Market Scan Research Articles

Long-Term Cost Analysis of Third-Line Treatment Options for Overactive Bladder.

We aimed to analyze the long-term cost of overactive bladder third-line treatments. This insurance claims review analyzed the 2015 to 2020 MarketScan (MKS) claims data set subjects age ≥ 18, diagnosis of overactive bladder (OAB) using ICD-9/ICD-10 codes and receipt of treatment for percutaneous tibial nerve stimulation, sacral neuromodulation (SNM), or botulinum A. Age, gender, treatment types, and cost were extracted. Treatment costs were aggregated at the level of patient and treatment type for total payment and patient contribution by combining copay, coinsurance, and deductible. We used the Wilcoxon rank-sum test for continuous and chi-square test for categorical variables. SAS v9.4 was used for analyses. Significance was set at P < .05. We identified 17,755 patients from the commercial claims MKS and 10,912 patients from the Medicare supplemental (MDC) database with mean age 50.7±11.1 and 75.5±7.6 years, respectively, who underwent ≥ 1 third-line OAB treatment. Patients receiving third-line treatment were predominantly female (84.9%, MKS, 74.8%, MDC). Long-term costs over a 15-year period were estimated. Percutaneous tibial nerve stimulation is the most expensive in terms of total net payment ($105,337.50 MKS, $94,102.50 MDC) and patient contribution ($9177.60 MKS, $3921.00 MDC). Total net payment for botulinum A was $67,968 (MSK), $54,261 (MDC), and patient contribution cost was $2850 (MSK), $1110 (MDC). The most cost-effective option was SNM in terms of both total net payment ($5179.10 MKS, $6099.00 MDC) and patient contribution ($59.10 MKS, $60.00 MDC). SNM was the most cost-effective third-line treatment for OAB looking over a 15-year period in terms of both total net payment and patient contribution.

Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database

Abstract Burn injuries affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decreased unplanned healthcare utilization after acute care discharge and increased healthcare costs for patients who have undergone burn injury grafting. This study describes postacute care hospitalization healthcare use in burn patients. A retrospective commercial claims database review was performed utilizing Truven MarketScan (MS) database. In a 10-year MS sample, 23,262 patients with burn injuries were identified and matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. Pre- and postburn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, pre- and postburn periods were defined using the burn event date of the matched case adjusted by the pair’s relative difference in enrollment into the MS database. A series of negative binomial regressions were completed to evaluate the data. For every outcome, except skilled nursing facility, healthcare utilization was greater in the preinjury burn group relative to controls. Healthcare utilization for the burn cohort postinjury was greater for every outcome compared to controls and remained higher for at least 25-month postinjury and did not return to preinjury levels during this time frame. Relatively higher healthcare utilization prior to injury in burn patients may indicate an important difference in baseline health, and an opportunity for injury prevention.

PD29-02 RISK OF HYPERTENSION AFTER RENAL TRAUMA

You have accessJournal of UrologyCME1 May 2022PD29-02 RISK OF HYPERTENSION AFTER RENAL TRAUMA Matthew S. Swallow, Odinachi I. Moghalu, Joshua J. Horns, Benjamin J. McCormick, and Jeremy B. Myers Matthew S. SwallowMatthew S. Swallow More articles by this author , Odinachi I. MoghaluOdinachi I. Moghalu More articles by this author , Joshua J. HornsJoshua J. Horns More articles by this author , Benjamin J. McCormickBenjamin J. McCormick More articles by this author , and Jeremy B. MyersJeremy B. Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002577.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The risk of hypertension after renal trauma (RT) is not well-defined. Previous studies are limited by small cohorts and/or difficulty in long-term follow up after trauma. We aimed to utilize the Truven Health MarketScan (MS) database to evaluate the risk of hypertension after RT. METHODS: We conducted a retrospective analysis of inpatient records in MS from 2008-2017 for patients with renal and bladder/urethral trauma. Patients with a diagnosis of RT or non-renal lower genitourinary trauma (GUnRT) (bladder/urethral trauma) were identified through ICD-9/10 codes. The development of HTN (also defined by ICD-9/10 codes) was compared between those who experienced RT and a control group of those who experienced GUnRT. Patients were excluded if they experienced both trauma types, had pre-existing HTN, had less than one year of enrollment data prior to trauma, or if they were under 18 years of age. An adjusted analysis included multiple covariates. RESULTS: There were a total of 6,542 RT patients and 5,144 GUnRT patients. The median age was 52 years (IQR 31-65) for RT patients and 49 years (IQR 38-64) for GUnRT patients. Median follow up data was 18 months (IQR 6-38) for RT patients and 21 months (IQR 7-42) for GUnRT patients. A total of 2,232 (34.1%) RT patients developed post-trauma HTN compared to 1,194 (23.2%) GUnRT patients. On multivariate analysis, risk of post-trauma HTN was higher in individuals with RT compared to GUnRT (hazard ratio 1.75, 95% CI 1.63-1.88, p<0.001). Other covariates associated with increased risk of post-trauma HTN included increasing age, female gender, increased Charlson Comorbidity Index, increased inpatient length of stay, and presence of one or more of the following comorbidities: smoking, diabetes, obesity, hyperlipidemia, and alcohol use. Undergoing either an open or minimally invasive kidney procedure was not associated with a higher rate of HTN (hazard ratio 1.095, 95% CI 0.94-1.27, p=0.239). CONCLUSIONS: Patients experiencing renal trauma have an associated higher rate of developing hypertension compared to a control population. Patient age, female gender, and medical history of diabetes, obesity, and hyperlipidemia was also associated with increased risk of post-trauma HTN. Source of Funding: University of Utah Division of Urology © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e504 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew S. Swallow More articles by this author Odinachi I. Moghalu More articles by this author Joshua J. Horns More articles by this author Benjamin J. McCormick More articles by this author Jeremy B. Myers More articles by this author Expand All Advertisement PDF DownloadLoading ...

