Lower Healthcare Resource Research Articles

Is there a role for APD in countries with low healthcare resources?

Is there a role for APD in countries with low healthcare resources?

COVID-19 outbreaks surveillance through text mining applied to electronic health records

BackgroundThe COVID-19 pandemic has caused significant disruptions to everyday life and has had social, political, and financial consequences that will persist for years. Several initiatives with intensive use of technology were quickly developed in this scenario. However, technologies that enhance epidemiological surveillance in contexts with low testing capacity and healthcare resources are scarce. Therefore, this study aims to address this gap by developing a data science model that uses routinely generated healthcare encounter records to detect possible new outbreaks early in real-time.MethodsWe defined an epidemiological indicator that is a proxy for suspected cases of COVID-19 using the health records of Emergency Care Unit (ECU) patients and text mining techniques. The open-field dataset comprises 2,760,862 medical records from nine ECUs, where each record has information about the patient’s age, reported symptoms, and the time and date of admission. We also used a dataset where 1,026,804 cases of COVID-19 were officially confirmed. The records range from January 2020 to May 2022. Sample cross-correlation between two finite stochastic time series was used to evaluate the models.ResultsFor patients with age ≥18 years, we find time-lag (τc\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ au_c$$\\end{document}) = 72 days and cross-correlation (p^ij\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\widehat p}_{ij}$$\\end{document}) ~0.82, τc\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ au_c$$\\end{document} = 25 days and p^ij\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\widehat p}_{ij}$$\\end{document} ~0.93, and τc\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ au_c$$\\end{document} = 17 days and p^ij\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\widehat p}_{ij}$$\\end{document} ~0.88 for the first, second, and third waves, respectively.ConclusionsIn conclusion, the developed model can aid in the early detection of signs of possible new COVID-19 outbreaks, weeks before traditional surveillance systems, thereby anticipating in initiating preventive and control actions in public health with a higher likelihood of success.

Primary headaches prevalence, characteristics, and healthcare utilization in Italian medical students.

Among university students, migraine is notably prevalent and is linked to compromised academic performance and daily functioning. Medical students are a particularly vulnerable category due to the demanding nature of their training, as they are often exposed to headache trigger factors. We therefore aimed to determine the prevalence, characteristics, and healthcare-seeking practices of primary headaches among Italian medical students. We conducted a cross-sectional study among medical students attending the Università Cattolica del Sacro Cuore in Rome who completed a self-administered questionnaire designed following the International Classification of Headache Disorders-3 criteria. The questionnaire assessed sociodemographic and headache features, healthcare utilization, the use of symptomatic andpreventive treatment, and headache trigger factors. Five hundred thirty-six students filled out the questionnaire. The lifetime and last-year prevalence of headache in this cohort was 76.7% (n = 411). Among the students surveyed, migraine had a prevalence of 26.9%, probable migraine of 12.9%, and tension-type headache (TTH)/probable TTH of 36.9%. Two hundred and forty-six students (59.8%) reported that their headache worsened after starting university. All students reporting headache had at least one trigger factor. In students fulfilling the criteria for migraine (n = 144), 137 (95.1%) had previously used acute non-prescription treatments, and eight concurrently useda preventive treatment. Thirty-five students fulfilling the criteria for migraine underwent a brain MRI scan (24.3%), 43 performed a neurological evaluation (29.9%), 36 received a diagnosis of migraine (25%), and 20 (13.9%) accessed the emergency room. Migraine and TTH are common among medical students in Italy despite low healthcare resource utilization. These results support the need to promote public health policies and strategies in order to reduce the disability and burden associated with primary headaches among medical students.

