Long-term Care Costs Research Articles

Projecting Long-Term Care Costs Among Older Adults With ADL Disabilities and Cognitive Impairment in China.

Mounting evidence suggests that cognitive impairment is strongly associated with disability in activities of daily living (ADL disability) and long-term care (LTC) costs. However, studies forecasting future LTC costs often overlook these relationships. Consequently, this study aims to more accurately project future LTC costs in China over the next 20 years by considering the intertwined association between disability and cognitive impairment on future LTC costs. Data were from 10 959 adults ≥65 years from the 2005-2018 waves of the Chinese Longitudinal Healthy Longevity Surveys. We used the Markov model to project the population of China and track the transition of older adults in the next 20 years between 4 disability-cognition states. We employed a 2-part model to estimate LTC costs (direct and indirect LTC costs) per capita. The proportion of disabled older adults with cognitive impairment was projected to increase from 1.4% in 2021 to 3.4% in 2040, while that of those without cognitive impairment was projected to decrease from 4.7% in 2021 to 4.5% in 2040. The direct and indirect LTC costs were projected to increase from 0.3% and 0.2% of gross domestic product (GDP) in 2021 to 1.4% and 0.7% in 2040 for disabled persons without cognitive impairment and from 0.1% and 0.1% of GDP in 2021 to 1.3% and 1.3% in 2040 for those with cognitive impairment, respectively. Policy-makers could include the assessment of cognition in the LTC needs assessment and allocate more compensation to LTC insurance participants with cognitive impairment.

Disability during the last ten years of life: Evidence from a register-based study in Austria

Abstract Background Many older adults experience disability in activities of daily living during the last years of life, but survey-based analyses suffer from non-representative samples due to selective participation and attrition. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. Methods In this retrospective mortality follow-back study, we analyse receipt of ALTCA, a cash benefit based on physician assessed disability during the last 10 years of life, among all decedents aged 65 years and over from 2020 in Austria (n = 76,781). The impact of sex, age of death, and cause of death on the duration and probability of receipt of ALTCA was assessed with regression models. Results 10 years before death 10% of older men and 25% of older women received ALTCA, which increased to 27% and 51% at 5 years, 56% and 77% at 1 year, and finally to 70% and 87% at 1 month before death. On average, ALTCA was received for 3.2 years in men and 4.5 years in women. The probability to receive ALTCA and its duration increased sharply with age at death and varied by underlying causes of death: those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and experienced shorter durations of it, while those who died from dementia, Parkinson’s disease, chronic heart disease, or chronic obstructive lung disease were more likely to receive ALTCA and longer so. Conclusions Most older adults received ALTCA for multiple years before death, and this increased strongly with age at death and varied across causes of death. Our register-based estimates of late-life disability were twice as high as survey-based estimates, which points to an underestimation in previous studies. Policy-makers should be aware that costs of long-term care will likely increase as life expectancy rises and deaths from dementia and organ failure increase in ageing European societies. Key messages • A large majority of older adults in Austria experience late-life disability. On average, older men were disabled for 3.2 and older women for 4.5 years. • Probability and duration of late-life disability increased steeply with age at death and was higher for those who died from dementia, Parkinson’s disease, or chronic heart or lung disease.

Long-term costs of dental care for thailand preschool children by using a system dynamics model

BackgroundA System Dynamics Model (SDM) is a computer simulation to alleviate the problem by comparing strategies and policies. Addressing the costs by using SDM helps in allocating the resources efficiently in managing the strategies.ObjectiveTo describe the costs of primary, secondary, and tertiary prevention of dental caries for 0–5-year-old children by SDM.MethodsThe SDM was developed to explore the cost of primary and secondary prevention (supervised toothbrushing, STB and fluoride varnish, FV), the treatment cost for caries (tertiary prevention), and the total cost under three scenarios; STB, FV and base case (no intervention).ResultsWhen the children aged 5 years, the treatment cost under the base case was the highest at 57.6 million baht while 53.5 million baht in FV and 51.9 million baht in STB. As a total cost, 64.1 million baht under FV, 60.9 million baht under STB, and 57.6 million baht under base case. Sensitivity analysis reveals that the effective rate of STB must be at least 30%, and FV should be a minimum of 50% to ascertain the total cost reduction relative to the base case scenario.ConclusionCaries treatment costs were lower when STB and FV were implemented than in the base case scenario. The overall cost under FV was the highest, followed by STB, with no total cost savings observed as compared to the base case situation. Despite that, carrying out the STB rather than the FV would save a total of 3.2 million baht. Treatment costs under interventions would be lower than expected, and overall cost reductions might be obtained by comparing the base case if the intervention's effective rates are higher, according to sensitivity analysis.

