Major Healthcare Costs Research Articles

Virtual versus usual in-office care for multiple sclerosis: The VIRTUAL-MS multi-site randomized clinical trial study protocol

BackgroundMultiple sclerosis (MS) affects nearly 1 million people and is estimated to cost $85.4 billion in the United States annually. People with MS have significant barriers to receiving care and telemedicine could substantially improve access to specialized, comprehensive care. In cross-sectional analyses, telemedicine has been shown to be feasible, have high patient and clinician satisfaction, reduce patient costs and burden, and enable a reasonable assessment of disability. However, no studies exist evaluating the longitudinal impact of telemedicine care for MS. Here we describe the study protocol for VIRtual versus UsuAL In-office care for Multiple Sclerosis (VIRTUAL-MS). The main objective of the study is to evaluate the impact of telemedicine for MS care on: patient clinical outcomes, economic costs, patient, and clinician experience. MethodsThis two-site randomized clinical trial will enroll 120 adults with a recent diagnosis of MS and randomize 1:1 to receive in-clinic vs. telemedicine care for 24 months. The primary outcome of the study is worsening in any one of the four Multiple Sclerosis Functional Composite 4 (MSFC4) measures at 24 months. Other study outcomes include patient and clinician satisfaction, major healthcare costs, Expanded Disability Status Scale, treatment adherence, and digital outcomes. ConclusionThe results of this study will directly address the key gaps in knowledge about longitudinal telemedicine-enabled care in an MS population. It will inform clinical care implementation as well as design of trials in MS and other chronic conditions.Trial registration:NCT05660187

Sternal bone anatomy on preoperative imaging as an independent predictor of deep sternal dehiscence following median sternotomy

Complications following median sternotomy are associated with morbidity, mortality, and major healthcare costs. With plastic surgeons being increasingly consulted to close complex sternotomy wounds, a more accurate risk stratification tool for this comorbid patient population is warranted. This study examines the association of preoperative radiologic sternal measurements and deep sternal dehiscence, comparing this with other known clinical risk factors. A decreased manubrium sternal thickness relative to body weight (<0.13mm/kg) and an absolute inferior sternal width ≤13.8mm had a significant association with the development of deep sternal dehiscence, even with adjustment for known clinical risk factors. With such measurements assisting in further risk stratification, the opportunity to improve risk assessment holds value for plastic and reconstructive surgeons who are consulted to close extensive sternotomy wounds.

Out-of-Pocket Expenditures of Myocardial Infarction Patients in Pondicherry, South India

Background: Myocardial infarction (MI) is a leading cause of morbidity and mortality worldwide. In India, incidence of MI is rapidly increasing due to lifestyle changes, ageing and rising healthcare costs. The out-of-pocket expenditure (OOPE) for MI care in India can be substantial, as majority of healthcare costs are paid by patients or their families. However, little is known about the actual OOPE incurred by MI patients in tertiary care centres in Pondicherry, South India. This study aims at estimating the OPPE by MI patients attending the tertiary care centre in Pondicherry. The findings can inform policymakers and healthcare providers in developing interventions to reduce the financial burden of MI care in patients and their families.&#x0D; Methods: This was a hospital-based, cross–sectional study conducted on patients attending Cardiology's outpatient department OPD, who had myocardial infarction in the past for about 3 months to 3 years at the time of enrolment in the study. A pre-designed and validated questionnaire was used to collect information regarding socio-demographic details and cost of health expenditures (direct medical and non-medical costs and indirect cost for both the participants and caregivers). Data analysis was done using SPSS24 Software. The median and inter-quartile range was used for assessing the cost of health expenditures.&#x0D; Results: Study participants underwent invasive and non-invasive procedure as part of their management. More than 93% underwent invasive, and the cost ranges from 1,694.03 USD to 2470.00 USD (1,20,000 INR to 1,75,000 INR). They spent 10.58 USD to 21.17 USD (750 INR to 1,500 INR) for their monthly medication. The travel expenses for each follow-up visit were between 5.64 USD to 70.57 USD (400 INR and 5000 INR). The majority of participants received health insurance or reimbursement of 1834 USD (1,30,000 INR) from their firm, 12.7% of the participants lost a payment of 162 USD to 776.28 USD (11,500 INR – 55,000 INR).&#x0D; Conclusion: The cost of the invasive procedure for myocardial infarction patients was 1694.03 USD to 2470.00 USD, which was the major share from the out-of-pocket expenditure compared with the other direct and indirect costs.