Patient-Reported Outcomes Among Adults with Hemophilia A on Prophylactic Treatment

Background: People with hemophilia A (PwHA) face unique challenges in managing their condition, which can impact health-related quality of life. Those who are receiving optimal prophylactic treatment may be able to overcome some of these challenges. Measuring patient-reported outcomes (PROs) could help clinicians and PwHA understand the impact of prophylaxis. Methods: This was a survey designed to assess PROs in adult PwHA receiving prophylactic treatment with either emicizumab or factor VIII (FVIII) replacement therapy. Respondents were recruited through the membership of the Hemophilia Federation of America. To facilitate descriptive comparisons between the experiences of PwHA on either of the two prophylaxis regimens, PwHA with inhibitors were not included. Survey questions focused on outcomes related to healthcare resource use (clinic and emergency department [ED] visits), out-of-pocket expenses, and employment status. Responses are reported in counts and proportions or means with standard deviations (SD). Results: A total of 114 PwHA (60 who reported taking emicizumab and 54 taking FVIII for prophylaxis) responded to the survey. Among them, 89 (78%) received their care at 38 different Hemophilia Treatment Centers across the US. Characteristics of survey respondents are reported in Table 1. Of note, among those receiving emicizumab, 51 (85%) had severe, 7 (12%) had moderate, and 2 (3%) had mild hemophilia A. Among those receiving FVIII, 39 (72%) had severe, 10 (19%) had moderate, and 5 (9%) had mild disease. When asked about healthcare resource use over the past 6 months, PwHA receiving emicizumab reported a mean (SD, range) of 1 (0.9, 0 to 5) clinic visit and 0.1 (0.4, 0 to 2) ED visit, while those receiving FVIII prophylaxis reported a mean of 1.2 (1.4, 0 to 10) clinic visits and 0 (0.2, 0 to 1) ED visits. When asked about out-of-pocket expenses, 19 (32%) of respondents receiving emicizumab and 18 (33%) of those receiving FVIII reported having none. The highest average (SD) hemophilia-related out-of-pocket expenses included lodging (emicizumab vs FVIII: $62 [98] vs $363 [1,997]), over-the-counter medication ($49 [83] vs $125 [433]), prescription medication ($24 [52] vs $58 [249]), and childcare ($27 [44] vs $35 [70]). When asked questions about employment, 22 (37%) of respondents receiving emicizumab and 27 (50%) of those receiving FVIII prophylaxis reported that hemophilia had no impact on their professional or work life. Conversely, 17 (28%) of respondents receiving emicizumab and 17 (32%) of those receiving FVIII reported changing their line of work or career due to hemophilia. Notably, 13 (22%) and 12 (22%) reported having to take a job that offered good health insurance, among those receiving emicizumab and FVIII prophylaxis, respectively. Conclusions: In this survey PwHA receiving prophylactic treatment reported low healthcare resource use, variable out-of-pocket expenses, and a spectrum of hemophilia-related impacts on employment. This study highlights the heterogeneity of experiences among PwHA and potential opportunities for optimization of the patient experience with prophylactic treatment. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Adalimumab Is Associated With Lower Healthcare Resource and Steroid Use Versus Vedolizumab in Biologic-Naive Crohn's Disease: A Retrospective Claims Database Analysis.

We compared real-world healthcare resource utilization (HRU), Crohn's disease (CD)-related complications, and time to systemic corticosteroid discontinuation between patients with CD treated with adalimumab versus vedolizumab as initial biologic. Biologic-naïve adults with CD and ≥2 claims between 05/20/2014 and 09/30/2019 for adalimumab or vedolizumab were identified in the IBM MarketScan research database. Patient characteristics were assessed during the 6-month baseline period before biologic initiation (index date). Adalimumab- and vedolizumab-treated patients were propensity score-matched 1:1 on demographics, disease characteristics, and comorbidities with ≥10% prevalence that differed significantly between groups. Categorical, continuous, and time-to-event outcomes between groups during the 12-month follow-up on/after index were compared with chi-square tests, Wilcoxon rank-sum tests, and Kaplan-Meier analyses, respectively. Adalimumab- and vedolizumab-treated patients were matched (n = 461 per group) and baseline characteristics balanced. Significantly fewer adalimumab- versus vedolizumab-treated patients had a CD-related emergency room visit (12-month proportion: 14.5% vs 21.0%; log-rank P < 0.01) or inpatient admission (14.9% vs 20.2%; log-rank P < 0.05). Rates of CD-related surgeries were similar (9.3% vs 11.5%; log-rank P = 0.282). Among patients without internal/perianal abscess or fistula or intestinal stricture at baseline (N ADA = 360, N VDZ = 364), numerically but not significantly fewer adalimumab- versus vedolizumab-treated patients had CD-related complications at 12 months (18.3% vs 22.3%; P = 0.171). Among patients with corticosteroid use at index (N ADA = 143, N VDZ = 139), significantly more adalimumab- versus vedolizumab-treated patients discontinued corticosteroids (12-month proportion: 90.2% vs 76.3%; log-rank P < 0.001). Patients with CD treated with adalimumab as their first biologic experienced significantly lower CD-related HRU and were more likely to discontinue corticosteroids compared to vedolizumab-treated patients.