Long-Term Care in Germany in the Context of the Demographic Transition—An Outlook for the Expenses of Long-Term Care Insurance through 2050

Demographic aging results in a growing number of older people in need of care in many regions all over the world. Germany has witnessed steady population aging for decades, prompting policymakers and other stakeholders to discuss how to fulfill the rapidly growing demand for care workers and finance the rising costs of long-term care. Informed decisions on this matter to ensure the sustainability of the statutory long-term care insurance system require reliable knowledge of the associated future costs. These need to be simulated based on well-designed forecast models that holistically include the complexity of the forecast problem, namely the demographic transition, epidemiological trends, concrete demand for and supply of specific care services, and the respective costs. Care risks heavily depend on demographics, both in absolute terms and according to severity. The number of persons in need of care, disaggregated by severity of disability, in turn, is the main driver of the remuneration that is paid by long-term care insurance. Therefore, detailed forecasts of the population and care rates are important ingredients for forecasts of long-term care insurance expenditures. We present a novel approach based on a stochastic demographic cohort-component approach that includes trends in age- and sex-specific care rates and the demand for specific care services, given changing preferences over the life course. The model is executed for Germany until the year 2050 as a case study.

Disability during the last ten years of life: evidence from a register-based study in Austria.

Analyses of late-life disability based on survey data of the oldest old often suffer from non-representative samples due to selective participation and attrition. Here, we use register data on the Austrian long-term care allowance (ALTCA) as a proxy for late-life disability. In this retrospective mortality follow-back study, we analyze receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living during the last 10years of life, among all decedents aged 65years and over from 2020 in Austria (n = 76,781) and its association with sex, ageatdeath, and underlying cause of death. We find that on average, ALTCA was received for 3.5 and 5.3years in men and women. At 10years before death, 10% of men and 25% of women received ALTCA, which increased to 56% and 77% at one year before death. Both the probability and duration of ALTCA increased with age at death and varied by cause of death: Those who died from cancer, myocardial infarction, and external causes of death were less likely to receive ALTCA and for shorter durations, while those who died from dementia, Parkinson's disease, chronic heart disease, or chronic lung disease were more likely to receive it and longer so. Overall, our register-based estimates of the prevalence of late-life disability were higher than previous survey-based estimates. Policy-makers should be aware that costs of long-term care will rise as life expectancy rises and deaths from dementia and chronic heart disease will likely increase in therapidly aging European societies.

Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes

ObjectivesThis study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus, from a U.S. payer perspective. MethodsA cohort simulation Markov model was developed including the effects of diabetes and major complications from diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities, were based on data from electronic health records, and published literature. Outcomes evaluated were lifetime incremental costs, quality-adjusted life years (QALYs), and ratios. Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes and of reduced MTMC visit frequency. ResultsOver a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The incremental cost-effectiveness ratio (ICER) of the MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure, with an improvement in glycosylated hemoglobin and systolic blood pressure. ConclusionThe study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term health care costs.

Differences in Cumulative Long-Term Care Costs by Dental Visit Pattern Among Japanese Older Adults: The JAGES Cohort Study.

Long-term care (LTC) costs create burdens on aging societies. Maintaining oral health through dental visits may result in shorter LTC periods, thereby decreasing LTC costs; however, this remains unverified. We examined whether dental visits in the past 6 months were associated with cumulative LTC insurance (LTCI) costs. This cohort study of the Japan Gerontological Evaluation Study targeted independent adults aged≥65 years in 2010 over an 8-year follow-up. We used data from a self-reported questionnaire and LTCI records from the municipalities. The outcome was cumulative LTCI costs, and exposure was dental visits within 6 months for prevention, treatment, and prevention or treatment. A 2-part model was used to estimate the differences in the predicted cumulative LTCI costs and 95% confidence intervals (CIs) for each dental visit. The mean age of the 8 429 participants was 73.7 years (standard deviation [SD] = 6.0), and 46.1% were men. During the follow-up period, 17.6% started using LTCI services. The mean cumulative LTCI cost was USD 4 877.0 (SD = 19 082.1). The predicted cumulative LTCI costs were lower among those had dental visits than among those who did not. The differences in predicted cumulative LTCI cost were -USD 1 089.9 (95% CI = -1 888.5 to -291.2) for dental preventive visits, -USD 806.7 (95% CI = -1 647.4 to 34.0) for treatment visits, and -USD 980.6 (95% CI = -1 835.7 to -125.5) for preventive or treatment visits. Dental visits, particularly preventive visits, were associated with lower cumulative LTCI costs. Maintaining oral health through dental visits may effectively reduce LTCI costs.

