Medical Cost Savings Research Articles

Behavioral Monitoring Tool for Pig Farmers: Ear Tag Sensors, Machine Intelligence, and Technology Adoption Roadmap.

Simple SummaryIn a pig farm, it is challenging for the farm caretaker to monitor the health and well-being status of all animals in a continuous manner throughout the day. Automated tools are needed to remotely monitor all the pigs on the farm and provide early alerts to the farm caretaker for situations that need immediate attention. With this goal, we developed a sensor board that can be mounted on the ears of individual pigs to generate data on the animal’s activity, vocalization, and temperature. The generated data will be used to develop machine learning models to classify the behavioral traits associated with each animal over a testing period. A number of factors influencing the technology adoption by farm caretakers are also discussed.Precision swine production can benefit from autonomous, noninvasive, and affordable devices that conduct frequent checks on the well-being status of pigs. Here, we present a remote monitoring tool for the objective measurement of some behavioral indicators that may help in assessing the health and welfare status—namely, posture, gait, vocalization, and external temperature. The multiparameter electronic sensor board is characterized by laboratory measurements and by animal tests. Relevant behavioral health indicators are discussed for implementing machine learning algorithms and decision support tools to detect animal lameness, lethargy, pain, injury, and distress. The roadmap for technology adoption is also discussed, along with challenges and the path forward. The presented technology can potentially lead to efficient management of farm animals, targeted focus on sick animals, medical cost savings, and less use of antibiotics.

Outcomes of two different chemical modalities in management of post traumatic clotted hemothorax

Management of traumatic hemothorax is an important problem in thoracic surgery. As an alternative to surgical treatment in patients who developed clotted hemothorax after trauma, intra-pleural fibrinolysis has been used with favorable results. This modality of treatment may reduce known morbidities secondary to surgical procedures and may result in significant medical cost savings. Aim of the study is to test the efficacy and safety of tissue plasminogen activator and Streptokinase for management of post traumatic clotted hemothorax. Patients and Methods: our study included 40 patients presented with clotted hemothorax after chest trauma . Patients were divided into two groups each contains 20 patients. First group treated with intra-pleural Alteplase (tissue plasminogen activator) and the second group treated with streptokinase, both were instilled via an intercostal chest tube. Clinical and radiologic (chest radiographs (CXR) and chest computed tomography (CT) data used for evaluation of efficacy of both protocols. Results: Alteplase give excellent results in clotted hemothorax , it showed dramatic improvement in both chest tube drain and pleural thickness without bleeding complications. Streptokinase protocol showed only improvement of chest tube drain. Conclusion : Intrapleural Alteplase is safe and more efficient than Streptokinase as a chemical modality in treating patients presented with post traumatic clotted hemothorax.

Cost-effectiveness analysis of a school- and community-based intervention to promote a healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: the Feel4Diabetes-study

The Feel4Diabetes-study implemented a school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes mellitus (T2DM) in six European countries. The intervention included a special focus on families at increased T2DM risk. The current study evaluates the intervention's cost-effectiveness.A Markov-type health economic model was developed to predict the incidence of T2DM and its complications. Incremental cost-effectiveness ratios (lifetime horizon, societal perspective) were calculated based on the overall intervention effect on health behaviour, and stratified for low- and high-risk families. Sensitivity analyses captured input parameters uncertainty. A budget impact analysis was performed.The increase in children's water consumption and physical activity led to a modest gain in quality adjusted life years (QALYs) at a low intervention cost and budget impact. Medical cost savings due to avoided illness could only be achieved on the very long-term (>30 years). The intervention in its entirety was cost-effective (more QALYs at a reasonable investment) in Belgium, Finland, Bulgaria, and Hungary, while being dominant (net savings and more QALYs) in Greece and Spain. Results were cost-effective for the low-risk families, who only received the school- and community-based intervention component. Results for the high-risk families were only cost-effective (with considerable uncertainty) in Greece and Spain, but not when the intervention would need to be repeated.The Feel4Diabetes-intervention is potentially cost-effective, especially in countries with a high overweight and obesity prevalence, at a limited budget impact. The incremental financial investments to reach and support high-risk families did not result in the hoped-for health benefits.

