Mean Annual Healthcare Costs Research Articles

Impact of a Geriatric Case Management Program on Health Plan Costs

We evaluated the impact of HIP, Health Plan of New York's geriatric case management (GCM) program, which is offered to Medicare Advantage members at high risk for high health care costs and utilization. The study design was a comparison of health plan costs for program participants and nonparticipants eligible for the program, controlling for variables predictive of high health care costs measured prior to program enrollment. The GCM program's impact on health care cost was derived from regression models comparing the costs of 101 program participants without exposure to other disease management programs to 1585 eligible nonparticipants, controlling for age, sex, and health care costs in the pre-program period. Net costs or savings from the program were computed as the sum program operation costs and the estimated change in health care costs associated with program participation. Mean annual health care costs for each program participant were $7720 lower than for eligible nonparticipants (P = .0090). The lower health care costs were attributable to the lower costs for inpatient and outpatient hospital and skilled nursing facility settings, exceeding the higher costs for physician office visits and prescription drugs. Estimated program costs were $2755 per member managed by the program, yielding a net savings of $4965 per member enrolled. A GCM program was successfully implemented in a large Medicare Advantage program. The reductions in health care costs achieved through GCM exceeded program costs resulted in meaningful savings for the health plan.

Personal assistance, income and employment: the spinal injuries survey instrument (SISI) and its application in a sample of people with quadriplegia

Our aim was to ascertain what effect access to personal care package (PCP) has on the labour market activities of people who have a spinal cord injury (SCI). We developed a new instrument called the spinal injuries survey instrument (SISI). The SISI is a 35-item instrument, which contains items on health, education, employment, along with measures of personal assistance, mobility and psychological attribution style. The SISI was administered, with the Short Form 36 (SF-36) health status instrument, to 250 people with an SCI. The response rate was 72%. A retrospective, matched case-control sampling approach matched individuals who received a PCP, with a cohort who did not. The matching criteria included the site and severity of spinal lesion, age and gender. Although data on the reliability of the instrument are currently lacking, our empirical results are consistent with other studies: (1) mean annual health care costs (AUD$8741) are comparable with Walsh's estimates (2) SF-36 data support Kreuter's contention that mental health is resilient to SCI and (3) a post-injury employment rate of 29.7% corroborates Murphy et al. We present additional data describing income, educational attainment and family support. Our discussion borrows a conceptualization of disability by Sen, that includes both an 'earning handicap' (an impediment to earn income) and a 'conversion handicap' (an impediment to the enjoyment of income). Our application of the SISI provides evidence of both. The labour income of people with quadriplegia is AUD$10,007 per annum, while diminished health status, increased out-of-pocket health expenditure and loss of time suggest a conversion handicap.

Impact of Age on Healthcare Costs and Resource Utilization in Patients with Crohnʼs Disease from a Payer Perspective

Purpose: To evaluate the impact of age on healthcare costs and resource utilization in pts with CD. Methods: A retrospective analysis, using the PharMetrics database, of pts with a dx of CD (ICD-9 code 555.x) from Jan. 1, 2000 through June 30, 2005 was conducted. Pts had to be continuously enrolled for 6 months pre-and 12 months post-CD dx, and have 2 distinct claims for CD. Mean/pt healthcare resource utilization and costs were calculated for pts in the yr following their initial CD dx. Outcomes are presented for all pts with CD, and by the following age grps: pediatric <18 yrs, adults 18 to 64 yrs, and pts ≥ 65 yrs. Results: The cohort consisted of 13454 CD pts. Over half of the pts were females and the mean age was 42 yrs. Mean annual total healthcare costs for all pediatric CD pts were $16700. The mean healthcare costs were highest among pediatric and pts ≥ 65 with CD ($19347 and $19900). Inpt hospitalization costs had the largest component of the mean annual total cost for all pts followed by drug, and outpt costs. Resource utilization was highest for pts ≥ 65 yrs. Conclusions: There is limited data assessing the healthcare costs and resource utilization in pts with CD by age group. Healthcare costs among this pt population are high. Pediatric pts and pts ≥ 65 yrs had higher mean healthcare costs than adults 18 to 64 yrs, primarily driven by inpt hospitalizations. New therapies that can reduce hospitalizations have the potential to decrease overall cost of care for CD pts.Table: Mean Healthcare Costs and Resource Utilization.

One-year cost-effectiveness of tiotropiumversusipratropium to treat chronic obstructive pulmonary disease

The aim of this paper is to assess the health economic consequences of substituting ipratropium with the new, once-daily bronchodilator tiotropium in patients with a diagnosis of chronic obstructive pulmonary disease (COPD). This prospective cost-effectiveness analysis was performed alongside two 1-yr randomised, double-blind clinical trials in the Netherlands and Belgium. Patients had a diagnosis of COPD and a forced expiratory volume in one second (FEV1) < or = 65% predicted normal. Patients were randomised to tiotropium (18 microg once daily) or ipratropium (2 puffs of 20 microg administered four times daily) in a ratio of 2:1. The mean number of exacerbations was reduced from 1.01 in the ipratropium group (n = 175) to 0.74 in the tiotropium group (n = 344). The percentages of patients with a relevant improvement on the St. George's Respiratory Questionnaire (SGRQ) were 34.6% and 51.2%, respectively. Compared to ipratropium, the number of hospital admissions, hospital days and unscheduled visits to healthcare providers was reduced by 46%, 42% and 36% respectively. Mean annual healthcare costs including the acquisition cost of the study drugs were 1721 Euro (SEM 160) in the tiotropium group and 1,541 Euro (SEM 163) in the ipratropium group (difference 180 Euro). Incremental cost-effectiveness ratios were 667 Euro per exacerbation avoided and 1084 Euro per patient with a relevant improvement on the SGRQ. Substituting tiotropium for ipratropium in chronic obstructive pulmonary disease patients offers improved health outcomes and is associated with increased costs of 180 Euro per patient per year.

