Mean Number Of Outpatient Visits Research Articles

THE IMPACT OF TREATMENT SWITCH AMONG PATIENTS WITH ULCERATIVE COLITIS NEWLY TREATED WITH A BIOLOGIC – A JAPAN RETROSPECTIVE CLAIMS DATABASE STUDY

Abstract INTRODUCTION Biologics have largely expanded treatment options for ulcerative colitis (UC) patients. Despite advanced treatments, up to 50% of patients treated with any biologic also suffer loss of response or intolerance. This study assessed the healthcare resource utilization (HCRU) associated with treatment switch as an indicator of suboptimal treatment of UC in patients newly treated with a biologic in a real-world setting in Japan. METHODS A retrospective cohort analysis was performed using the Japan Medical Data Center (JMDC) claims database for the period from 01/01/2016 through 09/30/2022. Adult patients with at least two UC diagnoses and newly treated with a biologic on or after the UC diagnosis were included. The index date was defined as the date of the first observed biologic prescription fill or injection after the UC diagnosis. Patients with a record of pregnancy one year before or one year after the index date and patients with at least two CD diagnosis were excluded. Patients were classified as switchers if they discontinued their index biologic treatment and switched to another biologic or 5-aminosalicylic acid or immunomodulator during a 12-month study period after the index date. All-cause HCRU during the study period were described and compared (unadjusted) between the 2 cohorts (switchers vs non-switchers). RESULTS Among 47,572 patients diagnosed with UC, 1,214 met criteria for inclusion, of which 261 (21.5%) were in the switchers cohort and 953 (78.5%) in the non-switchers cohort. Overall, the mean age (SD) was 41.3 (12.4) years old and 31% (n=376) were female. In the switchers group, 85.8% (n=224) discontinued index treatment and switched to another biologic, 5.0% (n=13) to a 5-ASA and 11.1% (n=29) to an immunomodulator. Among switchers, 59.0% (n=154) of switching occurred during the first 6 months after index treatment. During the 12-months follow-up period, the mean number of outpatient visits were similar between cohorts (15.5 visits vs 14.3 visits, p = 0.01). However, a greater proportion of the switchers cohort experienced inpatient hospitalization compared to non-switchers (43.7% [n=114] vs 19.6% [n=187], p<0.001). In addition, the inpatient hospitalizations had a longer mean length of stay in the switchers group vs non-switchers (12.9 days vs 4.5 days, p<0.001). CONCLUSION This real-world analysis using the JMDC database showed that roughly one out of five patients newly treated with a biologic switched to another treatment within 12 months of the treatment initiation. Those who experience treatment switch were also more likely to be hospitalized and had a longer length of stay versus patients who did not switch treatment. These findings highlight the continued burden of non-remission associated with treatment switch and the need for more efficacious and safe treatment interventions early in disease management.

Telehealth Use Among Adults with Sickle Cell Disease before and during the COVID-19 Pandemic in the United States

Introduction: Individuals living with sickle cell disease (SCD) have suffered from a lack of access to care, which is strongly associated with poor quality of care and negative health outcomes. The COVID-19 pandemic has likely further limited these patients' access to regular care. At the same time, the use of telehealth has rapidly expanded, which has been shown to improve access to care for many conditions. However, the pattern of adoption of telehealth among adult patients with SCD is little known. This study aimed 1) to examine the use of telehealth visits, along with in-person visits, among U.S. adults with SCD before and during the COVID-19 pandemic and 2) to identify patient subgroups that used a telehealth outpatient visit during the first year of the pandemic (03/2020-02/2021). Methods: This retrospectivestudy used commercial insurance claims data from the Merative™ MarketScan ® Research Databases between 1/1/2019 and 12/31/2021. Individuals were included if they were between 18 and 62 years old, had ≥3 inpatient or outpatient claims with a SCD diagnosis, had no cancer diagnosis, and were enrolled in the data at least for 11 months each year of the study period. For the first objective, the number of telehealth and in-person outpatient visits made by the study population were measured each month throughout the study period. For the second objective, the outcome was whether or not a study individual used a telehealth visit during the first year of the pandemic (03/2020 to 02/2021) with any diagnoses. Demographic (age and gender) and socioeconomic (employment classification and status, geographic region, and rural vs. urban area) characteristics and baseline SCD-related outpatient visits 1-year prior (03/2019-02/2020) were measured and used as covariates when appropriate. Descriptive and multiple logistic regression analyses were performed. Employment classification and status were not included in the multiple logistic regression analysis due to a large number of other or unknown values. Results: Of the 846 SCD patients (mean [SD] age = 37.2 [12.8], 62.4% female) included, 342 (40.4%) used a telehealth visit during the pandemic. Before the shutdowns implemented in 03/2020, the mean number of outpatient visits was 1,172.4 [SD=69.9] per month; 1.1 [SD=1.2] (0.1%) were telehealth and 1,171.3 [SD=69.3] (99.9%) were in-person (Figure 1). During the first year of the pandemic (03/2020-02/2021), the mean outpatient visits were 1,243.3 [SD=154.7] per month; 67.7 [SD=22.2] (5.4%) were telehealth and 1,175.6 [SD=168.9] (94.6%) were in-person. After the first year, overall outpatient visits increased to 1,419.4 [SD=96.87] per month due to increases in in-person visits (1,357.1 [SD=92.0] per month) and a slightly decreased level of telehealth visits (62.3 [SD=10.3] per month). Patient characteristics associated with a higher likelihood of using telehealth include: age 35-44 (compared to 18-34; odds ratio [OR]: 1.466, 95% CI: 1.102-2.123, p=0.0433), female (compared to male; OR: 1.774, 95% CI: 1.321-2.399, p=0.0002), living in the West (compared to the South; OR: 1.887, 95% CI: 1.015-3.509, p=0.0448), and 13 or more outpatient visits 1 year prior to the pandemic (compared to 0-3 visits; OR: 1.722, 95% CI: 1.138-2.606, p=0.0101), whereas living in the North Central (compared to the South; OR: 0.538, 95% CI: 0.349-0.829, p=0.0050) or rural area (compared to urban; OR: 0.505, 95% CI: 0.336-0.759, p=0.0010) were associated with less likelihood of using telehealth, after controlling for other covariates. Conclusion : Using nationally representative data, this study found that telehealth use among adults with SCD in the U.S. rapidly increased immediately after the shutdown orders in March 2020, decreased in a few months, and then remained steady afterwards. When a patient visit can be effectively conducted via telehealth, such as a follow-up visit for continued treatment, efforts focused on increasing telehealth use among young adults, males, those living in the North Central and/or rural areas could improve access to regular care, which could lead to better health outcomes.