The Etiology and Pathophysiology Genesis of Benign Prostatic Hyperplasia and Prostate Cancer: A New Perspective.

Background: The etiology of benign prostatic hyperplasia and prostate cancer are unknown, with ageing being the greatness risk factor. Methods: This new perspective evaluates the available interdisciplinary evidence regarding prostate ageing in terms of the cell biology of regulation and homeostasis, which could explain the timeline of evolutionary cancer biology as degenerative, inflammatory and neoplasm progressions in these multifactorial and heterogeneous prostatic diseases. Results: This prostate ageing degeneration hypothesis encompasses the testosterone-vascular-inflamm-ageing triad, along with the cell biology regulation of amyloidosis and autophagy within an evolutionary tumorigenesis microenvironment. Conclusions: An understanding of these biological processes of prostate ageing can provide potential strategies for early prevention and could contribute to maintaining quality of life for the ageing individual along with substantial medical cost savings.

Abstract MP03: The Health And Economic Impact Of Using A Sugar Sweetened Beverage Tax To Subsidize Fruit And Vegetable Purchase In New York City: A Modeling Study

Background: Both high sugar intake and low fruit and vegetable (FV) consumption increase the risk of coronary heart disease (CHD). Sugar-sweetened beverage (SSB) taxes can reduce sugar intake, whereas FV subsidies increase FV consumption. Several cities in the US have proposed an innovative policy that used the SSB tax revenue towards FV subsidies. It is unclear what the long-term health and economic impact this innovative policy could have in large cities such as New York City (NYC). Objective: To project lifetime CHDs averted and costs if a penny-per-ounce SSB tax were used to subsidize FV incentives in NYC using a validated microsimulation model of cardiovascular disease. Methods: We used the SHINE CVD model to compare the cost and CHD outcomes of a combination of SSB tax and FV subsidy policy with only SSB tax, only FV subsidy, and no policy from a healthcare sector perspective, respectively. Population demographics and health profiles were estimated using data from the 2013-2014 NYC Health and Nutrition Examination Survey. We simulated 10,000 adults starting at age 40. CHD risk factor trajectories and risk of incident CHD events were derived from six pooled prospective U.S. cohorts. Policy effects and price elasticity were derived from recent meta-analyses. SSB tax (penny-per-ounce) and FV subsidy were modeled to directly affect incidence rates of CHD events. Medical costs were included and discounted at 3%. Results: Compared to the non-policy scenario over the simulated lifetime, the SHINE CVD model projected that the policy intervention with SSB taxes only would prevent 62 per 10,000 (95% CI: 57 - 67) CHD events at a penny-per-ounce rate, the intervention with FV subsidies only would prevent 28 per 10,000 (95% CI: 24-34), and the combined policy would prevent 91 CHD events (95% CI: 87 - 96). Total medical cost savings over the simulation period ranged from $22.5 million (95% CI: $21.5 - $23.6 million), $13.1 million (95% CI: $12.3 - $13.8million), and $37.9 million (95% CI: $36.5 - $39.4million), or $0.45 million/year, $0.27 million/year, $0.75 million/year for SSB taxes only, FV subsidies only, and the combined policy, respectively. Conclusion: Using a computer simulation model, we showed how converting SSB tax revenues into FV subsidies could result in substantial benefits within the NYC population in terms of CHD outcomes and overall healthcare cost savings. Results from the SHINE CVD model may inform the ongoing policy-making efforts.

Cost-Effectiveness Analysis of Switching from Trivalent to Quadrivalent Seasonal Influenza Vaccine in Argentina.