Evaluating the health outcomes of aging in place: the role of medicaid aging waiver program on U.S. older adults

The Medicaid Aging Waiver program (MAW) subsidizes the cost of long-term care (LTC) at home or in communities to satisfy older people’s increasing desire to age in place. The MAW program might be health improving for older people by allowing them to age at home. However, less quality and quantity of home-based care comparing to nursing home care could offset some of the potential benefits. I use policy expenditure across states over time linked with detailed health information from the Health and Retirement Study (HRS) to identify the associated effects of MAWs on health outcomes of older adults who are at risk of needing LTC and who are resources constrained to be potentially eligible for Medicaid. Overall, the findings suggest that the MAW program is beneficial to health: a $1,000 increase in MAW spending for each older person results is associated with a 1.4 percent improvement in self-reported health status, a 1.5 percent reduction in functional mobility limitations, a 1.6 percent decrease in Instrumental Activities of Daily Living (IADL) limitations, and a 1.7 percent improvement in negative psychological feelings. For older people who are most likely not eligible for MAWs, such as those who are wealthy or in good health and do not require LTC, these health-improving effects have not been observed.

Narrating the Sociocultural Experience and Management of Stigma Related to Military Caregiving

ABSTRACT Despite accelerating the recovery and rehabilitation of wounded veterans and saving the U.S. substantial sums in avoided long-term care costs, military caregivers (MCs) are an underserved community lacking resources and support. On top of managing a variety of emotional, physical, relational, and occupational challenges, MCs experience stigma. Indeed, caregiving can be a stigmatized task, especially for military-affiliated individuals who may be expected to adhere to cultural norms of personal sacrifice and resilience in the face of adversity. The current study uses narrative inquiry to better understand the unique experiences and characteristics of MCs providing care for veterans experiencing posttraumatic stress. Specifically, this study examined MCs’ narratives to uncover the sociocultural experience and management of stigma related to military caregiving. Interviews with 15 military caregivers of veterans experiencing PTS demonstrated that military caregivers experienced stigma for 1) staying in the relationship, 2) enabling the veteran, 3) mismanaging the condition, and 4) flaking on plans and relationships. In response to stigma, MCs often challenged stigma through strategies of denial or evasion of responsibility. This study contributes to communication scholarship by introducing co-stigma management and further interrogating processes related to stigma management communication. In addition, the results can inform Veteran Affairs (VA) healthcare, caregiver assistance programs, health practices, and support-seeking behaviors.

Health budget implications of mechanical thrombectomy for acute ischaemic stroke in Australia.

This research evaluates the budget impact of treating acute ischaemic stroke (AIS) using a combination of mechanical thrombectomy (MT) with stent retrievers (SR) and intravenous tissue-plasminogen activator (IV-tPA) in Australia. This study examined the economic impact over five years for a patient cohort based on the number of patients treated with MT+ IV-tPA in Australia 2021, versus treatment with IV-tPA alone. A budget impact (BI) model was developed to project direct medical costs (economic impact) of IV-tPA+ MT with SR vs. Intravenous tissue-plasminogen activator alone over a five-year period (2021-2025 inclusive) from a healthcare perspective. The model is composed of a short-run decision tree model based on a 3-month post-treatment modified Rankin Scale (mRS) from the EXTEND-IA study and a published long-run Markov state transition model. Acute, mid-term and long-term care costs were projected based on anticipated mRS scores from the EXTEND-IA trial. Estimated yearly and cumulative budget impact were reported to indicate the economic impact of the two treatment strategies for AIS in the Australian healthcare system. MT+IV-tPA had a greater budgetary impact than IV-tPA alone, with annual savings starting at Year 1 and continuing through to Year 5. Cost savings of 21% or approximately $36 million can be achieved over five years for the patient cohort treated in Australia in 2021. Each MT procedure performed delivers approximately $3280 in annual health system savings per patient. Treatment of AIS with a combination of MT+IV-tPA generates significant savings in the Australian healthcare system compared with IV-tPA alone.

