insurance in Greece. Primary data were extracted from the “Health and Welfare” survey, a health interview survey conducted by the Hellenic National School of Public Health and refer to 2017. The final sample of the analysis consisted of 1,945 adults. To assess the personal characteristics associated with subscription to private health insurance, a binary logistic regression analysis was conducted, where the dependent variable was the subscription to private health insurance, while independent variables were region of residence, gender, age, occupation, marital status, family income, possession of social health insurance, educational level, existence of chronic condition, smoking status and time since last check-up. In total, 12.6% of the sample was subscriber to private health insurance. Most of the participants with private health insurance were 40-54 years old (40.0%), male (51.8%), had tertiary education (58.4%), lived in Attica (60.0%), had a monthly income higher than 1,000€ (76.4%), had social health insurance (89.0%), didn’t have a chronic condition (69.8%), were employers/self-employed (30.7%) and had their last health check-up one year before the interview (81.6%). The personal characteristics that were found to be associated with subscription to private health insurance were: area of residence: Attica (OR=4.178), income level: 1,001€-1,500€ (OR=2.111), 1,501€-2,000€ (OR=2.250) and 2,001€+ (OR=5.435), absence of chronic condition: (OR=1.600), occupation: Employer/self-employed (OR=3.164), absence of social health insurance (OR=4.117), time since last health check-up: >1 and ≤5 years (OR=0.589), 5> years or never (OR=0.290) and level of education: Secondary (OR=3.161) and Tertiary (OR=3.364). Investigation of the socioeconomic factors that are associated with acquiring private health insurance may lead to targeted policies concerning private health insurance population coverage uptake and, thus, to a decrease in out-of-pocket payments, who are high in Greece, compared to other countries.

PMU8 Health Care Spending And The Pareto Principle - The Minority That Causes The Majority

This study aims to evaluate annual healthcare spending by a German sickness fund, and to analyze the distribution of costs incurred by members of the public insurance population in 2018. Costs were analyzed using claims data from a German statutory health insurance fund (AOK PLUS) for the year 2018. Data included costs related to inpatient care and outpatient care, including respective medications and surgeries, as well as cost of aids and remedies that have been reimbursed by the sickness fund. All patients with continuous insurance (except death) from AOK PLUS for the period 01/01/2018-31/12/2018 were included in the analysis. The claims dataset included 3,061,982 individuals (52.52% female) with a mean age of 47.00 years; 1.68% of patients died within the observational year. Average annual healthcare spending per person was €2,837 (median: €923), with 48.59% of total costs incurred for outpatient care and medications (mean/median: €1,378/€729), 42.25% for inpatient care (including medications) (mean/median: €1,198/0€), and 9.16% for aids and remedies (mean/median: €260/€0). Around 5.72% of the insured patient population did not incur any costs in 2018, while 5.93% of patients incurred expenses greater than €10,000. Patients in the highest spending quintile accounted for 74.76% of all healthcare-related costs in 2018; this translates into an average annual cost of €10,630 per person. Similarly, the most costly patients at the 10%/5%/1% levels accounted for 59.12%/44.33%/19.43% of annual healthcare spending (i.e. €16,768/€10,630€/€25,146/€55,122 per patient). The distribution of healthcare spending is highly skewed with a minority of insured persons causing the majority of costs. In order to improve the cost-effectiveness of the healthcare system, it is of utmost importance to identify and characterize patients who drive healthcare costs, as well as the sectors and interventions that are triggering high healthcare spending.

16948 A closer look at drug adherence rates of acne vulgaris medications in the Humana insurance population—A retrospective analysis

Background: Treatment of acne vulgaris, a chronic skin disease that negatively affects quality of life, can be challenging due to poor medication adherence. Few studies have evaluated factors associated with acne medication adherence at a nationwide level. This current study quantitatively assesses the adherence rates of acne medications of the Humana Insurance database population.