Advance care planning and outpatient visits among older adults across cognitive levels

Advance care planning (ACP) can help reduce end-of-life care challenges for persons with Alzheimer's disease and related dementia and their care partners. Building on our previous work, we examined the impact of ACP on outpatient/doctor visits in older adults with dementia/impaired cognition and normal cognition. Using datasets from the 2014 Health and Retirement Study (HRS), we conducted a cross-sectional study of 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. Our findings indicated that having at least one ACP measure was significantly associated with a higher mean number of outpatient visits in both cognition groups. Based on our findings, we recommend considering healthcare access and use as an intervening variable in future ACP research.

Multi-disciplinary management of type 1 and 2 skin tears using a silver-based hydrofiber dressing.

Skin tear is a common problem encountered in the emergency department. If it is not properly managed, it can lead to wound infection, skin necrosis and a need for further surgical intervention and skin grafting. Current management is to cleanse the wound, replace the thin skin tear followed by coverage with a dressing that is inducive for wound healing. Several dressings have been suggested for the coverage of these wounds. But, up to now, there has been no mention of the use of a silver-based hydrofiber dressing in the management of this condition. The objective of this study was to explore the use of a silver-based hydrofiber dressing for the management of paper-thin skin tears. We retrospectively reviewed all patients with Type 1 or 2 skin tears that had undergone management using a silver-based hydrofiber dressing between October 2019 and October 2020. Demographic data and medical history was obtained by retrospective chart review. Data that was collected included: age, sex, comorbid illnesses, defect location, defect size, complications, number of times the silver-based hydrofiber dressing was replaced and the number of days required to achieve complete wound healing. A total of 65 patients were included in the study. There were 42 males and 23 females. There were 28 patients whose age was greater then 85 years old, of which 14 patients were over 90 years old. The mean number of outpatient visits was 2. The mean defect size was 33 cm2 (range 1 cm × 1 cm to 18 × 10 cm). The mean number of days required for total wound healing was 13 days (range 7-21). We did not encounter any patients that required further surgical debridement or split-thickness skin grafting. The use of a silver-based hydrofiber dressing was well tolerated by the elderly population as it provided an easy, efficient, economical and effective form of management of skin tears. We suggest that a silver-based hydrofiber dressing can be used as a first-line treatment method for type 1 and 2 skin tears.

Health Care Utilization among Homeless-Experienced Adults Who Were Seen by a Mobile Addiction Health Clinic in Boston, Massachusetts: A Quasi-Experimental Study

Background: Mobile health clinics improve access to care for marginalized individuals who are disengaged from the healthcare system. This study evaluated the association between a mobile addiction health clinic and health care utilization among people experiencing homelessness. Methods: Using Medicaid claims data, we evaluated adults who were seen by a mobile addiction health clinic in Boston, Massachusetts from 1/16/18–1/15/19 relative to a propensity score matched control cohort. We evaluated both cohorts from four years before to one year after the index visit date with the mobile clinic. The primary outcome was the number of outpatient visits; secondary outcomes were the number of hospitalizations and emergency department (ED) visits. We used Poisson regression to compare changes in outcomes from before to after the index date in a quasi-experimental design. Results: 138 adults were seen by the mobile clinic during the observation period; 29.7% were female, 16.7% were Black, 8.0% Hispanic, 68.1% White, and the mean age was 40.4 years. The mean number of mobile clinic encounters was 3.1. The yearly mean number of outpatient visits increased from 11.5 to 12.1 (p = 0.43; pdiff-in-diff = 0.15), the number of hospitalizations increased from 2.2 to 3.0 (p = 0.04; pdiff-in-diff = 0.87), and the number of ED visits increased from 5.4 to 6.5 (p = 0.04; pdiff-in-diff = 0.40). Conclusions: The mobile addiction health clinic was not associated with statistically significant changes in health care utilization in the first year. Further research in larger samples using a broader set of outcomes is needed to quantify the benefits of this innovative care delivery model.