Does the neighborhood built and social environment reduce long-term care costs for Japanese older people? The JAGES2010-2019 cohort study

Japan's population has been aging steadily, evidenced by it spending JPY 11 trillion (USD 110 billion) on annual long-term care (LTC) costs in 2021. In this context, understanding the factors influencing LTC costs has become increasingly vital. Although studies have reported positive relationships between neighborhood environment and health outcomes, the connection between LTC costs and neighborhood environment remains unclear. To address this gap in the literature, this cohort study, conducted from 2010 to 2019 across seven Japanese municipalities and involving 34,982 older people, examined the relationship between eight neighborhood environment elements and the mean monthly cumulate costs (MMCC) of LTC. The results showed that older people who reported the presence of fresh food stores nearby and dangerous places for walking alone at night in the neighborhood had lower MMCC, by JPY 1,367.6 and 1,383.3 per month, respectively, than respondents who did not report the presence of these neighborhood elements. Meanwhile, older people whose neighborhoods had easily accessible facilities had higher MMCC of JPY 739.4. This study's key findings reveal significant relationships between neighborhood environment elements and LTC costs and can be used to support developments in urban design to support healthy aging and reduced LTC costs.

Cost of Care for Newborns With Neonatal Abstinence Syndrome in a State Medicaid Program

Neonatal abstinence syndrome (NAS) is a medical condition among neonates experiencing substance withdrawal due to the mother's substance use during pregnancy. While previous studies suggest that the overall incidence and annual costs of NAS are increasing, to date, the long-term costs have yet to be demonstrated in Medicaid populations. To examine the demographic differences and long-term costs of care for neonates diagnosed with vs not diagnosed with NAS. This cohort study used claims data from the Alabama Medicaid Agency for neonates born to Medicaid-eligible mothers between January 1, 2010, and December 31, 2020. Data were analyzed in June 2022. A diagnosis of NAS within 30 days of birth. Rate of NAS by demographic and birth characteristics, long-term costs attributable to NAS status and demographic and birth characteristics, and distribution of this expenditure over the enrollment period. A total of 346 259 neonates with Medicaid eligibility were born during the study period (mean [SD] gestational age, 38.4 [2.2] weeks; 50.5%, male), 4027 (1.2%) of whom had an NAS diagnosis within 30 days of birth. A larger percentage of neonates with an NAS diagnosis were male (52.7%) than in the group without NAS (50.5%). Neonates with NAS also weighed less at birth (mean difference, -212.0 g; 95% CI, -231.1 to -192.8 g) and had older mothers (mean difference, 3.4 years; 95% CI, 2.6-4.2 years). An NAS diagnosis had an estimated additional cost of $17 921 (95% CI, $14 830-$21 012) over the enrollment period, and this cost was not evenly distributed over that period. In this cohort study of neonates born into the Alabama Medicaid population, those with an NAS diagnosis had a different demographic profile and a higher cost to state Medicaid agencies than those without NAS. These findings warrant further effort to reduce the occurrence of NAS.

Air pollution and the burden of long-term care: Evidence from China.

We examine the causal effects of PM2.5 exposure on the burden of long-term care (LTC) by matching a satellite-based PM2.5 (particulate matter smaller than 2.5micrometers (μm) in diameter) dataset with a nationally representative longitudinal study in China from 2011 to 2018. We find significant adverse effects of PM2.5 exposure-instrumented by thermal inversions-on the LTC burden. A 10μg/m3 increase in annual PM2.5 exposure increases average monthly hours of LTC and the associated financial costs by 28h and CNY 452, respectively. The effects are greater for those who had never smoked nor experienced severe PM2.5 pollution (annual average PM2.5>35μg/m3) in the previous 5years. We also find that as PM2.5 increases, chronic diseases, particularly cardiovascular diseases, could lead to a higher likelihood of LTC dependency but reduce the total hours and costs of LTC provision. Finally, we find that PM2.5 reduces the total years of LTC need, suggesting that PM2.5 increases LTC costs by increasing the severity of LTC dependency, rather than the duration of LTC need. Our findings can assist policymakers in planning for LTC provisions and clean air policies.