The impact of bone mineral density screening on incident fractures and healthcare resource utilization among postmenopausal breast cancer survivors treated with aromatase inhibitors

Postmenopausal women with hormone receptor-positive breast cancer (BC) often receive aromatase inhibitor (AI) therapy. However, AIs induce bone loss and BC survivors are at an increased risk of bone fractures. This study determined whether receipt of baseline dual-energy x-ray absorptiometry (DXA) screening is associated with decreased incident fractures and lower healthcare resource utilization. We retrospectively analyzed 22,713 stage 0-III primary BC survivors who received AI therapy ≤ 1year prior to BC diagnosis from the Medicare-Linked Surveillance, Epidemiology, and End-Results database. We categorized DXA screening for those who had a procedural claim within 12months prior through 6months after first AI claim. We used propensity score methods to assess the association of DXA screening with bone fractures and health resource utilization. Of the study cohort, 62% received a DXA screening. Women with comorbid dementia, renal disease, and congestive heart failure were less likely to receive a DXA. After adjusting for confounders, BC survivors who received a DXA had a 32% decreased risk of any bone fracture compared to those who did not (hazard ratio (HR): 0.68, 95% confidence interval (CI): 0.60-0.76, p < 0.001). Similarly, those who received a DXA were less likely to be hospitalized (HR 0.73 (0.62-0.86)) or use outpatient services (HR 0.85 (0.74-0.97)). Bone density screening is associated with decreased incident bone fractures and a lower likelihood of utilizing healthcare resource for fracture-related events. Postmenopausal BC survivors treated with AIs should undergo appropriate bone density screening to reduce morbidity, mortality, and health care expenses.

Achieving Lower LDL-C Levels After a Recent Myocardial Infarction Might Be Associated with Lower Healthcare Resource Use and Costs in Spain.

IntroductionThere is little evidence on the relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels and costs in patients on lipid-lowering therapy (LLT). We described healthcare resource use and costs (direct and indirect) by achieved LDL-C in patients receiving LLT after a recent myocardial infarction (MI) in Spain.MethodsThis was a retrospective observational study of anonymized electronic medical records from seven regions in Spain (BIG-PAC® database; n = 1.9 million). Eligible patients were adults (≥ 18 years) hospitalized for an MI between January 2015 and December 2017, treated with a statin and/or ezetimibe, and having recorded LDL-C values at baseline and during follow-up. Healthcare resource use and direct and indirect costs (in 2018, €) were described by achieved LDL-C levels during a follow-up of 18 months.ResultsOf 6025 patients (mean age, 69.7 years; 77% male), only 11% achieved LDL-C goals as defined in the 2016 ESC/EAS guidelines (< 70 mg/dL), and just 1% reached the lower target (< 55 mg/dL) in the current 2019 guidelines. Achieving lower LDL-C levels translated to lower healthcare resource use and costs. Mean total (direct and indirect) costs ranged from €5044 for patients with LDL-C < 55 mg/dL to €7567 for patients with LDL-C ≥ 130 mg/dL.ConclusionVery few patients achieved recommended LDL-C goals despite using LLT. Achieving lower LDL-C levels after an MI might be associated with lower healthcare resource use and costs. Use of more intensive LLT, leading to greater reductions in LDL-C, could therefore be beneficial both from a clinical and an economic perspective.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02187-1.