An Economic Evaluation of Donepezil in Mild to Moderate Alzheimer’s Disease: Results of a 1-Year, Double-Blind, Randomized Trial

The costs and consequences of donepezil versus placebo treatment in patients with mild to moderate Alzheimer’s disease (AD) were evaluated as part of a 1-year prospective, double-blind, randomized, multinational clinical trial. Patients received either donepezil (n = 142; 5 mg/day for 28 days followed by 10 mg/day according to the clinician’s judgement) or placebo (n = 144). Unit costs were assessed in 1999 Swedish kronas (SEK) and converted to US dollars (USD). Donepezil-treated patients gained functional benefits relative to placebo on the Progressive Deterioration Scale (p = 0.042) and Instrumental Activities of Daily Living scale (p = 0.025) at week 52. Caregivers of donepezil-treated patients spent an average of 400 h less annually providing care than caregivers of placebo-treated patients. Mean annual healthcare costs were SEK 137,752 (USD 16,438) per patient for the donepezil group and SEK 135,314 (USD 16,147) in the placebo group. With the average annual cost of donepezil at SEK 10,723 (USD 1,280) per patient, the SEK 2,438 (USD 291) cost difference represented a 77% cost offset. When caregiver time and healthcare costs were included, mean annual costs were SEK 209,244 (USD 24,969) per patient in the donepezil group and SEK 218,434 (USD 26,066) in the placebo group, a total saving associated with donepezil treatment of SEK 9,190 (USD 1,097) per patient [95% CI of SEK –43,959 (USD –5,246), SEK 25,581 (USD 3,053); p = 0.6]. The positive effects on the efficacy outcome measures combined with no additional costs from a societal perspective indicate that donepezil is a cost-effective treatment, representing an improved strategy for the management of patients with AD.

Early treatment cost in epilepsy and how it varies with seizure type and frequency

The purpose of this paper is to describe the temporal pattern of healthcare cost in two population-based samples of new cases of epilepsy from two different regions of the US, and show how it varies with seizure type and frequency. Epilepsy-related healthcare cost from onset through 4 years of follow-up was determined for two population-based incident samples from Houston, TX and Rochester, MN. Cases were identified over the period 1987–1991 and followed through 1994. Annual use and cost was calculated for the first through fourth year of treatment for each person in the combined samples to examine the temporal pattern of early treatment cost. A multivariate model was estimated to examine how seizure type and seizure frequency affect early treatment cost while controlling for location, age, gender, and ethnicity. Our estimates indicate high initial healthcare cost at onset for most patients followed by lower cost in subsequent years. The mean annual epilepsy-related healthcare cost per patient was $3157 for the first year, $702 for the second year, $471 for year three, and $411 for year four. Cost was significantly higher for groups whose seizures continued and were relatively frequent, but was not significantly different for groups with partial seizures as compared with primary generalized seizures. There was a 2.2-fold difference in 4-year cost between patients with a single seizure at onset and those having recurrent seizures at the rate of more than one per month, controlling for seizure type, age, gender, and ethnicity.

PGI7: BUDESONIDE CIR IS COST-EFFECTIVE IN MAINTENANCE THERAPY OF CROHN'S DISEASE IN FINLAND

OBJECTIVE: To assess the economic outcome, from a health care budget perspective, of treating Crohn's disease (CD) patients with budesonide controlled ileal release (CIR) 6 mg per day as maintenance therapy compared to no maintenance therapy (NMT). METHODS: A validated decision-analytic model (Noble et al., 1998) on the treatment of (CD) was used. The model was adjusted to specifically depict CD patient management in Finland. The analysis was based on pooled patient data from randomised, double blind clinical trials comparing budesonide CIR (n = 90) in maintenance therapy with placebo (n = 90). In accordance with the clinical trials the analysis covered a study period of up to one year. The analysis took into account clinical outcomes and consequences of these in terms of health care resource use and associated costs, e.g., costs of hospitalisations, diagnostic and surgical procedures, outpatient care and drug consumption. Panel and literature data was used for events not investigated in the clinical trials. Cost inputs were derived from Tampere University Hospital for year 1998. Days in remission and relapse were translated into Quality Adjusted Life Years (QALYs) using CD specific health-state utility data from the literature. RESULTS: The outcomes of the clinical trials were reflected in the model as a 26.4% reduction in annual number of relapses for the average patient in the budesonide CIR treatment group. Mean annual health care cost per patient was 17,740 FIM (2,000 USD) for the budesonide CIR patient and 16,608 FIM (1,877 USD) for the NMT patient. The difference between the groups amounted to a cost per gained QALY of 68,610 FIM (7,753 USD), which is well in line with what is considered a cost-effective treatment strategy. CONCLUSION: Budesonide CIR means fewer relapses per average patient and is a cost-effective treatment strategy for the treatment of Crohn's disease in Finland.

Illiteracy among Medicaid Recipients and its Relationship to Health Care Costs

Poor literacy is associated with poor health status, but whether illiteracy is also linked to higher medical care costs is unclear. We characterized the literacy skills of 402 randomly selected adult Medicaid enrollees to determine if there was an association between literacy skills and health care costs. Each subject's literacy skills were measured with a bilingual (English/Spanish) reading-assessment instrument. We also reviewed each subject's health care costs over the same one-year period. The mean reading level of this Medicaid population was at grade 5.6. Mean annual health care costs were $4,574 per person. There was no significant relationship between literacy and health care costs. While there are compelling reasons to improve poor reading skills among Medicaid enrollees, illiteracy in this population does not appear to contribute to the high cost of providing government-sponsored care.