Cost effectiveness of non-drug interventions that reduce nursing home admissions for people living with dementia.

Six million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health-care cost driver. We evaluated the cost effectiveness of non-pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD. We used a person-level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence-based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality-adjusted life years and incremental cost-effectiveness ratios. All four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1-way, 2-way, structural, and probabilistic sensitivity analyses. Dementia-care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non-pharmacologic interventions.

The Impact of Patient Characteristics on Outcomes of Surgically Managed Vertebral Osteomyelitis in the United States: Insights from a National Database Study.

This study was conducted to assess the patient characteristics, types of treatment, and outcomes of patients who are surgically treated for vertebral osteomyelitis (VO) in the United States. VO can be treated with or without surgical intervention. Surgically treated cases of VO are associated with significant morbidity and mortality, and incur major healthcare costs. There are few studies assessing the characteristics and outcomes of patients with VO who are treated surgically, as well as the overall impact of surgically managed VO on the healthcare system of the United States. Utilizing the Nationwide Inpatient Sample (NIS) database, 44,401 patients were identified who underwent surgical treatment for VO over a fifteen year period. Severity of comorbidity burden was calculated using the Deyo Index (DI). Surgical approach and comorbidities were analyzed in regard to their impact on complications, mortality rate, LOS, and hospitalization charges. The incidence of surgical intervention for patients who had VO increased from 0.6 to 1.1 per U.S. persons over the study period. Surgically treated patients had a mean age of 56 years, were 75.8% white, were 54.5% male, 37.9% carried Medicare insurance, and they had a mean DI of 0.88. Anterior/posterior approach (OR: 3.53), thoracolumbar fusion (OR: 2.69), thoracolumbar fusion (OR: 19.94), and anterior/posterior approach (OR: 64.73) were the surgical factors that most significantly predicted any complication, mortality, increased LOS, and increased hospital charges, respectively (P < 0.001). The mean inflation-adjusted total hospital cost increased from $20,355 to $39,991 per patient over the study period. VO has been steadily increasing in the United States. Incidence and inflation-adjusted costs nearly doubled. Anterior/posterior approach and thoracolumbar fusion most significantly predicted negative outcomes. VO is associated with lengthy and expensive hospital stays resulting in a significant burden to patients and the healthcare system.

Epidemiology, Aetiology And Clinical Characteristics Of Ischaemic Stroke in Young Adults: A Retrospective Study From Denizli, Turkey

The incidence of cerebrovascular disease (CVD) in young adults is approximately 6-26 per 100,000 worldwide, and this numbers are increasing every year. Stroke aetiology among young adults are more diverse than those among older adults and require extensive diagnostic work-up. The aim of our study is to determine risk factors and stroke etiology in stroke pa-tients aged 45 years and younger, followed in our clinic for the last 10 years, and to compare them with literature.&#x0D; The study is included in the patients between the age of 18-45 years and are followed by Ischemic CVD in Pamukkale University Neurology clinic between January 2010 and Novem-ber 2020.The clinical and demographic data of the patients were retrospectively analyzed.&#x0D; The most common risk factor was smoking (31.4%); hypertension (20.2%), diabetes mellitus (14.4%), hyperlipidemia (14.4%) and coronary arterial disease (11.6%) were following it. According to Trial of Org in Acute Stroke Treatment (TOAST) classification there were, large vessel disease in 13.4%, small vascular disease in 19.8%, cardioembolism in 16.7%, other determined aetiology in 11.5% and the most frequently stroke of undetermined etiology in 38.6%. The most common reason in other determined aetiology was Antiphospholipid An-tibody Syndrome.&#x0D; The incidence of young stroke is increasing every year and it is necessary to determine the underlying reasons to prevent and to give treatment for aetiology. Thus this will contribute to head off major health care costs, loss of workforce and to save young lives.