The burden of seasonal influenza disease in Argentina is considerable. The cost-effectiveness of trivalent (TIV) versus quadrivalent influenza vaccine (QIV) in Argentina was assessed. An age-stratified, static, decision-tree model compared the costs and benefits of vaccination for an average influenza season. Main outcomes included: numbers of influenza cases; general practitioner (GP) visits; complicated ambulatory cases; hospitalizations; deaths averted; and costs per quality-adjusted life years (QALYs) gained. Epidemiological data from Argentina for 2014–2019 were used to determine the proportion of A and B strain cases, and the frequency of mismatch between vaccine and circulating B strains. To manage uncertainty, one-way and probabilistic sensitivity analyses were performed. Switching from TIV to QIV would prevent 19,128 influenza cases, 16,164 GP visits, 2440 complicated ambulatory cases, 524 hospitalizations, and 82 deaths. Incremental cost–effectiveness ratios (ICERs) per QALY were 13,590 and 11,678 USD from the payer’s and societal perspectives, respectively. The greatest health benefits and direct medical cost savings would occur in ≥ 65-year-olds. One-way sensitivity analyses demonstrated the principal drivers of ICER to be vaccine acquisition costs, environmental B strain predominance, and B strain mismatch. Introducing QIV in Argentina would be beneficial and cost-effective relative to TIV, particularly in older adults.

Impact of an Oral Antineoplastic Renewal Clinic on Medication Possession Ratio and Cost-Savings.

The primary objective of this study was to evaluate the impact of a pharmacist-driven oral antineoplastic (OAN) renewal clinic on medication adherence and cost savings. This was a preimplementation and postimplementation retrospective cohort evaluation within a single US Department of Veterans Affairs health care system following implementation of a pharmacist-managed OAN refill clinic. The primary outcome was medication adherence defined as the median medication possession ratio (MPR) before and after implementation of the clinic. Secondary outcomes included the proportion of patients who were adherent from pre- to postimplementation and estimated cost-savings of this clinic. Patients were eligible for inclusion if they had received at least 2 prescriptions of the most commonly prescribed oral antineoplastic agents at the institution between September 1, 2013 and January 31, 2015. Of preimplementation patients, 96 of 99 (96.9%) were male and all patients (n = 35) in the postimplementation group were male. The mean age of the preimplementation group was 69.2 years while the postimplementation group was 68.4 years. Median MPR in the preimplementation group was 0.94, compared with 1.06 in the postimplementation group (P < .001). Thirty-six (36.7%) patients in the preimplementation group were considered nonadherent to their OAN regimen compared with zero patients in the postimplementation group. Estimated total cost savings was $36,335 in the postimplementation period. Implementation of a pharmacist-driven OAN renewal clinic was associated with a 12% increase in median MPR while saving an estimated $36,335 during the 5-month postimplementation period.

56600 Statin use and medical expenditure in patients with Parkinson’s disease

ABSTRACT IMPACT: Despite their clinical benefits reported in patients with Parkinson’s, statin use is not associated with cost savings. OBJECTIVES/GOALS: Statins have unique lipid-lowering, anti-inflammatory and anti-oxidant benefits. Their pleiotropic benefits were shown to decrease risk of occurrene and progression of Parkinson’s disease (PD). In this study we explored whether or not statin use reflects medical or prescription cost savings. METHODS/STUDY POPULATION: Records from the Medical Panels Expenditure Survey (MEPS) database made available by the Agency for Healthcare Research and Quality were used to identify all PD subjects (n=613). Demographics and PD ICD9/10 codes, 332/G20, were abstracted from the medical condition files for all the subjects (1996-2018). Prescribed cholesterol drugs were identified based on generic and brand names following a manual review to detect any misspellings. Total medical expenses and prescription expenses were abstracted for all identified PD subjects. Subject were surveyed for two consecutive years, thus expenses were assessed for each of the two surveyed years. Costs were adjusted for inflation and expressed in 2018 dollars. The relationship between cholesterol drug use, cost and age or gender was evaluated by Fisher’s exact test. RESULTS/ANTICIPATED RESULTS: Out of the 613 PD subjects identified, 421 received no cholesterol management, 15 received non-statins, 153 received a statin and 24 received a statin-based combo therapy. While the medical expenses in the general population receiving a statin are roughly three times higher than non-statin users, no significant cost difference was noticed between PD subjects receiving or not statins. However, after adjusting for age and gender, receiving statin vs. non-statin vs combo vs none was significantly associated with total expense (p=0.017) suggesting that cholesterol management decision may play a significant role. DISCUSSION/SIGNIFICANCE OF FINDINGS: Selection of specific cholesterol treatment may play a considerable role in the overall PD expenditure. Duration of statin treatment and type of statin are expected to play a role.