T1 Healthcare Utilization After Thermal Injury: An Analysis Using a Commercial Claims Database

IntroductionBurn Injuries directly affect more than 500,000 people per year in the United States but no previous studies have looked at the impact on the healthcare system. Several prior studies have shown decrease in unplanned healthcare utilization after acute care discharge following burn injury and increased healthcare costs in patients who have undergone grafting for burn injury. The goal of this study is to describe post-acute care hospitalization healthcare use in burn patients.MethodsA retrospective commercial claims database review was performed of the Truven MarketScan (MS) database. In a 10 year MS sample, 23,262 patients with burn injuries were identified and were matched to a control population in a 1:1 ratio based on age, sex, and total time in the MS database. For the burn patient population in the study, pre-burn and post-burn utilization of therapy, emergency department, nutritional support, psychiatry/psychology, home health, skilled nursing facility, inpatient, and outpatient visits were recorded. For controls, we defined their pre-burn and post-burn periods using the burn event date of the matched case adjusted by the pair’s relative difference in initial enrollment into the MS database, and then recorded the same utilization metrics. A series of negative binomial regressions were completed to evaluate the data.ResultsAt the conclusion of the study, for every outcome, except skilled nursing facility, healthcare utilization was greater in the pre-injury burn group relative to controls. Healthcare utilization for the burn cohort post-injury was greater for every outcome compared to controls. Relative to controls, healthcare utilization remains higher for at least 25 months post-injury in the burn patients and does not return to pre-injury levels during this time frame.ConclusionsIn a commercial claims database study, the healthcare utilization of the burn patients is higher both before and after burn injury than matched controls. Utilization does not return to preburn levels in the 25-month follow-up period. Additionally, burn patients have higher healthcare utilization prior to injury compared to matched controls, which may indicate an important difference in baseline health of these patients, and an opportunity for injury prevention.

A machine learning approach for predictive models of adverse events following spine surgery

BACKGROUNDRates of adverse events following spine surgery vary widely by patient-, diagnosis-, and procedure-related factors. It is critical to understand the expected rates of complications and to be able to implement targeted efforts at limiting these events. PURPOSETo develop and evaluate a set of predictive models for common adverse events after spine surgery. STUDY DESIGNA retrospective cohort study. PATIENT SAMPLESWe extracted 345,510 patients from the Truven MarketScan (MKS) and MarketScan Medicaid Databases and 760,724 patients from the Centers for Medicare and Medicaid Services (CMS) Medicare database who underwent spine surgeries between 2009 and 2013. OUTCOME MEASURESOverall adverse event (AE) occurrence and types of AE occurrence during the 30-day postoperative follow-up. METHODSWe applied a least absolute shrinkage and selection operator regularization method and a logistic regression approach for predicting the risks of an overall AE and the top six most commonly observed AEs. Predictors included patient demographics, location of the spine procedure, comorbidities, type of surgery performed, and preoperative diagnosis. RESULTSThe median ages of MKS and CMS patients were 49 years and 69, respectively. The most frequent individual AE was a cardiac dysfunction in CMS (10.6%) patients and a pulmonary complication (4.7%) in MKS. The area under the curve (AUC) of a prediction model for an overall AE was 0.7. Among the six individual prediction models, the model for predicting the risk of a pulmonary complication showed the greatest accuracy (AUC 0.76), and the range of AUC for these six models was 0.7 and 0.76. Medicaid status was one of the most important factors in predicting the occurrences of AEs; Medicaid recipients had increased odds of AEs by 20%–60% compared with non-Medicaid patients (odds ratios 1.28–1.6; p<10−10). Logistic regression showed higher AUCs than least absolute shrinkage and selection operator across these different models. CONCLUSIONSWe present a set of predictive models for AEs following spine surgery that account for patient-, diagnosis-, and procedure-related factors which can contribute to patient-counseling, accurate risk adjustment, and accurate quality metrics.