Resource utilization and total cost of care among Medicare advantage patients with metastatic pancreatic cancer receiving NCCN category 1 preferred regimens.

531 Background: Medicare Advantage accounts for almost 40% of Medicare beneficiaries in 2021. There is limited research evaluating utilization and cost for Medicare Advantage patients with metastatic pancreatic cancer (m-PANC) receiving various NCCN Category 1 preferred regimens. Methods: We used ICD-10 diagnosis codes to identify patients with m-PANC without end-stage renal disease in the 2016-2019 Milliman Consolidated Health Cost Guidelines Sources Database (CHSD) claims files. Study patients had 2+ claims with a pancreatic cancer diagnosis and Medicare Advantage coverage for 3 months pre- and 1 month post-metastasis diagnosis. Patients with stand-alone Part D plan coverage or aged&lt;65 years were excluded. Total cost of care (TCOC) was the sum of the average paid by the insurer and patient. Study patients were treated with NCCN Category 1 preferred regimens: 1L gemcitabine/nab-paclitaxel (gem/nab), 1L gemcitabine monotherapy (gem mono), 1L FOLFIRINOX (FFX), and 2L+ liposomal irinotecan (5FU was not included in this analysis; see Limitations for further details). Results: Of the approximately 2.5 million patients covered by Medicare Advantage in CHSD, there were 946 patients that received an NCCN Category 1 chemotherapy regimen between 2016 and 2019. Among NCCN Category 1 preferred regimens, patients receiving 2L+ liposomal irinotecan had the lowest mean admissions per beneficiary and mean readmission rate (0.5 and 8%) compared to patients receiving gem/nab (0.8 and 12%), gem mono (0.6 and 8%), or FFX (0.6 and 9%). Patients receiving 2L+ liposomal irinotecan also had the shortest length of stay per inpatient admission in days (2.9) compared to patients receiving gem/nab (5.1), gem mono (3.6), or FFX (4.3). Mean claims per beneficiary for emergency department observations was lowest among patients receiving 2L+ liposomal irinotecan (0.7), compared to patients receiving gem/nab (0.9), gem mono (1.0), or FFX (0.89). Patients receiving 2L+ liposomal irinotecan had lower median TCOC ($31,885) than patients receiving gem/nab ($39,479) or FFX ($32,632). Conclusions: Patients with Medicare Advantage receiving 2L+ liposomal irinotecan-based regimens to treat m-PANC had lower healthcare resource utilization in key categories and lower median total costs than patients receiving other NCCN Category 1 preferred regimens. Limitations: Analysis of different populations or time periods may yield different results. Our study used claims data and not electronic health records (EHRs), so we could not control for clinical covariates. Patient characteristics and regimen performance might influence which regimens patients receive. We did not adjust TCOC or utilization for LOT durations. We did not study whether liposomal irinotecan-based therapy patients received concomitant 5FU or prior gemcitabine-based therapy.

Clinical and Patient Reported Outcomes of Pre- and Postsurgical Treatment of Symptomatic Uterine Leiomyomas: A 12-Month Follow-up Review of TRUST, a Surgical Randomized Clinical Trial Comparing Laparoscopic Radiofrequency Ablation and Myomectomy