Estimating the Costs and Benefits of Supported Quarantine and Isolation in Massachusetts: The Missing Link in Covid-19 Response

The slow rollout of vaccines against SARS-CoV2, the virus that causes Covid-19 disease, and the emergence of viral variants that threaten vaccines’ efficacy demonstrate the urgent need to bolster non-vaccine public health strategies to mitigate viral transmission. Quarantine and isolation are critical epidemic mitigation strategies wherein exposed or infected individuals, respectively, stay apart from others until they are no longer contagious. For SARS-CoV-2, the CDC recommends quarantine and isolation periods ranging from 7-14 days. Successfully completing this period of separation may prove too challenging for many individuals. Challenges may include forfeiting wages, forgoing procurement of basic necessities, and failing to fulfill family or community obligations. “Supported” quarantine and isolation refers to public programs that aim to help individuals overcome these challenges by providing financial incentives and wraparound services so that they can successfully complete separation periods and stop transmission of the virus. The purpose of this paper is to estimate the need for a supported quarantine and isolation program in Massachusetts and to describe a budgeting model to help the state calculate the costs of instituting them, compared to the costs of not providing them, for the duration of the SARS-CoV2 epidemic.To assess the need for supported quarantine and isolation programs we reviewed the literature on successful support programs and interviewed public health practitioners working directly with infected individuals through the Massachusetts contact tracing program. We found three main drivers of failed quarantine and isolation: the need to go to work to maintain salary, the need to purchase essential necessities, and the need for social services counseling. Our model estimates the costs of addressing these challenges, through both home-based and facility based programs. We assessed that providing these supports would result in a weighted-average cost of $430/person. Using current projections of when the epidemic will resolve and the number of new cases per day averaged over the time period from March-December 2020, our model estimates providing these services to infected individuals and their contacts would be in the range of $300-570 million, depending on the trajectory of infections over the next 211 days and assumptions regarding the number of contacts per infected individual. In addition, we modeled the medical care costs of failed quarantines and isolation, in which onward transmission of the virus is not interrupted. Each Covid-19 case is associated with ~$2,500/person in medical care expenses.1 The model estimates how sensitive direct medical costs are to the Effective Reproduction Number, (Rt), or the average number of people an infected person will in turn infect. A supported quarantine program that reduces infection transmission can offer savings in direct medical costs. For example, if a supported quarantine program could reduce an average Rt of 1.09—the average Rt of the SARS-CoV2 epidemic in Massachusetts through 2020—to 1.06, this intervention could save $610 million in medical costs, exceeding the estimated cost of the program at this level of incidence and transmission. While estimated savings are particularly pronounced when high levels of transmission are brought down, even at low levels of transmission, a reduction in Rt is associated with lower direct medical costs for payors.

There’s no place like home—Integrating a pharmacist into the hospital-in-home model

BackgroundHospital-in-home (HIH) is an innovative model that provides hospital-level care in a patient’s home. Pharmacists can enhance the HIH model through medication reconciliation and medication optimization. ObjectivesTo integrate a clinical pharmacist into the HIH model and to conduct a formative evaluation of pharmacist contributions, including medication discrepancy resolution, cost savings, and cost avoidance. Practice descriptionThis is a prospective quality improvement study conducted at the Veterans Affairs Boston Healthcare System. Practice innovationWe integrated a pharmacist into the HIH model. The pharmacist conducted a medication reconciliation at hospital discharge and after discharge through home video telehealth and provided longitudinal medication management. Evaluation methodsWe adapted the PRECEDE-PROCEED model to guide program implementation. We conducted a formative evaluation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, evaluating the reach, efficacy, adoption, and implementation of the pharmacist in the HIH team. We calculated cost savings associated with pharmacist-managed home intravenous (IV) therapy, cost avoidance from deprescribing, and cost avoidance from earlier hospital discharge. ResultsThe HIH program enrolled 102 patients from May 2019 to March 2020. The pharmacist completed 99 (97%) discharge and 95 (93%) postdischarge medication reconciliations, most of which 71 (75%) were conducted using home video telehealth. The pharmacist identified and resolved a total of 453 medication discrepancies: 181 (40%) at discharge and 272 (60%) during postdischarge medication reconciliation. A total of 84 (19%) discrepancies were considered high risk. The pharmacist managed 104 days of home IV therapy, resulting in a cost savings of approximately $17,000. The cost avoided by identifying and deprescribing 145 inappropriate medications was approximately $51,000. The cost avoided by earlier hospital discharge was $1.2 million. ConclusionIntegrating a pharmacist into the HIH model enables the detection and resolution of medication discrepancies. Cost savings from medication deprescribing, cost avoided from pharmacist-managed home IV therapy, and cost avoided from early hospital discharge totaled $1268 million.