Prevalence and Predictors of Renal Impairment Among Patients with Multiple Myeloma (MM): An Analysis of Oncology Clinic Electronic Health Records Linked to Commercial Claims in the United States

BackgroundAlthough incurable, MM is responsive to treatment, and the prognosis of MM patients has improved dramatically over the past two decades. This has led to increased recognition of the importance of effective long-term management of the classic clinicopathological features of MM. Renal impairment (RI) is a defining hallmark of active myeloma. While it is known that RI is associated with poor survival and can complicate drug dosing and limit treatment options, patterns of renal function and risk factors of RI in MM are poorly characterized. This study seeks to characterize the natural history and risk factors of RI in MM using a unique real-world dataset that links patient-level electronic health records (EHR) to healthcare insurance claims.MethodsThe Oncology Services Comprehensive Electronic Records (OSCER) database contains EHR data from community and hospital-affiliated oncology clinics in the U.S. The MarketScan (MS) database contains healthcare claims information from large employers, managed care organizations, Medicare, and Medicaid programs. This study used a subset of MM patients with overlapping data from OSCER and MS, allowing the analysis of EHR-based serum creatinine and claims-based comorbidity data in the same patient.Patients ≥ 18 with a MM diagnosis between 2011 and February 28, 2016 in an OSCER clinic; had at least 6 months of continuous MS benefits coverage; no MM diagnosis in MS in the 3 months prior to OSCER MM diagnosis; and no evidence of another malignancy prior to MM diagnosis were included in the study. Index date was the date of OSCER MM diagnosis and patients were followed up until February 28, 2017. Baseline (BL) patient characteristics and potential risk factors of RI, including demographics, BMI, ECOG, ISS stage, and comorbidities (e.g., hypertension, diabetes, hypercalcemia, etc.) were assessed in the 6 months prior to index. Intravenous bisphosphonate (IV BP) use was assessed during follow-up. Renal function was assessed using the MDRD eGFR method or CKD stage diagnosis codes, with RI defined in this study as eGFR < 60 or stage 3+ CKD. BL eGFR was assessed using the serum creatinine measurement closest to the index in the interval 1 month before and 1 month after index.The prevalence of RI in the year following diagnosis was calculated based on the average number of at-risk patients during this period. Change in renal function for up to 4 years post-diagnosis was assessed by BL renal function and was characterized based on the worst recorded estimate of renal function during this period. A multivariate Cox model was used to assess the impact of BL risk factors and IV BP use during follow-up on progression to RI in patients without RI at BL (eGFR ≥ 60 and CKD diagnosis). Follow-up IV BP use (dose count) was treated as a time-dependent variable.ResultsThe median number of eGFR values recorded per patient during follow-up was 18 (range: 7-36). Among newly diagnosed MM patients (n = 625), 69% (95% CI: 65-73%) experienced ≥ 1 episodes of eGFR < 60 ml/min or stage 3+ CKD diagnosis (RI) within 1 year of diagnosis, with 16% (13-20%) experiencing an episode of eGFR 15-29 or stage 4 CKD and 15% (11-18%) experiencing an episode of eGFR < 15 or stage 5 CKD.Among patients without RI at diagnosis (n = 281), 37% (31-43%) subsequently experienced at least one episode of RI during follow-up (Figure 1). In addition, 26% (20-32%) of patients with BL eGFR 30-59 or stage 3 CKD experienced progression to an episode of eGFR < 30 or stage 4+ CKD, and 31% (20-42%) of patients with BL eGFR 15-29 or stage 4 CKD progressed to an episode of eGFR < 15 or stage 5 CKD.In our multivariate Cox model, use of the IV BP zoledronic acid (ZA) during follow-up; ECOG; baseline eGFR; known predisposing conditions, including autoimmune diseases, vascular conditions, and infections of the kidney were found to be associated with higher risk for experiencing an episode of RI in patients with high BL renal function (Figure 2). In our sample, 12 doses of ZA was associated with a 2.4-fold (1.2-4.8) increase in risk of RI. A baseline ECOG of 1 vs. 0 was also associated with a 2.4-fold (1.1-5.2) increase in risk of RI.ConclusionsUsing a unique EHR-insurance claims linked data source, we found that two-thirds of patients experienced at least one episode of renal impairment within the first year of MM diagnosis. Repeated exposure to zoledronic acid and poor performance status may increase the risk of RI in patients without renal impairment at diagnosis. DisclosuresBlock:Amgen, Inc.: Consultancy. Fu:Amgen: Employment, Equity Ownership. Wade:Wade Outcomes Research and Consulting: Employment, Equity Ownership. Jaramillo:Amgen, Inc.: Consultancy; SimulStat: Employment. Bhatta:Amgen, Inc.: Employment, Equity Ownership. Raskin:Amgen, Inc.: Employment, Equity Ownership. Hernandez:Amgen, Inc.: Employment, Equity Ownership.