The objective of this study was to determine the efficacy, safety, and healthcare resource use of laparoscopic radiofrequency ablation (LAP-RFA) compared with myomectomy in patients with symptomatic uterine leiomyomas (ULs). This was a secondary analysis of the original postmarket randomized, multicenter, longitudinal, comparative TRUST (Treatment Results of Uterine Sparing Technologies) United States trial in patients with symptomatic ULs. After the procedure, subjects were followed over a 12-month period. Multicenter trial, including hospitals with or without an academic affiliation, surgery centers, and fertility centers performing outpatient procedures for uterine myomas. A total of 57 patients were randomized to either LAP-RFA (n=30) or myomectomy (n=27). LAP-RFA or myomectomy (laparoscopic or abdominal). The main outcome measures of this study were part of the secondary outcomes of the original TRUST trial. The primary outcome of this study was the reduction of UL symptoms and the improvement in patient-reported outcomes scores over time. Secondary outcomes included postprocedure hospitalization, length of stay, complications, reinterventions, and recovery time. There was a significant improvement in UL symptoms at 3 and 12 months after the procedure within each treatment group, and these improvements were similar between treatment groups. There was a significant reduction in UL symptoms per month between baseline and 12-months after the procedure for both LAP-RFA and myomectomy of 72% and 85%, respectively. A significant improvement was seen in all patient-reported outcomes scores over time for both groups. At 3 and 12 months after the procedure, the percentages of patients who were hospitalized in the LAP-RFA group were 74% and 49% lower than those of patients in the laparoscopic myomectomy group, respectively, with the 3-month difference being statistically significant. The length of hospital stay was significantly shorter in the LAP-RFA group compared with the myomectomy group (8.0 ± 5.7 hours vs 18.8 ± 14.6 hours; p < .05). Doctors recommended taking significantly less time off before returning to work for the patients in the LAP-RFA group compared with those in the myomectomy group (10.3 ± 5.1 days vs 14.5 ± 5.4 days; p < .05). The total number of days until back to normal activity was significantly lower in the LAP-RFA group compared with the myomectomy group (16.3 ± 15.2 days vs 26.5 ± 15.9 days; p < .05). The results from this 12-month follow-up study suggest that LAP-RFA is a safe, effective, uterine-sparing alternative to laparoscopic myomectomy in the treatment of ULs. These data points build on previously published studies showing that LAP-RFA has lower healthcare resource use overall, including lower postprocedure hospitalization rate and shorter length of stay. In clinical practice, LAP-RFA is a promising treatment approach to ULs for women.

Hospitalisation and mortality from COVID-19 in Mexican indigenous people: a cross-sectional observational study

BackgroundDespite having a large indigenous population, little is known about the differences in COVID-19-related health outcomes between indigenous and non-indigenous patients in Mexico. The aim of this study is to...

Cost-Effectiveness of Peer-Educator-Delivered Lifestyle Modification for Type 2 Diabetes Prevention in a Young Healthy Population in Sri Lanka: A Trial-Based Economic Evaluation and Economic Model.

BackgroundThis study evaluated the cost effectiveness of an intensive lifestyle modification (LSM) intervention delivered by peer educators for the prevention of type 2 diabetes mellitus in a young at-risk population in a low healthcare resource setting.ObjectiveThe aim of this study was to evaluate the short-term and long-term cost effectiveness of an intensive lifestyle modification intervention for type 2 diabetes prevention in a young urban at-risk population in Sri Lanka.MethodsThis was an economic evaluation using cost and outcome data from a randomized controlled trial. We randomized 3539 healthy individuals aged 5–40 years with risk factors for type 2 diabetes to either 3-monthly (P-LSM n = 1727) or 12-monthly (C-LSM n = 1812) peer-educator advice aimed at reducing weight, improving diet, reducing psychological stress and increasing physical activity. A cost-effectiveness analysis was conducted from a health system perspective with outcomes expressed as disability-adjusted life-years (DALYs). Intervention costs and outcomes were collected during a median clinical trial period of 3 years and extrapolated to a lifetime horizon using economic modelling. Uncertainty in the lifetime model was explored by structural and probabilistic sensitivity analyses.ResultsThe costs of the more intensive peer support programme were partially offset by reduced costs of type 2 diabetes complications recorded over the trial period and completely offset by lifetime cost savings of 6000 LKR. The more intensive P-LSM also averted more DALYs, estimated at 0.456 DALYs over the lifetime of participants.ConclusionsIn a young at-risk Sri Lanka population, an intensive LSM programme was cost effective, averting more DALYs at an acceptable additional cost than a much less intensive LSM programme. Early intervention in young at-risk people represents good value for money from the Sri Lankan health care payer perspective.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-021-00284-5.