Abstract 11358: Total Cost of Care in Heart Failure Patients Receiving Parenteral Iron Therapy for Iron Deficiency Anemia: A Retrospective Analysis

Introduction: Iron deficiency (ID) is a common comorbidity in heart failure (HF) patients. This study compared healthcare costs between treatment with ferric carboxymaltose (FCM) and low dose IV iron (LDI) in HF patients with iron deficiency anemia (IDA). Methods: Medical and pharmacy claims from IQVIA PharMetrics ® Plus data were analyzed. Adult patients who received FCM or LDI (i.e iron sucrose, iron dextran, sodium ferric gluconate complex in sucrose) from 2017 to 2019, who had HF and IDA medical claims and were continuously eligible 6 months before (baseline) and 12 months after first (index) IV iron infusion were included. Patients with chronic kidney disease who required dialysis were excluded. Eligible FCM patients were required to receive 2 FCM doses within 21 days of index date. Healthcare resource use and costs for pre- and post-index periods were summarized descriptively. Post-index monthly inpatient, outpatient (excluding IV iron), and total costs for FCM and LDI were compared using generalized linear model with gamma log-link adjusting for pre-index monthly cost, age, gender, year of index treatment and Charlson Comorbidity Index. Results: Data from 3,153 FCM patients and 3,971 LDI patients were analyzed. Unadjusted mean number of outpatient visits increased numerically in the LDI group and unchanged for FCM, whereas ER visits and inpatient admissions decreased numerically for both treatment groups in the post-index period compared to baseline. After adjusting for covariates, post-index monthly inpatient costs [adjusted cost ratio (ACR)= 0.70, p <0.001], outpatient costs (ACR=0.74, p <0.001) and total costs (including IV iron) (ACR = 0.81, p <0.001) were significantly lower for FCM than LDI. Conclusion: Higher acquisition cost of FCM was offset by lower inpatient and outpatient costs in HF patients with IDA receiving FCM than LDI during the 12 months after IV iron treatment, resulting in significantly lower total healthcare costs for FCM compared to LDI.

Analysis of Medical Resource Consumption in Multiple Myeloma Patients Who Received Autologous Hematopoietic Stem Cell Transplantation

<p>目的:探討多發性骨髓瘤病人施行造血幹細胞移植之醫療資源耗用分析。</p> <p>方法:本研究為回溯性之研究,研究樣本取自單一醫學中心,2010 年至 2017 年為 新診斷多發性骨髓瘤且有進行造血幹細胞移植的病人。結果:結果顯示接受造血幹細胞移植的病人年齡為 57.77 ± 8.24 歲,平均門診次數為 97.77 ± 64.72 次,住院次數為 5 ± 3.09 次,急診次數為 3.04 ± 5.02 次, 門診總花費為 1,318,724.23 ± 1,009,450.62 元,住院總花費為 1,020,685.5 ±478,821.88 元。</p> <p>結論:接受治療的病人在第一年的門診及住院費用為最高,第二年之後會開始遞 減,而不接受治療的人則有相反的表現,第一年門診及住院費用最低,之後開始逐年上升,所花的醫療費用比接受治療的人更高。</p> <p> </p><p>Objectives: We conducted a medical resource consumption analysis in multiple myeloma patients who received hematopoietic stem cell transplantation at a single center.<br />Methods: This was a retrospective study, and the subjects were newly diagnosed multiple myeloma patients who received hematopoietic stem cell transplantation from January 2010 to 31 December 2017 at a single medical center.</p> <p>Results: The mean age of patients who received hematopoietic stem cell transplantation was 57.77 ± 8.24 years. The mean number of outpatient visits was 97.77 ± 64.72, mean number of hospitalizations was 5 ± 3.09, mean number of emergency department visits was 3.04 ± 5.02, total outpatient cost was 1,318,724.23 ± 1,009,450.62 NTD, and total hospitalization cost was 1,020,685.5 ± 478,821.88 NTD.</p> <p>Conclusions: This study showed that the cost was the highest during the period of active treatment, and if the patient’s condition improved, the cost would decrease accordingly. This result was similar to that of our study, in which the outpa-tient and hospitalization expenses of the treated patients were the highest in the first year and began to decrease after the second year. The opposite was true for untreated patients whose outpatient and hospitalization expenses were the lowest in the first year and then increased annually. The medical expenses of untreated patients were higher than those of treated patients.</p> <p> </p>

Asthma Control during COVID-19 Lockdown in Patients with Severe Asthma under Biological Drug Treatment

Introduction: Coronavirus disease 2019 (COVID-19) has deeply affected the management of patients with severe asthma, treated with add-on biological therapies. Objective: In this study, severe asthmatic patients on treatment with one of three different biologics (omalizumab, mepolizumab, benralizumab) underwent a survey to evaluate the effects of COVID-19 on the management of their clinical condition, with regard to the changes caused by the limited access to health facilities during the pandemic period. Methods: In this prospective observational study, 28 severe asthmatic outpatients referring to the Respiratory Unit of Magna Graecia University Hospital, Catanzaro (Italy), were asked to answer a telephone survey from May to July 2021. This survey included the evaluation of demographic and clinical data, as well as the number of lung function tests performed, exacerbations, biologic doses administered at hospital, or at general practitioner office, or through self-administration. Adherence to biological therapies before and during the pandemic period was also assessed. Moreover, the most recent asthma control test (ACT) score and the last forced expiratory volume in the first second (FEV1) measurement, recorded during the pandemic phase, were compared to the pre-pandemic (baseline) period. Results: When comparing the pre-pandemic data with the pandemic observations, the mean ACT score and the exacerbation rate did not significantly change [ACT, 21.5 ± 2.8 to 23.0 ± 3.9 (p = 0.1); exacerbation rate, 0.3 ± 0.6 and 0.5 ± 1.5 (p = 0.3)]. When considering some variables related to disease management in the same periods, a statistically significant difference was detected with regard to the mean number of outpatient visits (5.2 ± 3.8 vs. 0.9 ± 2.5, p < 0.0001), as well as to the mean number of accesses to health facilities for the administration of biological drugs (from 7.0 ± 3.4 to 2.5 ± 3.9, p < 0.0001). None of the patients reported to have been infected with the SARS-CoV-2 virus and no adverse drug reactions (ADR) occurred during the study. Conclusions: The above results suggest that COVID-19 pandemic did not induce any significant change related to severe asthma control. Indeed, add-on treatment with biological drugs was regularly continued, despite the obvious limited access to health facilities.