Синдром дисмобільності: зміна парадигми в царині профілактики переломів

Остеопоротичні переломи зумовлюють серйозні витрати на охорону здоров’я, знижують незалежність/якість життя пацієнта і підвищують ризик смерті. Незважаючи на різні види терапії щодо зниження ризику майбутніх переломів, мало хто проходить лікування навіть після перелому стегна. Очевидно, що підходи минулого, спрямовані на зниження ризику остеопоротичних переломів, насамперед шляхом діагностики остеопорозу і призначення препаратів, що впливають на кісткову тканину, не були успішними. Потрібен інший підхід; таке зміщення фокуса й обговорюється в даній статті. Кажучи коротко, відповідно до концепції синдрому дисмобільності остеопоротичний перелом розглядають як клінічний результат наслідку і вважають, що остеопороз є лише частиною синдрому, який призводить до перелому, «пов’язаного з остеопорозом». Іншими компонентами цього синдрому є саркопенія, ожиріння, діабет, остеоартрит і теоретично безліч інших факторів, що збільшують ризик падінь із супутнім підвищеним ризиком перелому. Таким чином, концепція синдрому дисмобільності зрушує галузь дослідження, а також, що важливо, вивчення даних у літніх людей, у яких можливі остеопоротичні переломи, за межі єдиного фокуса на кістку для більш закономірного зосередження на цілісному підході до зниження ризику переломів.

Cost and healthcare utilization analysis of culturally sensitive, shared medical appointment model for Latino children with type 1 diabetes.

This study evaluated costs and healthcare utilization associated with a culturally-sensitive, medical and education program for pediatric Latino patients with type 1 diabetes. Program participants included Latino children ages 1-20 years old diagnosed with type 1 diabetes (n=57). Control subjects with type 1 diabetes were matched by age, sex, and zip code to intervention participants from the Colorado All Payer Claims Database. Data included emergency department (ED) visits, hospitalizations, demographic information, and health insurance claims data 180 days prior to program start/index date through 1 year after program start/index date. We tracked program staff time and estimated costs for healthcare utilization using data from the scientific literature. Generalized Estimating Equation (GEE) models with logit link were used to estimate group differences in probabilities of ED visits and hospitalizations over 6-month periods pre/post-study, accounting for correlation of within-subject data across time points. Sensitivity analyses modeled longer-term cost differences under different assumptions. The intervention group had fewer hospitalizations, 2% versus 12% of controls (p=0.047,OR=0.13;95%CI: 0.02-0.97) for 6 months following start date. The intervention group had fewer ED visits, 19% versus 32% in controls (n.s.; p=0.079,OR=0.52;95%CI:0.25-1.08) and significantly fewer hospitalizations, 4% versus 15% of controls (p=0.039,OR=0.21;95%CI: 0.05-0.93) 6-12months post-start date. One-year per-patient program costs of $633 and healthcare cost savings of $2710 yielded total per-patient savings of $2077, or a 5-year cost savings of $14,106. This unique type 1 diabetes management program altered health service utilization of program participants, reducing major healthcare cost drivers, ED visits, and hospitalizations.

TAC induced cardiac hypertrophy leads to increased levels of circulating microvesicles

Abstract Introduction Cardiac hypertrophy and heart failure are wide spread diseases of elderly patients in the industrialised world and drive a majority of healthcare costs in these countries. Therefore, there is a high urgency to understand the development and progress of heart failure to find new therapeutic strategies especially in early stages. Microvesicles are involved in the development and propagation of almost all cardiac diseases and increased levels of circulating microvesicles can be found in blood of patients with chronic heart failure. To point out the underlying mechanisms and to provide a new animal model based approach, we investigated microvesicle (MV)-release in mice that underwent Transverse Aortic Constriction (TAC). TAC is a common method to induce cardiac hypertrophy and heart failure in mice by inducing pressure overload. We hypothesized that TAC leads to upregulation of total MV and MV of specific origin. Methods and results Wildtype C57BL/6 mice underwent TAC to induce cardiac hypertrophy and heart failure. After TAC, mice developed cardiac hypertrophy as determined by altered heart weight/ bodyweight ratio, end-diastolic and end-systolic diameter and decreased fractional shortening. Total numbers of circulating microvesicles were detected 1, 4 and 12 weeks after TAC. We found that total numbers of circulating macrovesicles raised in a time dependent manner. Similar observations could be done with samples stained for annexin V, although results were not significant. Moreover, microvesicles were stained with specific surface markers for lymphocyte (CD3), monocyte (CD14), endothelial cells (CD31), thrombocytes (CD41), B-cells (CD45) and neutrophils (Lys6). One week after TAC increased numbers of specific microvesicles could be detected which in the course declined rapidly. Only microvesicles subgroup of lymphocyte origin showed significant increase one week after TAC-OP. Conclusion In this study, we show that total number of circulating microvesicles raise after TAC over an observation period of 12 weeks. Furthermore, we found that increased numbers of circulating microvesicles of specific origin like lymphocytes, monocytes, endothelial cells, thrombocytes, B-cells and neutrophils showed a trend towards increased levels one week after TAC with a rapid decline in subsequent detection. To our knowledge this is the first time that the impact of TAC on number of circulating microvesicles in mice was investigated. Future studies should characterize the content and effects of these MV on recipient cells to elucidate possible contributions to heart failure progression or protective effects. Detecting new harmful or protective effects of heart failure triggered by circulating microvesicles could offer new highly needed approaches to suppress heart failure development or deliver the possibility to develop new drugs for heart failure treatment. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Else Kröner-Fresenius