Issues and challenges for urban development in Indian cities post pandemic: A case of Jaipur

The greatest challenge the whole world is facing currently is how urban development can be processed based on COVID -19 pandemic can be addressed. A country like India which has low healthcare resources, large population of poor people, many of whom are already burdened with other health issues, pose challenges on every dimension. Numerous problems like overcrowding, pollution, housing shortage, proliferation of slums, inefficient infrastructure, increased instances of disasters, unhealthy living conditions, shortage of open spaces, etc. are the major cause of concern in most of the Indian cities. As a result, severe outbreaks of major epidemics have been observed in the past, which led to a huge loss of resources and human life. Thus, it is important to understand the appropriateness of present trends of urban planning and development. “COVID-19” has spread ruthlessly in major Indian cities due to the high population densities and shared sanitation facilities, thus affecting millions of people. Considering “Jaipur” as a case study, the 10th largest city of India, known for its trade and commerce has been affected tremendously due to pandemic and has experienced enormous loss of human life and economic resources. Thus, it is imperative to understand the various urban problems faced by cities, which has increased the vulnerability to the pandemic and has facilitated its spread. This paper investigates various urban problems faced by Indian cities in general and specific to the context of Jaipur, which facilitates the spread of Pandemic. Hence, proposing various urban planning measures in order to cope up with the challenges arising in urban development of Indian cities to be able to cater to such situation.

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

BackgroundFirst-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the...

Incremental Risk of Developing Severe COVID-19 Among Mexican Patients With Diabetes Attributed to Social and Health Care Access Disadvantages.

OBJECTIVEDiabetes is an important risk factor for severe coronavirus disease 2019 (COVID-19), but little is known about the marginal effect of additional risk factors for severe COVID-19 among individuals with diabetes. We tested the hypothesis that sociodemographic, access to health care, and presentation to care characteristics among individuals with diabetes in Mexico confer an additional risk of hospitalization with COVID-19.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional study using public data from the General Directorate of Epidemiology of the Mexican Ministry of Health. We included individuals with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 between 1 March and 31 July 2020. The primary outcome was the predicted probability of hospitalization, inclusive of 8.5% of patients who required intensive care unit admission.RESULTSAmong 373,963 adults with COVID-19, 16.1% (95% CI 16.0–16.3) self-reported diabetes. The predicted probability of hospitalization was 38.4% (37.6–39.2) for patients with diabetes only and 42.9% (42.2–43.7) for patients with diabetes and one or more comorbidities (obesity, hypertension, cardiovascular disease, and chronic kidney disease). High municipality-level of social deprivation and low state-level health care resources were associated with a 9.5% (6.3–12.7) and 17.5% (14.5–20.4) increased probability of hospitalization among patients with diabetes, respectively. In age-, sex-, and comorbidity-adjusted models, living in a context of high social vulnerability and low health care resources was associated with the highest predicted probability of hospitalization.CONCLUSIONSSocial vulnerability contributes considerably to the probability of hospitalization among individuals with COVID-19 and diabetes with associated comorbidities. These findings can inform mitigation strategies for populations at the highest risk of severe COVID-19.

Age, neutrophil lymphocyte ratio, and radiographic assessment of the quantity of lung edema (RALE) score to predict in-hospital mortality in COVID-19 patients: a retrospective study

Background: Case fatality rate of COVID-19 patients in Surabaya is higher than global cases. Thus, it is important to identify risk factors to reduce the mortality rate. This study aimed to assess the factors associated with hospital mortality of COVID-19 patients, and develop a prediction score based on these findings. Methods: We analyzed 111 patients, who were diagnosed with COVID-19 based on reverse-transcriptase polymerase chain reaction. The following patient characteristics were obtained from records: age, gender, type of symptoms, onset of symptoms, neutrophil lymphocyte ratio (NLR), absolute lymphocyte count, chest x-ray abnormalities, lung involvement, type of lesion, radiographic assessment of the quantity of lung edema (RALE) score, and mortality. Data were analyzed using SPSS 25.0. Results Multivariate analysis showed that age >50 years ( p=0.043), NLR score >5.8 ( p=0.016) and RALE score >2 ( p=0.002) can predict the mortality of COVID-19 patients in the hospital. ROC curve analysis of the score ability to predict mortality showed an area under the curve of 0.794. The cut-off point is 4.5, with a sensitivity of 96.7% and specificity of 49.4% to predict the mortality of COVID-19 patient in the hospital. Conclusions Age, NLR score and RALE score were associated with mortality of COVID-19 patients in the hospital and could be used as a predictor for discharge probability of COVID-19 patients in low health care resource setting. The prediction score may be useful for frontline physicians to effectively manage patients with a higher score to prevent mortality.