Nationwide registry of glecaprevir plus pibrentasvir in the treatment of HCV in Taiwan

The study evaluated the real-world treatment outcomes of Glecaprevir/pibrentasvir (GLE/PIB) including effectiveness, safety and healthcare resource utilization based on a nation-wide registry in Taiwan. The Taiwan HCV Registry (TACR) is a nation-wide platform organized and supervised by the Taiwan Association for the Study of the Liver. Data were analyzed for patients treated with GLE/PIB, including 3144 patients who had treatment outcome available. The primary endpoint was sustained virological response (SVR12, undetectable HCV RNA throughout 12 weeks of end-of-treatment). The overall SVR12 rate was 98.9% (3110/3144), with 98.8%, 99.4% and 100% in patients receiving 8 weeks, 12 weeks, and 16 weeks of GLE/PIB respectively. The SVR12 rate in the treatment-naïve cirrhotic patients receiving 8 weeks of GLE/PIB was 98.2% (108/110). The most common AEs were fatigue (7.5%), pruritus (6.7%) and dizziness (1.5%). The mean number of outpatient visits during the GLE/PIB was 5.94 visits for patients treated with 8 weeks, significantly different from the patients treated with 12 weeks of GLE/PIB (6.90 visits). The results support the effectiveness and safety of GLE/PIB treatment in real-world clinical practice, and provide further evidence that the shorter, 8-week GLE/PIB regimen is effective and cost-saving.

Cost of Pediatric Acute Lymphoblastic Leukemia Care in the Current Treatment Era

Introduction: Acute lymphoblastic leukemia (ALL) is the most common malignancy of childhood, with a current incidence of 3,000 cases annually. Incremental alterations in treatment over time have resulted in overall survival rates that now exceed 90%. Although minor differences exist between ALL treatment protocols from different cooperative groups, risk-stratified treatment for ALL is generally standard across the country. As more has been understood about ALL biology and outcomes, treatments have been further risk stratified to optimize outcomes for higher risk individuals while minimizing toxicities for those with more favorable disease characteristics. With the improvements in outcome for ALL, cost of care is a critical component and financial toxicity for patients and society requires evaluation.Methods: Using commercial insurance data from the OptumLabs ® Data Warehouse, a cohort of 1941 ALL patients was identified, aged 1-30 years and diagnosed between 2000 and 2017 in the United States. ALL diagnosis was confirmed based on ICD-9 and ICD-10 diagnostic codes, in combination with bone marrow and lumbar puncture procedure codes within 14 days of diagnosis. Individuals were followed up to 36 months from diagnosis. Mean monthly and cumulative costs were computed for the initial 8 months of therapy and for 36 months from diagnosis, as were mean number of inpatient and outpatient days. Costs were further broken down by the types of services provided. All results were stratified by age group (1-9 years, 10-12 years, ≥13 years) as a proxy for risk group, with the younger group most consistent with standard risk disease and the older groups indicating high risk and very high risk disease, respectively.Results: Among the 1941 identified ALL patients (1-9 years, 1233; 10-12 years, 162; ≥13 years, 546), 44% were female, 51% were white, median age at diagnosis was 6 years (interquartile range 3-14 years) and 941 of enrolled patients had continuous data through 36 months. Mean cost of care over the approximate 3 years of therapy was $537,000, with approximately 58% of costs incurred within the initial intensive 8 months of therapy. Mean cost was highest among the ≥13 year age group, both for the initial 8 months of therapy ($487,000, 95% CI $449,300-530,400)), as well as over the 36 months following diagnosis ($850,000, 95% CI $778,400-937,100) (Figure). This was reflective of the highest mean number of inpatient days among the ≥13 year age group (88.1 days over 36 months, 95% CI 82.1-94.9) compared to the 10-12 year group (73.2 days, 95% CI 64.3-85.1) and the 1-9 year group (47.5 days, 95% CI 45.2-50.9). Mean number of outpatient visits over 36 months was not significantly different between 1-9 and 10-12 year age groups but was significantly higher among the ≥13 year age group compared with the 1-9 year group. Thirty-six month survival varied by age group and was highest among the 1-9 year group (95.9%, 95% CI 94.6-97.2) compared with the 10-12 year group (90.5%, 95% CI 85-4-95.8) and the ≥13 year group (79.6%, 95% CI 75.8-83.6).Conclusions: This robust real-world cost analysis shows for the first time that the average cost of ALL care in the current treatment era, including inpatient and outpatient data, is more than $500,000. We showed that the cost of care is highest among the oldest pediatric age group, indicating increasing cost with increased therapeutic intensity. This study provides a valuable benchmark that can be used to analyze the financial toxicity of ALL therapy on patients and families and can be re-assessed over time as novel therapeutics are introduced into ALL therapy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Effects of Patient-Initiated Visits on Patient Satisfaction and Clinical Outcomes in a Type 1 Diabetes Outpatient Clinic: A 2-Year Randomized Controlled Study.