Abstract 4: Unveiling the Economic Burden of Stroke in the European Union: Comparisons With the USA

Introduction: Stroke places a significant economic impact on health and social care systems, as well as indirect costs through premature retirement, and absenteeism, reducing productivity and economic output, and necessitating care for patients from friends and family. This study aims to provide novel and up- to-date evidence on the economic burden of stroke across 27 EU countries allowing to draw comparisons with the USA. Methods: Stroke-related costs were estimated for 27 EU countries in 2021. Country-specific resource use was estimated using aggregate data on morbidity, mortality, health, social and informal care, apportioned to stroke using patient-level data based on responses from 140,000 participants. Resource use was valued using country-specific unit costs. To allow for meaningful comparisons with the 2018 American Heart Association (AHA) estimates of stroke costs in the USA, costs are reported in US $ adjusted for price differentials and inflation. Results: In 2021, excluding long-term care costs as not included in AHA estimates, stroke cost the EU health care systems $39 billion (2% of health expenditure). Within this total, there was wide variation in per-capita healthcare costs (ranging from $30 in Malta to $177 in Austria), with that for the EU being $87. In the USA, comparable stroke-related healthcare costs accounted for 2% ($35 billion) of US health expenditure, and $108 per capita (comparable to Belgium - $103). In the EU-27, productivity losses due to early mortality were estimated at $8 billion ($19 per capita), compared to $21 billion in the USA ($65 per capita). Long-term nursing home care costs were є21 billion in the EU-27, driving the proportion of total healthcare expenditure due to stroke to 3%. Unpaid care for stroke patients accounted for $38 billion in the EU-27, with absence from work costing the EU economy an additional $4 billion. The total costs of stroke for the EU-27 were $110 billion. Conclusions: This study provides contemporary estimates of the wide-ranging impact of stroke on all aspects of 27 European countries’ economies, allowing for meaningful comparisons with the USA. The data help inform evidence based polices to reduce the impact of stroke, promoting care access and better health outcomes and economic sustainability.

Addressing the Proliferation of Anti-Personnel Mines

Anti-personnel mines, first used in World War II, continue to be a persistent threat to life up to today. With technological advances, landmines have been easily deployed and difficult to detect, and an estimated 25,000 km2 is currently considered contaminated with landmines. Widespread in Egypt, Afghanistan and Iraq, these landmines have resulted in great humanitarian and economic devastation and continue to do so presently. For example, Egypt witnessed 19 casualties per day due to landmines in 2020. Further, given their low cost and ease of use, non-state armed groups (NSAGs) are currently liberally using landmines. Globally, the estimated cost to clear landmines is around $50-$100 billion, with the countries most affected unable to afford these costs. In this study, we discuss the history of use, efforts to curb, and current deployment of landmines. The economic factors connected with anti-personnel mine use are discussed, including the cost associated with procuring and clearing landmines. The multifaceted ways that landmines impact economic growth are detailed, including the cost of emergency and long-term medical care, loss of infrastructure and farmland, and barriers to accessing education, health care, and employment. The study particularly focuses on Afghanistan, Cambodia, Egypt, Iraq, Myanmar and Russia. The role of the International Committee of the Red Cross in assisting victims, building awareness, and supporting governments is discussed. Events from 1939 to the current day are examined, as are the relevant UN treaties and events from the Anti-Personnel Mine Ban Convention, 1997, to the present United Nations Mine Action Strategy (2019-2023). The treaties are discussed in the context of their effectiveness and impact, particularly on NSAGs. Several proposed solutions are presented and examined for their potential feasibility and effectiveness, including awareness building, technological approaches and international coordination. There is an urgent need to bring landmines to our conversation in order to address their continuing threat, and this study aims to do the same.

Variation in direct healthcare costs to health system by residents living in longterm care facilities: a Registry of Senior Australians study.