Pandemic Policy in Developing Countries: Recommendations for India

Each country faces unique challenges in addressing the COVID-19 pandemic India’s relatively low healthcare resources, limited state capacity, and large populat

DOP19 Real-world healthcare resource utilisation among patients with inflammatory bowel disease administered vedolizumab for 6 months

Abstract Background Inflammatory bowel disease (IBD) is associated with high healthcare resource utilisation. Vedolizumab (VDZ) is a gut-selective monoclonal antibody that binds the α4β7 integrin and is indicated for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) or Crohn’s disease (CD). We investigated real-world healthcare resource utilisation for these patients in the 6 months after initiating VDZ treatment. Methods This retrospective, non-interventional, cohort study examined healthcare resource utilisation for adults with IBD treated with VDZ at Mt Sinai Medical Center (New York, NY) between June 1, 2014, and May 31, 2019. IBD-related healthcare resource utilisation (emergency room [ER] visits, hospitalisations, procedures, corticosteroids) and VDZ treatment patterns (induction, persistence, adherence) were assessed for 6 months after first VDZ infusion. Discontinuation was defined as a ≥90-day gap between infusions or stopping VDZ treatment &amp;lt;6 months after the first infusion. Patients who had ≥90-day gaps were not counted as discontinuing if they experienced clinical benefit that continued beyond the 6-month period. Results 880 patients treated with VDZ were assessed. Mean age was 39.6 years; 51.6% of patients were female. 369 (41.9%) and 504 (57.3%) patients were diagnosed with CD and UC, respectively. 81.4% of patients received 3 VDZ induction doses by Day 98; 69.0% received 4 doses by Day 120. The rates of ER visits, hospitalisations and elective surgical or urgent hospitalisations and procedures among VDZ-treated patients were &amp;lt;1 per 100 pt–months. Steroids (oral or IV) were prescribed to 42.2% of patients during the 6-month period. In the 2 months after their last infusion, 81.6% of patients who received ≥3 VDZ doses were steroid-free. Timing of the last infusion was variable. Overall VDZ persistence was 68.0% (65.0% and 70.2% for CD and UC, respectively; Figure). Most patients (67.2%) had ≥80% of days covered in a 180-day period Conclusion At a tertiary IBD centre, VDZ was associated with low healthcare resource utilisation during the first 6 months of treatment. More than two-thirds of patients persisted with treatment, with most being steroid-free at last follow-up.

Understanding and Addressing the Treatment Gap in Mental Healthcare: Economic Perspectives and Evidence From China.

A common challenge faced by the healthcare systems in many low- and middle-income countries is the substantial unmet mental healthcare needs, or the large gap between the need for and the provision of mental healthcare treatment. This paper investigates the potential causes of this treatment gap from the perspective of economics. Specifically, we hypothesize that people with mental illness face 4 major hurdles in obtaining appropriate healthcare, namely the high nonmonetary cost due to stigma, the high out-of-pocket payment due to insufficient public funds devoted to mental health, the high time costs due to low mental healthcare resource availability, and the low treatment benefit due to slow technology diffusion. We use China as a study setting to show country-specific evidence. Our analysis supports the above theoretical argument on the 4 barriers to access, which in turn sheds light on the effective approaches to mitigate the treatment gap. Four policy options are then discussed, including an information campaign for mental health awareness, increasing public investment in primary mental healthcare resources, transforming the healthcare system towards an integrated people-centered system and capitalizing on e-health technologies.