We investigated the effects of replacing regular outpatient follow-up through prescheduled visits with patient-initiated visits on patient satisfaction and clinical variables of type 1 diabetes (T1D). A 24-month randomized controlled trial in which adults with T1D were allocated to either patient-initiated unlimited access to outpatient visits or usual care through regular prescheduled visits. The primary outcome was seven patient-reported experience measures of patient satisfaction focused on benefit of consultation and accessibility of the outpatient clinic. Secondary outcomes included clinical variables of diabetes and use of staff resources. We enrolled 357 outpatients (intervention, n = 178; control, n = 179). After 24 months, participants in the intervention group experienced more benefit from consultations compared with baseline within groups (P < 0.05) and fewer unnecessary visits compared with control subjects (P < 0.05). Patient needs covered and satisfaction with the outpatient clinic were high and unchanged in both groups, and accessibility was increased (three questions, all P < 0.05). A calculated seven-item patient satisfaction sum score favored the intervention group over control subjects (P < 0.001). There were no significant changes in glycated hemoglobin (HbA1c), LDL, blood pressure, and complication status. The mean number of outpatient visits over 24 months (± SD) was lower in the intervention group compared with control subjects (4.4 ± 2.8 vs. 6.3 ± 2.7; P < 0.001), while the number of telephone contacts was higher (3.1 ±3.4 vs. 2.5 ± 3.2; P < 0.001). Patient satisfaction remained high or improved with patient-initiated on-demand use of the diabetes outpatient clinic, with no decline in the quality of diabetes care, and a reduction in the use of staff resources.

Clinical and Economic Burden of Transfusion-Dependent β-Thalassemia in Adult Patients in the United States

Introduction: β-thalassemia is a genetic blood disorder in which defective β-globin synthesis leads to ineffective erythropoiesis. Patients with transfusion-dependent β-thalassemia require lifelong management with blood transfusions and iron chelation therapy. Complications related to iron overload can cause significant morbidity and mortality, and it is well understood that the chronic management of this disease presents a substantial burden to patients in terms of healthcare visits and costs. However, the specific clinical and economic burden has not been well characterized in the USA.Objectives: The objectives of this study were to analyze the clinical and economic burden of current disease management for patients with transfusion-dependent (TD) β-thalassemia in the USA over a 1-year time period.Methods: This retrospective matched cohort study was conducted using the Truven Health MarketScan® Research Databases (Truven Health Analytics, Ann Arbor, MI). The MarketScan® Databases provide detailed utilization, outcomes, and cost data for healthcare services performed in inpatient and outpatient settings, and contains de-identified data from > 110 million patient lives. Adult patients with TD β-thalassemia and matched controls were identified between Jan 1, 2011 and Sep 30, 2015. Patients were required to be ≥ 18 years old at the index date with ≥ 12 months of continuous enrollment post index date. TD β-thalassemia patients were required to have ≥ 2 claims with a β-thalassemia (ICD-9-CM 282.44, ICD-10-CM D56.1) or hemoglobin E-β thalassemia (ICD-9-CM 282.47, ICD-10-CM D56.5) diagnosis, and ≥ 8 transfusion events to be defined as TD. Patients were excluded if they had ≥ 2 claims with any sickle cell diagnosis. Controls were required to have ≥ 1 medical claim and were excluded if they had a diagnosis of any thalassemia or sickle cell condition. Patients with TD β-thalassemia were matched to controls in a 1:5 ratio using exact matching based on age, sex, index year, payer type, and census division. Comorbidities were not used in matching because patients with TD β-thalassemia have a high burden of disease-associated comorbidities. Index date was the first claim for a β-thalassemia diagnosis in patients with TD β-thalassemia or the first medical claim for controls. Outcomes examined were disease burden such as comorbid conditions, healthcare utilization and costs specific to the management of TD β-thalassemia, as well as general healthcare utilization and costs during the 12 months post index date. Chi-squared tests and Fisher's exact test were used for categorical variables and the Wilcoxon-Mann-Whitney test was used for continuous outcomes.Results: Fifty patients with TD β-thalassemia met selection criteria and were matched to 250 controls. Mean age was 34.7 ± 9.1 years for both patients and controls. Patients with TD β-thalassemia had higher rates of diabetes (18% vs 6%, P = 0.009), cardiac disease (30% vs 2%, P < 0.001), hypogonadism (22% vs 7%, P = 0.002), osteoporosis (16% vs 1%, P < 0.001), and hypothyroidism (12% vs 4%, P = 0.045) compared with controls. On average, patients with TD β-thalassemia required 17 transfusions per year, 23 days apart. Mean number of outpatient visits was significantly higher in the TD β-thalassemia cohort compared with matched controls; however, inpatient and ER visits were not significantly different (Table 1). Mean total healthcare costs among the TD β-thalassemia cohort were USD 128,062 ± 62,260, compared with USD 5,438 ± 11,855 in controls (P < 0.001). Medical and medication costs were significantly higher in the TD β-thalassemia cohort compared with matched controls (Table 2). Among patients with TD β-thalassemia, total costs were primarily driven by chelation and transfusion costs, with other costs displayed in the figure. The majority of patients with TD β-thalassemia received oral chelators (72%), whereas 30% of patients received injectable chelators; 14% of patients received both oral and injectable chelators.Conclusions: Ongoing comprehensive treatment for TD β-thalassemia poses a substantial clinical and economic burden as compared with matched controls. Patients with TD β-thalassemia had significantly higher healthcare resource utilization, medication costs, and total costs compared with matched controls, and required frequent visits to their healthcare provider, which poses a burden to their quality of life and work productivity. [Display omitted] DisclosuresSheth:Novartis, Celgene, ApoPharma, Bluebird Bio: Consultancy. Weiss:Celgene: Employment; Zocdoc: Other: Equity ownership (options have not vested yet); Zocdoc: Other: Husband's employment. Parisi:Celgene: Employment, Equity Ownership. Ni:Celgene: Employment.