Impacts of Changing Sexual Behavior on Chlamydia and Gonorrhea Burden Among US High School Students, 2007 to 2017.

Rates of adolescent sexual activity have long been declining in the United States. We sought to estimate the number of cases of gonorrhea and chlamydia averted over 1 decade associated with these declines and associated costs saved. We analyzed data from the Centers for Disease Control and Prevention's Youth Risk Behavior Survey of US high school students from 2007 to 2017 and combined it with epidemiological estimates drawn from the literature to parameterize a dynamic population transmission model. We compared transmissions from observed behavioral trends with a counterfactual scenario that assumed sexual behaviors from 2007 remained constant for 10 years. We calculated outcomes by age and for 3 racial/ethnic groups (Hispanic, non-Hispanic Black, and non-Hispanic White adolescents) who vary on underlying burden and amount of behavioral change. We estimated 1,118,483 cases of chlamydia and 214,762 cases of gonorrhea were averted (19.5% of burden across all ages). This yielded $474 million (2017 dollars) savings in medical costs over the decade. The largest number of averted cases (767,543) was among Black adolescents, but the largest proportion (28.7%) was among Hispanic adolescents. Whatever its origins, changing sexual behavior among adolescents results in large estimated reductions in STI burden and medical costs relative to previous cohorts. Although diagnoses among adolescents have not declined at this rate, multiple explanations could make these apparently divergent trends consistent. Efforts to continue supporting effective sex education in and out of school along with STI screening for adolescents should reinforce these gains.

Abstract 16986: Reduced Medical Spending Overtime With Use of a Home Blood Pressure Monitoring Program

Background: Livongo’s Applied Health Signals Home Blood Pressure Monitoring Program (HBMP) offers patients a Bluetooth connected blood pressure cuff, hypertension (HTN) management education, and access to health coaches. Previous studies have demonstrated the clinical benefits of HBPM so the objective of this study was to also evaluate the impact on U.S. medical spending within the first year. Methods: People younger than 65 years with continuous enrollment in health benefits for the 12 months before and 12 months after launch of the HBMP and use of the program for at least three months were selected. Medical spending for those participants was compared to eligible but non-HBMP participant controls who were identified utilizing propensity score with nearest-neighbor matching methodology on age, gender, and pre-period medical spending with exact matching on Charlson Comorbidity Score Index in a 1:1 ratio. People with medical spending exceeding $50,000 monthly or $100,000 annually were excluded from the analysis. The HBPM participant baseline blood pressures were compared to BP values at 12-months to assess improvement in BP management. Mean medical spending based on the total allowed amounts per member per month (PMPM) was compared between the HBPM and non-HBPM groups using intention-to-treat difference-in-difference (DiD) analysis. Results: There were 1,417 HBPM participants with mean age of 51 years, 52% female, 64% with uncontrolled HTN (BP &amp;gt = 130/80) at baseline, and mean pre-period medical spending of $490 PMPM. For participants with uncontrolled HTN, mean systolic and diastolic BP reductions were 14.2 mmHg and 10.1 mmHg, respectively, with 54% decreasing in HTN stage or considered controlled. The HBPM group had a 1% reduction in medical spending to $474 PMPM while the non-HBPM group had an 18% increase in medical spending from $410 PMPM to $486 PMPM resulting in a medical savings of $81 PMPM. The HBPM group also had a reduction of 33% in inpatient utilization and 14% in ED visits. Conclusion: HBPM participants experienced improved BP control and a reduction in total medical cost savings resulting in a positive return on investment. The main drivers of medical savings were a reduction in ED and inpatient hospital utilization.