DU1 - Early Initiation of Long-Acting Injectable Antipsychotic Treatment is Associated with Lower Healthcare Resource Use and Costs in Patients with Schizophrenia

To determine if early initiation of long-acting injectable (LAI) antipsychotic treatment is associated with lower healthcare resource use and cost in patients with schizophrenia. This retrospective cohort analysis used 9.5 years of claims data (1/1/2007–6/30/2016) from Truven Health MarketScan® Commercial, Medicaid, and Medicare Supplemental databases. In patients ≥18 years with a new episode of schizophrenia, two mutually exclusive cohorts were identified based on time from date of first schizophrenia diagnosis (the new episode) to first date of starting a LAI (index date): ≤1 year (early initiators) and >1 year (late initiators). Patients were required to have continuous enrollment between the new episode of schizophrenia and LAI initiation and for ≥1 year before (baseline) and after (follow-up) index date. Logistic and general linear regression models were performed to estimate the adjusted hospitalization rate and healthcare costs, controlling patient demographic and clinical characteristics, insurance type, baseline all-cause hospitalizations and emergency department visits, and baseline psychiatric medication use (including oral antipsychotic use). 31% (n=1,388) initiated treatment early and 68% (n=2,978) initiated later. In risk-adjusted models, all-cause hospitalization rates were 22.1% (95%CI, 19.8%-24.5%) in early initiators and 26.9% (95%CI 25.2%-28.7%) in late initiators (p<0.001). 14.0% (95%CI, 12.2%-16.0%) of early initiators had a psychiatric hospitalization compared with 19.2% (95%CI 17.7%-20.8%) of late initiators (p<0.001). Adjusted psychiatric healthcare costs were significantly lower in early initiators compared with late initiators [mean (95%CI) $21,337 (20,135-22,539) vs. $24,228 (23,419-25,038)] (p<0.001). Adjusted all-cause healthcare costs were lower in early initiators compared with late initiators [mean (95%CI) $34,661 (32,531-36,791) vs. $36,342 (34,907-37,777)], but the difference was not statistically significant (p=0.21). Schizophrenia patients who initiated a LAI early had lower hospitalization rates and healthcare costs compared with late LAI initiators.

PMH25 - Quality of Life and Healthcare Resource Use in Patients With Major Depressive Disorder In China: Results From the Proact Study

Major depressive disorder (MDD) is associated with significant disability and poor quality of life (QoL) (1). It is the second leading cause of years lived with disability in China (2). Few studies have examined QoL beyond the acute or short-term maintenance phase. This study examined short- and long-term QoL and healthcare resource use in patients initiating antidepressant treatment. The Prospective Research Observation to Assess Cognition in Treated MDD patients (PROACT) is a non-interventional, prospective, multi-site study of Chinese MDD outpatients, aged 18–65 years, initiating new antidepressant monotherapy at Baseline with follow-up at Months 1, 2 and 6. Hamilton Depression Rating Scale – 17 Items (HAM-D17), Digit Symbol Substitution Test (DSST), EuroQoL five Dimensions (EQ-5D) and healthcare resource use were collected at each visit. The analysis population included patients with DSST assessment at both Baseline and Month 2 visits. Data were summarised descriptively. Of 1008 patients enrolled, 666 (66.1%) completed the study. 598 patients were included in the analyses. At Baseline, mean (SD) age was 36.5 (±12.0) years. 42.6% patients had previous depressive episodes. Mean (SD) HAM-D17 total score was 23.3±4.4 points. 34.6% and 64.5% patients were in remission (HAM-D17 ≤ 7) at Month 2 and 6 respectively. Mean (SD) EQ-5D utility was 0.74±0.14 at Baseline, while 0.93±0.09 versus 0.82±0.13 at Month 2, and 0.95±0.08 versus 0.81±0.14 at Month 6 for patients in remission compared to patients not in remission. Lower proportions of patients in remission compared to patients not in remission had seen a psychiatrist since Baseline at Month 2 (57.1% versus 64.4%) and since last visit at Month 6 (56.5% versus 63.0%). Same pattern was seen for non-psychiatric physician visits. Less than 2% of patients were hospitalised. Patients achieving remission reported better QoL and had lower healthcare resource use compared to patients not in remission.