PCV35 Costs of Septal Reduction Therapy for Obstructive Hypertrophic Cardiomyopathy: A US Claims Analysis

To quantify total healthcare resource utilization (HCRU) costs for patients with obstructive hypertrophic cardiomyopathy (oHCM) receiving septal myectomy (SM) or alcohol septal ablation (ASA). Retrospective study utilizing medical and pharmacy claims data representing >50 million US commercially insured and Medicare Advantage members from the HealthCore Integrated Research Database during 2013-2019. Direct medical costs included inpatient, outpatient, emergency department, and pharmacy (2019 $ US) and were the sum of plan paid, patient paid, and any coordination of benefit. HCRU costs were captured for ≥1 SM or ASA procedure for oHCM patients (≥18 years) and reported 12-months pre- and post-procedure. Of 119 identified patients, 95 (80%) received SM. Mean length of inpatient hospitalization stay was longer for SM (8.3 days) than ASA (6 days). Post-surgery HCM-related medication usage was greater for SM (98%) than ASA (88%). Mean number of outpatient visits increased from pre- to post-surgery (SM=12.2 vs 15.9; ASA=7.2 vs 9.5), with 86% of SM and 83% of ASA patients having ≥1 cardiology visit. Compared to the pre-surgery, total HCM-related costs increased during post-surgery period, index surgery inclusive (SM=$27,045 vs $119,772; ASA=$11,278 vs $54,351), driven by increased inpatient hospitalization (SM=$10,325 vs $112,923; ASA=$5,509 vs $47,450) and surgical cost (SM=$6,665 vs $92,031; ASA=$52 vs $44,815). For pre-SM vs post-SM, HCM-related medication costs decreased ($974 vs $744) along with outpatient visit costs ($14,202 vs $5,782); for ASA, HCM-related medication ($827 vs $1,201) and outpatient visit costs increased ($4,645 vs $5,431). Our results indicate a trend towards increasing costs after septal reduction therapy, driven mostly by inpatient hospitalization and surgical costs. All outpatient costs decreased after myectomy, while only diagnostic cost decreased in the ablation group. HCRU increased after surgery for both groups, with length of stay and HCM-related medication use being higher in SM.

60 A Retrospective Review of Factors Influencing Post-Hospital Discharge Follow-up in Patients with Burn Injuries

Abstract Introduction Approximately 486,000 burn injuries, requiring hospitalization and/or outpatient care occur annually. Physical and psychosocial problems may develop at any time during recovery and it is important that care continue after discharge to maximize outcomes. Often, patients discharge themselves from clinic for unknown reasons. The purpose of this study was to identify factors related to self-discharge. Methods A retrospective chart review of patients admitted to the burn center and outpatient follow up visits in 2018 was performed. Patients were grouped by lost to follow up (LTF) versus completed patients (COM). The LTF were further stratified by distance from clinic (≤ 50 miles vs. &amp;gt; 50 miles). COM were categorized as those who were discharged from clinic as PRN follow up visits. Results A total of 211 patients were scheduled for outpatient visits, mean age was 36.4 years and 74% were male. Most were Caucasian (41%) and Hispanic (31%). The most frequent payor sources were Medicaid (58%)/ Medicare (17%). Mean TBSA was 5.8 %, the most common mechanisms were Flame/Flash and Scald (30% each). Mean length of stay was 10.3 days, mean number of surgeries was 1.5. The majority of patients were discharged Home (71%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. LTF patients had a smaller TBSA (4.69%) compared to COM (9.62%). Comparison between LTF and COM, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=&amp;lt; 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p&amp;lt; 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. When LTF were stratified by distance, Native Americans were significantly more likely to live &amp;gt; 50 miles from the clinic (p &amp;lt; .00001). Conclusions A large percentage of patients discharged themselves from clinic. Factors associated with self-discharge include healed wounds, no scarring issues, smoking, substance abuse and mental illness. Given the geographic distribution of races and ethnicities in our state, it is unsurprising that Native Americans live distant to our clinic. This provides an opportunity to expand our outreach efforts and incorporate the use of technology to improve access to care for this population.

The Impact of Once-Monthly Paliperidone Palmitate on Healthcare Utilization Among Patients With Schizophrenia Treated in an Integrated Healthcare System: A Retrospective Mirror-Image Study.