ObjectiveThis study aimed to examine the national variation in government-subsidised healthcare costs of residents in long-term care facilities (LTCFs) and costs differences by resident and facility characteristics.MethodsA retrospective population-based cohort study was conducted using linked national aged and healthcare data of older people (≥65years) living in 2112 LTCFs in Australia. Individuals' pharmaceutical, out-of-hospital, hospitalisation and emergency presentations direct costs were aggregated from the linked healthcare data. Average annual healthcare costs per resident were estimated using generalised linear models, adjusting for covariates. Cost estimates were compared by resident dementia status and facility characteristics (location, ownership type and size).ResultsOf the 75,142 residents examined, 70% (N=52,142) were women and 53.4% (N=40,137) were living with dementia. The average annual healthcare cost (all costs in $A) was $9233 (95% CI $9150-$9295) per resident, with hospitalisation accounting for 47.2% of the healthcare costs. Residents without dementia had higher healthcare costs ($11,097, 95% CI $10,995-$11,200) compared to those with dementia ($7561, 95% CI $7502-$7620). Residents living in for-profit LTCFs had higher adjusted average overall annual healthcare costs ($11,324, 95% CI $11,185-$11,463) compared to those living in not-for-profit ($11,017, 95% CI $10,895-$11,139) and government ($9731, 95% CI $9365-$10,099) facilities.ConclusionsThe healthcare costs incurred by residents of LTCFs varied by presence of dementia and facility ownership. The variation in costs may be associated with residents' care needs, care models and difference in quality of care across LTCFs. As hospitalisation is the biggest driver of the healthcare costs, strategies to reduce preventable hospitalisations may reduce downstream cost burden to the health system.

WHEN POLICY INTENTIONS GO ASTRAY: THE DEPLOYMENT OF HOME CARE AND HOME SUPPORT MARKET TOOLS IN FRANCE AND QUEBEC

Abstract Using Gingrich’s (2011) typology of welfare markets, this contribution studies the selection and enactment of market tools in two different jurisdictions (France and Quebec). Quebec represents a classic example of a managed market with regional health authorities (CISSS/CIUSSS) seeking the lower the cost of long-term care by contracting services to community groups and the private sector. These contractual agents have gradually replaced health and social care professionals within the public system. France has opted to enact a consumer driven market with the introduction of the allocation personnalisée d’autonomie (APA) which provides cash benefits to eligible older adults who can then select the provider of their choice. Both of these market reforms are compared and analyzed across three types of territories : rural (Finistère and Bas-St-Laurent), urban (Paris and Montreal), and in industrial decline (Somme and Mauricie). Despite operating within highly differentiated long-term care policy frameworks and market tools, both jurisdictions face similar difficulties in the enactment of market mechanisms. For instance, rural territories fail to generate sufficient providers to develop a market where a regional health authority (Quebec) or older adults (France) can actually select a provider and negotiate terms of service. Public authorities must then intervene to generate market-like conditions. Regardless of the jurisdiction, the conceptualization of market mechanism has clearly an urban setting in mind making them ill-suited for other environment and there is gradual movement towards the development of austerity market where individuals are forced to seek alternatives beyond the market tools deployed by governments.

Long-term health care resource and cost savings with allergy immunotherapy: REACT study results

Allergy immunotherapy (AIT) can be administered as subcutaneous immunotherapy (SCIT) injections in the clinic or as sublingual immunotherapy (SLIT) tablets at home after initiation under medical supervision. To achieve long-term, sustained effects, a 3-year treatment duration is recommended. Our aim was to assess the association of AIT (SCIT and SLIT tablets) with long-term health care resource use (HRU) and costs in subjects with allergic rhinitis. REACT was a retrospective propensity score-matched cohort study using claims data from a German health insurance database (2007-2017), with up to 9 years of follow-up after AIT initiation. HRU and costs were evaluated for hospitalizations, ambulatory care visits, and prescriptions, in subjects who received AIT versus in matched controls with allergic rhinitis who had not received AIT, as well as for SCIT and SLIT tablets. Across all 9 years, the subjects who received AIT had a significantly lower incidence of hospitalization than the controls did. Generally, proportions of subjects with ambulatory care visits and hospitalizations were lower, and length of hospitalization was shorter, for those receiving SLIT tablets than those who received SCIT. Total costs were significantly higher with AIT versus for the controls during the treatment period (years 1 to 3), driven by prescriptions and ambulatory care visits, but they were lower in years 4 to 9. During years 1 to 3, prescription costs were generally higher for SLIT tablets than for SCIT, whereas ambulatory care costs were numerically lower. In most years, hospitalization costs were numerically lower for SLIT tablets than for SCIT. Initial higher HRU and costs of AIT during the expected treatment period are offset in the long term. At-home administration of SLIT tablets may further reduce ambulatory care costs.