Role of sex steroid hormones in pelvic organ prolapse.

Pelvic organ prolapse (POP) affects a significant percentage of women and contributes to major healthcare costs both in the United States and worldwide. This review examines the current understanding of the role of sex steroid hormones (estrogens, androgens, and progesterone) in POP in premenopausal, perimenopausal, and postmenopausal women. We reviewed the relevant studies on POP related to estrogens, androgens, and progesterone in both animal models and humans. Estrogen has a profound influence on the synthesis and metabolism of pelvic connective tissues, and may have the ability to both prevent POP and improve prognosis if used therapeutically. There is limited research regarding the role of androgens and progesterone and their receptors in POP and results so far have been contradictory, warranting further study to determine whether changes in androgen and progesterone receptor expression are a cause or effect of POP. Because of the role that estrogen plays in maintaining the integrity of pelvic floor connective tissues, we propose that rigorous and well-controlled studies are needed on the role of exogenous estrogen administration as a form of POP prevention. : Video Summary:http://links.lww.com/MENO/A583.

Prevalence and impact of self-reported painful and non-painful constipation in the general population.

Chronic constipation, defined by the Rome IV criteria, is a highly prevalent functional bowel disorder with major overlap with other bowel disorders. Therefore, a pooled-analysis to evaluate the presence of self-reported constipation in the general population was conducted. Further, its association with other bowel symptoms and its health-economic impact was analyzed. Collection of information on bowel symptoms' prevalence and their impact was done through an Internet survey (Medistrat Internet panel). The analysis focused on patients who reported constipation symptoms over the last 12months. Firstly, participants who with or without constipation were compared. Secondly, subjects reporting constipation with (PC) or without abdominal pain (NPC) were studied. KEYRESULTS: A total of 1012 subjects (45.2±0.5years old, 62% females), of whom 217 (21%) reported constipation, completed the survey. Women were significantly more represented in the group reporting constipation compared to those with other bowel symptoms (81.57% vs 56.60%, P<.0001). Subjects reporting constipation experienced more additional bowel symptoms than those who did not report constipation [3(2-6) vs 2(1-4), P<.0001]. Of those with constipation, 134 patients reported NPC compared to 83 patients with PC. The presence of PC was associated with higher prevalence of diarrhea symptoms, alternating bowel movements, bloating, cramps, gas, and altered stool frequency and consistency (all P<.01). Out of 83 PC patients, 38 (45.24%) fulfilled the Rome IV IBS criteria. Self-reported constipation, often associated with other bowel symptoms, is a highly prevalent condition in the Belgian general population. Especially when abdominal pain is present, this generates major healthcare costs.

Epithelial Mesenchymal Transition and Tissue Healing

Epithelial mesenchymal transition (EMT) is the ability of the cells to lose the epithelial features with gaining of mesenchymal one. It is a dynamic and reversible process induced by damage, hypoxia or inflammation. The execution of EMT events could be complete or partial during tissue repair of different organs. During wound healing, EMT has important role for re-epithelialization, angiogenesis and for Langerhans cells immunologic role. On the other hand, sustained EMT is a key mechanism underlying the wound scaring, fibrotic pathology of multiple organs, cataract and endometriosis. Hence, the understanding of EMT regulation during wound healing and tissue repair has important clinical implications as chronic wounds represent major health care costs. EMT could yield adult cells with stem cell characteristics. Therefore, one could predict that, it contributes to the pool of different progenitor cells to maintain organs homeostasis. Further analyses are necessary to determine whether EMT in normal tissues leads to the production of normal stem cells.

Cardiovascular Risk in Fatty Liver Disease: The Liver-Heart Axis-Literature Review.