IntroductionPrevious evidence demonstrated that patients with schizophrenia consumed substantial healthcare resources in an integrated healthcare system. This study evaluated the impact of initiating once-monthly paliperidone palmitate (PP1M) on healthcare resource utilization (HRU) among patients with schizophrenia treated in a US integrated healthcare system.MethodsThis retrospective study used electronic medical records from Atrium Health. Adults with at least two diagnoses of schizophrenia who received an initial PP1M dose between September 2009 and April 2019 (the corresponding date defined the index date) and at least one subsequent dose within 90 days were included. Additionally, patients were required to have received active care (at least one healthcare visit every 6 months) during 12-month pre- and post-index periods and at least one oral antipsychotic prescription during the 12-month pre-index period. Inpatient, emergency room (ER), and outpatient visits were compared over 12-month pre- versus post-index periods within the same cohort using McNemar’s and Wilcoxon signed rank tests. Findings were reported for all patients and separately in patients with at least one schizophrenia relapse (schizophrenia-related inpatient or ER visit) during the 12-month pre-index period.ResultsThe study cohort included 210 patients (mean age 34.2 years, 69.5% male, 39.1% had Medicaid). From the 12-month pre- to post-index period, the proportion of patients with visits and mean number of visits reduced for all-cause inpatient (67.6% to 22.4%, 1.2 to 0.4), 30-day readmission (12.4% to 2.4%, 0.2 to 0.1), and ER (68.6% to 45.7%, 2.3 to 1.2) visits, whereas the mean number of outpatient visits increased (8.7 to 11.6) (all P < 0.05). Similar trends were observed for mental health- and schizophrenia-related HRU. The trends in HRU in patients with prior relapse were similar with a higher extent of reduction in inpatient and ER use compared to the overall cohort.ConclusionInitiation of PP1M was associated with reduced acute HRU in patients with schizophrenia, indicating potential clinical and economic benefits, especially in patients with prior relapse.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01626-9.

Primary and Specialty Outpatient Visits for Older Women With Urinary Incontinence: A Comparison of Nurses to the General Population.

We evaluated patterns of outpatient visits seen for urinary incontinence (UI) among women 65 years or older in the Nurses' Health Study and the general Medicare population. We were interested in understanding whether nurses, with high health literacy, may receive more care for UI than the general population. Medicare Fee for Service claims data for women aged 66-91 years were compared for Nurses' Health Study participants (n = 3,213) and a propensity-matched sample from general Medicare Fee for Service beneficiaries (n = 3,213) with 1 or more outpatient evaluation and management visits for UI in 2012. We examined the mean number of outpatient visits for UI and the type of provider seen, using t tests and χ2 tests. Providers were categorized as specialist and nonspecialist providers using taxonomy codes. The percentage of women 65 years or older who had an outpatient visits for UI over 12 months was 6.4% in the Nurses' Health Study cohort and 5.4% in the general population. The mean number of office visits for UI in 2012 was similar between nurses and the matched general population (mean = 1.8 vs 1.8; P = 0.3). A small percentage of women saw both nonspecialists and specialists for UI (9.3% in the Nurses' Health Study and 10.0% in the Center for Medicare Services cohorts). We found that less than 7% of older women had outpatient evaluation of UI symptoms during a 12-month period, despite UI being very common in this age group. This was similar in nurses and the general population, suggesting that even high health care literacy does not increase UI care seeking.

Impact of Health Insurance on Health Care Utilisation and Out-of-Pocket Health Expenditure in Vietnam.

Background In recent years, health insurance (HI) has been chosen by many low- and middle-income countries to obtain an important health policy target—universal health coverage. Vietnam has recently introduced the Revised Health Insurance Law, and the effects of the voluntary health insurance (VHI) and heavily subsidised health insurance (HSHI) programmes have not yet been analysed. Therefore, this study is aimed at examining the impact of these HI programmes on the utilisation of health care services and out-of-pocket health expenditure (OOP) in general and across different health care providers in particular. Methods Using the two waves of Vietnam Household Living Standard Surveys 2014 and 2016 and the difference-in-difference method, the impacts of VHI and HSHI on health care utilisation and OOP in Vietnam were estimated. Results For both the VHI and HSHI groups, we found that HI increased the probability of seeking outpatient care, the mean number of outpatient visits, the total number of visits, and the mean number of visits at the district level of health care providers in the last 12 months. However, there was no evidence that the HSHI programmes increased the mean number of inpatient visits and the number of visits at the provincial hospital. We also found that while the VHI programme reduced OOP for both outpatient and inpatient care, the HSHI scheme did not result in a reduction in OOP for hospitalisation, although HI lowered the total OOP. Similarly, we found that for both groups, HI reduced OOP when the insured visited district and provincial hospitals. However, the statistically significant impact was not demonstrated when the enrolees of HSHI programmes visited provincial hospitals. Conclusion The study offers evidence that the Vietnamese HI scheme increased health care service utilisation and decreased OOP for the participants of the VHI and HSHI programmes. Therefore, the government should continue to consider improving the HI system as a strategy to achieve universal health coverage.

Comparison of characteristics and outcomes among veterans receiving first-line immunotherapy versus chemotherapy for stage IV non-small cell lung cancer.