Abstract 12085: Emergency Heart Failure Mortality Risk Grade (EHMRG) Score Quintiles Correlate With Short and Long-Term Healthcare Costs

Introduction: The use of the EHMRG model in the emergency department (ED) has been demonstrated to improve outcomes for patients presenting with acute heart failure (HF). It is unknown if the EHMRG model also correlates with healthcare costs, which has not been examined in other HF risk models. Hypothesis: We hypothesized that patients with higher EHMRG risk scores, i.e., sicker, would have higher costs of care in short-term (30-day) and longer-term (up to 2 year) time horizons. Methods: We examined direct costs of care from a health payer perspective using the original EHMRG derivation cohort of 11,857 patients hospitalized with acute HF in Ontario, Canada (from 2004) and linking to population-based case-costing databases. Costs were stratified by the quintiles of the EHMRG risk score (Q1 = lowest risk, Q5 = highest risk). Costs (in 2021 Canadian dollars) were categorized into hospital, physician, drug, home care, long term care (LTC), and other costs. Results: Patients in the lowest EHMRG risk quintile (Q1), compared to higher quintiles (Q2-Q5) had lower total cost of care in both the short-term ($8,113 vs $9,442, $10,557, $12,078 and $15,005, p <0.001) and long-term ($46,661 vs $55,904, $58,904, $63,286 and $64,229, p<0.001). This positive correlation between EHMRG risk quintile and cost of care was also observed for hospital costs ($26,388 [Q1] vs $35,659 [Q5], p<.0001) and LTC costs ($1,236 [Q1] vs $6,316 [Q5], p<.0001) at all time intervals, including at 2 years shown here. Physician costs and drug costs were positively correlated with EHMRG risk quintiles at 30 days (physician: $1,241 [Q1] vs $1,762 [Q5], p<0.0001; drug: $219 [Q1] vs $282 [Q5], p<.0001), and negatively correlated at 2 years (physician: $7,943 [Q1] vs $7,175 [Q5], p<.0001; drug: $4,539 [Q1] vs $4,377 [Q5], p<.0001). There was an increasing trend of costs irrespective of the formulation of the EHMRG risk score as 7-day risk quintile, 30-day risk quintile, or 30-day risk tertile. Conclusion: The EHMRG7 risk score was positively correlated with healthcare costs from 30 days to 2 years after initial ED presentation. This novel correlational study demonstrated that in the absence of an associated intervention, higher mortality risk in HF patients portends higher costs in short and long-term follow-up.

Abstract 15055: Annual Healthcare Costs After Acute Pulmonary Embolism: Results From a Prospective Multicenter Cohort Study

Introduction: Analysis of administrative data has helped to determine hospitalization costs related to acute pulmonary embolism (PE) in several countries, but estimating long-term costs of patient care after discharge is a more challenging task. Aims: To determine the direct annual costs related to the care of PE survivors based on data from a longitudinal cohort study performed at 17 German large-volume hospitals. Methods: The Follow-up of Acute Pulmonary Embolism (FOCUS) study enrolled unselected patients with acute PE. In addition to a structured ambulatory follow-up (FU) program (Figure) , we prospectively recorded duration and type of anticoagulation and the main and accompanying causes of all rehospitalizations during the first year of FU. Annual per-patient costs of post-PE care were calculated in 2022 euro (є) and converted to US$ adjusting for purchase parity power. Results: A total of 1,017 patients (45% women; median age 64 years [IQR, 52-74]) were included. Average costs of scheduled ambulatory FU visits and tests were estimated at є136.37 ($189.40) per patient; costs of oral anticoagulation after hospital discharge for the index event amounted to є827.72 ($1,149.61). The annual all-cause hospitalization rate was 31.96% (95% CI, 28.0-35.91%); the Table shows the primary indications and mean hospital costs (overall, and per indication). Of the є1,104.48 ($1,534.0) average rehospitalization costs per patient, 8.9% were related to recurrent thrombosis/PE or bleeding. Conclusions: Our results, derived from the population of a prospective multicenter study, help to dissect the direct annual costs of chronic post-PE care and may inform ambulatory care programs.