According to the World Health Organization, cardiovascular disease (CVD) remains the leading cause of death worldwide, accounting for approximately 18 million deaths per year. Nevertheless, the worldwide prevalence of metabolic diseases, such as type 2 diabetes mellitus, obesity, and non-alcoholic fatty liver disease (NAFLD), also known to be common risk factors for CVD, have dramatically increased over the last decades. Chronic alcohol consumption is a major cause of chronic liver diseases (CLD) as well as being a major health care cost expenditure accounting for the spending of tremendous amounts of money annually. NAFLD has become one of the major diseases plaguing the world while standing as the most common cause of liver disease in the Western countries by representing about 75% of all CLD. Currently, the most common cause of death in NAFLD remains to be CVD. Several mechanisms have been suggested to be responsible for associating FLD with CVD through several mechanisms including low-grade systemic inflammation, oxidative stress, adipokines, endoplasmic reticulum stress, lipotoxicity and microbiota dysbiosis which may also be influenced by other factors such as genetic and epigenetic variations. Despite of all this evidence, the exact mechanisms of how FLD can causally contribute to CVD are not fully elucidated and much remains unknown. Moreover, the current literature supports the increasing evidence associating FLD with several cardiovascular (CV) adverse events including coronary artery disease, increased subclinical atherosclerosis risk, structural alterations mainly left ventricular hypertrophy, increased epicardial fat thickness, valvular calcifications including aortic valve sclerosis and mitral annular calcification and functional cardiac modifications mainly diastolic dysfunction in addition to cardiac arrhythmias such as atrial fibrillation and ventricular arrythmias and conduction defects including atrioventricular blocks and bundle branch blocks. Patients with FLD should be evaluated and managed accordingly in order to prevent further complications. Possible management methods include non-pharmacological strategies including life style modifications, pharmacological therapies as well as surgical management. This review aims to summarize the current state of knowledge regarding the pathophysiological mechanisms linking FLD with an increased CV risk, in addition to associated CV adverse events and current management modalities.

Chronic Diseases in High-Cost Users of Hospital, Primary Care, and Prescription Medication in the Capital Region of Denmark.

A small proportion of patients account for the majority of health care costs. This group is often referred to as high-cost users (HCU). A frequently described characteristic of HCU is chronic disease. Yet, there is a gap in understanding the economic burden of chronic diseases associated with HCU to different types of health care services. To analyze which frequent chronic diseases have the strongest association with HCU overall, and HCU in hospital, primary care, and prescription medication. This is a register-based observational study on Danish health service costs for various diseases in different medical settings. A total of 1,350,677 individuals aged ≥ 18years living in the Capital Region of Denmark by 1 January 2012 were included. Chronic diseases, costs, and sociodemographic data were extracted from the nationwide registers, including data from hospitals, primary care, and medicine consumption. These information were merged on an individual level. Cancer, mental disorders except depression, and heart diseases have the strongest association with HCU overall. Mental disorders except depression were in the three diseases most prevalent in HCU in all the three health care services. Our results show that the chronic diseases that have the strongest association with HCU differ between different types of health care services. Our findings may be helpful in informing future policies about health care organization and may guide to different prevention, treatment, and rehabilitation strategies that could lessen the burden in the hospital.

Hemocompatibility study of surface-attached antibiofouling polymer monolayers

The interface between biomaterials and body fluid such as blood is a critical concern, because biomaterial-centered protein fouling and infection adversely affects the quality of life of many patients and cause major health care costs. Our research focused on polymer functionalization on surfaces to create antibiofouling interfaces (i.e. interfaces that repel the adhesion of proteins and microorganisms) in biomaterial-related applications, such as surgical instruments and blood-contacting biomedical devices. To this end, we have studied two hydrophilic polymers, namely poly(2-oxazoline) and poly(ethylene glycol), attached on metal oxide surfaces in brush configuration through a polyelectrolyte surface anchor, poly(L-lysine). Apart from antibiofouling properties, blood-contacting surfaces must also serve hemocompatibility. Here the hemocompatibility of antibiofouling monolayer on silicon oxide surfaces prepared from either poly(2-oxazoline) or poly(ethylene glycol) grafted on a main backbone poly(L-lysine), has been studied. The activation of C5a (complement system), TAT and kallikrein (coagulation cascade), PF4 and sP-selectin, (platelet activation) after incubation of the polymer-modified surfaces in whole blood was measured by means of ELISA kit. The results showed that in general, the contact between blood and polymer monolayer activated the complement system, but relatively did not activate the coagulation cascade and the platelet surface marker.