e19295 Background: Immunotherapy (IO) has revolutionized the treatment paradigm for patients with advanced non-small cell lung cancer (NSCLC). Study objectives were to evaluate utilization of IO as first-line (1L) therapy and compare clinical characteristics between patients receiving IO and those receiving CT in 1L setting. Methods: Using the U.S. Department of Veterans Affairs corporate data warehouse, patients with stage IV NSCLC diagnosed 2012-2017 and initiated non-targeted systemic therapy within 120 days of diagnosis were selected. Unadjusted descriptive statistics were used to compare patient characteristics, inpatient and outpatient clinic visits, and prevalence of select adverse events (AE) between patients receiving IO monotherapy and CT. Kaplan-Meier and Cox regression approaches with and without propensity score matching (PSM) were used for overall survival (OS) analyses. OS was calculated from treatment initiation date to death or end of study period in June 2019. Results: 4609 patients were included in the analysis: 3.4% (n = 156) received IO monotherapy, 96% (n = 4426) received CT, and 0.6% (n = 27) received IO+CT (IO+CT not included in analysis). IO patients were older than CT patients (median age 69 vs. 66 years, p &lt; 0.0001) and more frequently resided in the Midwest and West regions whereas CT patients were more likely to live in the Northeast and South (p = 0.0024). There were no significant differences in IO and CT by other demographic and clinical characteristics. Estimated median OS was 7.5 months (95% CI 7.2-7.7) for CT and 7.9 months (95% CI 5.3-12.6) for IO patients. The unadjusted HR for IO compared to CT patients was 0.81 (95% CI 0.67-0.98). With 1:4 PSM (144 and 559 patients matched in the IO and CT groups, respectively), the HR was 0.75 (95% CI 0.60-0.93). The mean number of outpatient visits for IO and CT patients were 47 and 36, respectively (p = 0.003). No difference in number of hospitalizations or length of hospital stays between the two groups was observed. Common AEs in the IO group were dyspnea (58%), colitis/enterocolitis (42%), and anemia (30%). Common AEs among CT patients were colitis/enterocolitis (36%), anemia (32%), and nausea/vomiting (31%). Conclusions: In a real-world 1L setting among veterans with NSCLC, improvement in OS was observed among patients receiving IO monotherapy compared to those receiving CT, and IO patients had a greater number of outpatient visits. Continued assessment of treatment patterns and impact of IO are needed as the use of IO continues to expand.

805 A Retrospective Review of Factors Influencing Post-hospital Discharge Follow-up in Patients with Burn Injuries and Necrotizing Soft Tissue Infections

Abstract Introduction Approximately 486,000 burn injuries requiring medical treatment occur each year. Medical treatments for burns vary and are dependent on the extent of the injury. Several physical and psychosocial problems may develop after discharge, including pain, itching, scarring, anxiety and depression, making it important and necessary for burn care treatment to continue even after discharge. Often, patients do not continue outpatient care due to unknown circumstances. The purpose of this study is to help identify factors that affect outpatient burn clinic visits after hospital discharge. Methods A retrospective chart review of patients admitted to the burn center who had an outpatient follow up visit in 2018 was performed. Patients were grouped by lost to follow up versus completed patients. Completed patients were categorized as those who were discharged from clinic as PRN follow up visits. Results A total of 211 patients were scheduled for outpatient visits in 2018, mean age was 36.4 years and 74% were male. Population consisted mainly of Caucasian (41%) and Hispanic (31%). The most common payor source was Medicaid (58%) and Medicare (17%). The mean TBSA was 5.8 % with the most common mechanisms were Flame/Flash and Scald (30% each). The mean length of stay was 10.3 days, mean number of surgeries was 1.5. Majority of patients were discharged Home (71%) and SNF (20%). The mean number of outpatient visits was 3.57. A total of 165 (78%) were lost to follow-up. Lost to follow up (LTF) patients had a smaller TBSA (4.69%) compared to those who completed follow-up (9.62%). Comparison between LTF and completed patients, showed no significant difference in age, race, distance from clinic, or disposition. However, larger TBSA (p=0.0009), longer length of stay (p=0.01), more surgeries (p=0.0105), patients with ongoing scar management (p=&amp;lt; 0.00001), and patients with Workman’s Comp (p=0.048) were more likely to complete outpatient follow up. Patients with closed wounds (p&amp;lt; 0.0001), substance abuse (p=0.0168), mental illness (p=0.0403), smokers (p=0.0192) were less likely to complete outpatient follow up as directed. The number of complications was also higher (p=0.0433) in the LTF group. Conclusions There were a large percentage of patients who discharged themselves from clinic care. Factors that were associated with self-discharge include healed wounds, no scarring issues noted, and patients with complications, smokers, substance abuse and mental illness. Self-discharge / LTF may be related to resolution of ongoing issues prior to last scheduled appointment. Applicability of Research to Practice Additional research is needed to determine additional factors affecting lost to follow up in our outpatient burn clinic.

Patient Characteristics of VA Telehealth Users During Hurricane Harvey.

Introduction: Research on patient characteristics of telehealth users is relatively new. More studies are needed to understand the characteristics of telehealth users during disasters. This study attempts to bridge this gap and examines patient characteristics of telehealth users compared with nontelehealth users at the Houston VA Medical Center (VAMC) immediately before and after Hurricane Harvey (2017). Methods: Since use of telehealth services reached its peak and gradually declined within 2 weeks after the landfall, the data analyses focused on 14 days before/14 days after Harvey. Two sets of analyses were conducted using chi-square, t test, and one-way analysis of variance: (1) Patient characteristics of telehealth users were compared with nontelehealth users. (2) Patient characteristics were compared between 3 subgroups of telehealth users. Results: Compared with nontelehealth users, telehealth users were older (mean age: 60.8 vs 58.5 years, P < .001) and had a higher mean Nosos health risk score (1.9 vs 1.4, P < .001). They also had a higher mean number of outpatient visits (28.0 vs 19.8, P < .001), higher emergency room use (37% vs 29%, P < .001), and higher rates of hospitalizations (21% vs 13%, P < .001) during the 12 months before Harvey. When compared to less frequent telehealth users, the most frequent telehealth users were the oldest and most medically complex patients. Conclusions: As the largest integrated health care system in the United States, the VA has many advantages favoring successful implementation of telehealth services during disasters. However, more research is needed to better understand how VA telehealth could meet the varying needs of veterans to lower risk of harm during differing types of disasters.