Efficacy, Safety and Immunogenicity of Biosimilars in Inflammatory Bowel Diseases: A Systematic Review.

Anti-tumor necrosis factor (anti-TNF) monoclonal antibodies have revolutionized the treatment of inflammatory bowel diseases (IBD). However, because of their complexity, their production is expensive contributing to their high price. As the patent protection of these therapies has expired in several countries, biosimilars have been developed to reduce the healthcare costs. The aim of this article is to review the literature on the safety, efficacy and immunogenicity of biosimilars in IBD. A PubMed literature search was performed using the following terms until May 2016: 'biosimilars', 'CT-P13', 'infliximab', 'Crohn's disease', 'ulcerative colitis', 'inflammatory bowel diseases', 'efficacy', 'safety', 'immunogenicity'. Additionally, abstracts from international meetings were also reviewed. A total of eleven studies in IBD patients provided real-world evidence on the efficacy, safety and immunogenicity profile of biosimilars in IBD patients. Based on the available evidence, CT-P13 is efficacious and well tolerated in IBD patients in a real-life setting. The vast majority of studies only included IBD patients who had never received biological therapies. Information regarding the interchangeability between CT-P13 and its originator is currently being investigated in the NOR-SWITCH trial. Otherwise, the immunogenicity profile of CT-P13 seems to be similar to the originator. The infliximab biosimilar seems to be efficacious, safe and with a similar immunogenicity profile as the originator in IBD. Large prospective post-marketing studies are needed to assess the long-term safety profile of CT-P13. The use of infliximab biosimilars may lead to major healthcare cost savings.

Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011-2015.

Up-to-date data on the burden of disease are important to identify patients with unmet needs and to optimize healthcare resources. We aimed to characterize the burden of pneumonia hospitalizations in Hong Kong and inform targeted healthcare policies for pneumonia control in the era of global aging. This was a population-based study using a territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Patients admitted to public hospitals, from 2011 to 2015, with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification Codes (480-486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-day readmission, hospital length of stay, and healthcare costs were assessed for seven age strata. We identified 323,992 patients (median age 80years, 44.4% female) with hospitalized pneumonia (organism unspecified 84.2%; bacterial pneumonia 12.3%; viral pneumonia 2.5%; others 1.0%). Annual incidence was 955.1 per 100,000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality, and 28-days readmission risks were 13.8, 21.6, and 19.5%, respectively. The average hospital length of stay was 14.1days with corresponding direct costs of $9348 USD per episode in the monetary value of 2015. Individuals aged ≥ 65years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths, and the majority of healthcare costs. Hospitalized pneumonia represents a considerable health and economic burden in Hong Kong, especially in older adults. The study provides a population-level baseline estimate for further cost-effective evaluation of targeted strategies for pneumonia control.

Left Ventricular Assist Devices (LVADS): History, Clinical Application and Complications.

Congestive heart failure is a major cause of morbidity and mortality as well as a major health care cost in the developed world. Despite the introduction of highly effective heart failure medical therapies and simple devices such as cardiac resynchronization therapy that reduce mortality, improve cardiac function and quality of life, there remains a large number of patients who do not respond to these therapies or whose heart failure progresses despite optimal therapy. For these patients, cardiac transplantation is an option but is limited by donor availability as well as co-morbidities which may limit survival post-transplant. For these patients, left ventricular assist devices (LVADs) offer an alternative that can improve survival as well as exercise tolerance and quality of life. These devices have continued to improve as technology has improved with substantially improved durability of the devices and fewer post-implant complications. Pump thrombosis, stroke, gastrointestinal bleeding and arrhythmias post-implant have become less common with the newest devices, making destination therapy where ventricular assist device are implanted permanently in patients with advanced heart failure, a reality and an appropriate option for many patients. This may offer an opportunity for long term survival in many patients. As the first of the totally implantable devices are introduced and go to clinical trials, LVADs may be introduced that may truly be alternatives to cardiac transplantation in selected patients. Post-implant right ventricular failure remains a significant complication and better ways to identify patients at risk as well as to manage this complication must be developed.

Comparison of Hospital Costs and in-Hospital Outcomes of Patients Admitted with Sepsis with and without Non Hodgkin Lymphoma

Background:According to the 2013 HCUP (Health Care Utilization Project) statistical brief, sepsis accounted for US$23.7 billion, or 6.2% of the aggregate costs for all hospitalizations. Sepsis is the second most common cause for hospitalizations, accounting for 3.6% of hospital stays. When considering the sepsis high cost burden, it is of paramount importance to identify the responsible factors. The main objective of this study is to evaluate impact of Non-Hodgkin Lymphoma (NHL) as a comorbidity either a history or as a present diagnosis of NHL, in patients admitted in the hospital with sepsis. Studies suggested increased risk of infections and mortality from bacteremia in patients with NHL in the past, (Shaikh et al, Cancer, 1987; Williams et al, Critical Care 2004 ) but recent data on health care cost burden associated with sepsis in NHL is limited.Methods:We analyzed the admissions for sepsis among adult patients using the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample, between 2010 and 2014. Patients were stratified into two groups based on the status of NHL (sepsis with NHL and sepsis without NHL) using the ICD-9 CM diagnostic codes. Baseline characteristics including age, race, gender, Charlson comorbidity index, were described in the two groups, using descriptive statistics. A survey weighted multivariate regression analysis was used to adjust for confounders. STATA version 15 (College Station, TX) was used to perform statistical analysis.ResultsBetween 2010 and 2014, a total of 4,501,621 admissions were identified with a primary diagnosis of sepsis. A total of 45,943 admissions had an underlying diagnosis of NHL. Mean age of patients hospitalized with sepsis and with NHL, was higher than patients without NHL (69.04 ±0.167 years; p<0.05 ), and 55% of the patients were males. Average hospital cost for each admission for patients with sepsis and NHL was ($78122.98±$1541.9;p<0.05), significantly higher than those without NHL. When adjusted for patient and hospital factors affecting population with NHL, such as age, race, gender, size of hospital, the average cost of a hospitalization was still significantly higher for patients with NHL. Similar results were found regarding outcomes, with a 32% increase in inpatient mortality for patients with sepsis and NHL (Odd ratio 1.32; p value=0.001)ConclusionSepsis is responsible for a major healthcare cost burden in the US. Identification of signs of early sepsis and high-risk patients could support the design of early therapeutic strategies with the goal of decreasing negative outcomes and also decrease overall costs This study highlights NHL as an independent factor for mortality and healthcare costs for sepsis. It may help implement preventive strategies to avoid complications from infections and reduce cost burden associated with sepsis and NHL. Future studies are needed to focus on improving preventive strategies e.g vaccinations, early diagnosis and prompt treatment of infections to prevent progression to sepsis in patients with NHL. DisclosuresNo relevant conflicts of interest to declare.

Analysis of drug utilization and health care resource consumption in patients with psoriasis and psoriatic arthritis before and after treatment with biological therapies.

ObjectivesTo describe the therapeutic pathways of patients with psoriasis (PSO) and psoriatic arthritis (PsA) before and after treatment with biological therapies in a real-world setting and to determine the relative consumption of health care resources.DesignRetrospective observational study.SettingReal-life clinical setting in 5 Italian local health units.ParticipantsA total of 351 male and female patients with at least 1 prescription for a biological drug from January 1, 2010 to December 31, 2013; patients with concomitant rheumatoid arthritis, ankylosing spondylitis, or Crohn’s disease were excluded.ResultsThe major health care cost (excluding drug costs) was represented by hospitalizations, mainly related to PSO /PsA-associated disorders and cardiometabolic disorders. Use of conventional drugs among biologics-naïve patients reached 50% in PSO and 80% in PsA; their use decreased following initiation of biological therapy. After the start of biological treatment, the incidence of hospitalization decreased both for PSO (from 12.3% to 3.2% in day hospital regimen and from 2.4% to 0.4% for conventional admission) and for PsA (from 11.1% to 8.1% and from 10.1% to 3.0%, respectively). Mean annual costs for hospitalization before biological treatment were €217 and €537 for PSO and PsA, respectively, while mean annual cost for concomitant drugs slightly increased after biologics initiation: from €249.8 to €269.4 for PSO and from €331.8 to €346.9 for PsA. The major consumption of health care resources occurred in the quarter preceding the beginning of biological treatment.ConclusionThe consumption of health resources is mostly related to hospitalization, seems to peak during the quarter before the beginning of biologics therapies, and subsequently decreases after biologics initiation. Further studies should focus on prescription scheme and economic burden of PSO and PsA in Italy to help optimize health care resources and potentiate services for patients.