The Role of Digital Technologies as an Alternative for Face-to-Face Knee Rehabilitation: A Systematic Review

Purpose: Digital technologies, including mobile applications, websites, and wearable devices, like smartwatches are among the newest approaches in prevention, care, and treatment studies; they could provide public access to high-quality rehabilitation services. The current review study aimed to evaluate the effects of digital technologies for enhancing physical activity, as well as improving and managing pain in individuals with knee injuries and pain. Methods: The keywords “digital care program”, “e-health”, “physical activity”, and “knee pain” were used to search the studies in the PubMed, Scopus, and Google Scholar databases. In total, 734 articles were found. Then, studies published in languages other than English; the articles with completely similar results; the studies on diseases other than knee problems, and those investigating children or adolescents were excluded. Thus, valid articles indexed in these databases that digital technologies were an except original in the intervention; databases that investigated the impact of digital technologies on osteoarthritis and total knee arthroplasty knee improvement, and the randomized controlled trials were included in this research. Eventually, 8 articles were evaluated in this study. The methodological quality of the studies was assessed using the PEDro score. Results: The overall outcome of the explored studies indicated that digital technologies significantly impact pain relief, and improve mobility, quality of life, and self-care in patients with osteoarthritis and total knee arthroplasty. Conclusion: Digital technologies increase the effectiveness of rehabilitation programs and play an essential role in creating a self-care culture. These technologies have resulted in savings in medical, commuting, pharmacotherapy, and surgery costs by communicating between patient and therapist at any time in any place.

Fibrosis index predicts variceal bleeding and reduces need for nonselective beta-blocker in compensated cirrhosis with initial small esophageal varices without red-color sign.

BackgroundVarious non-invasive markers predicting hepatic fibrosis are poor predictors of esophageal variceal bleeding (EVB). Elastography performs well but resource-limited. Controversy for small EV prevention also exists. We aim to investigate if a non-invasive marker could predict subsequent EVB within 1 and 2 years in patients with compensated liver cirrhosis (CLC), initial small EV without red-color sign (RCS), without use of non-selective beta-blockers (NSBB) and endoscopic variceal ligation (EVL). This marker would also be tested if it could help reduce use of NSBB, thereby avoiding potential side effects and saving medical costs.MethodsIn this retrospective cohort study, 6,803 CLC patients fulfilling the inclusion-exclusion criteria were enrolled between 2001 and 2018, and were followed-up for 1 year, 2 years. The primary outcomes were subsequent EVB within 1 and 2 years of enrollment. Another 281 CLC patients with NSBB use were compared for additional outcome analysis.ResultsIn total, 539 patients and 710 patients experienced EVB within 1 year and 2 years, respectively. The fibrosis index (FI) with cut-off value of 3.95 showed a negative predictive value (NPV) of 94.3% and an area under receiver operating characteristic (AUROC) of 62.95% for predicting subsequent EVB within 1 year. The EVB and mortality of patients with FI <3.95 and not taking NSBB were significantly lower than those of the other 3 groups. Similar results were demonstrated within 2 years.ConclusionsIn CLC patients with initial small EV and no RCS, low FI scores showed a high NPV and moderate AUROC in predicting subsequent EVB and mortalities, signifying clinically non-significant portal hypertension. Patients with low FI scores and not taking NSBB had significantly lowest EVB and mortality. The medical cost savings for cutting NSBB in these patients would be estimated at least $3 million per year in the U.S. Further randomized control trial study needed to validate this screening tool.

Cardiovascular Healthcare Cost Savings Associated with Increased Whole Grains Consumption among Adults in the United States.

Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.

Can automating surgical processes reduce operating room supply costs? A pilot study of a novel OR based technology.

Introduction In the struggling economic post covid era, there will be greater cost containment, efficiency, and quality pressures. How does novel technology to dynamically digitize and automate surgical processes, as an adjunct to existing static workflows, impact surgical supply costs in knee replacement surgeries compared to traditional non automated knee replacement surgeries? Materials/Methods A novel innovative patented technology (SIGHT Medical, Alexandria LA) was created to digitize surgical processes and interface with hospital data systems (EMR- EPIC and ERP- Lawson) within Ochsner health system. Medical Surgical supplies and billable medical supplies were captured by the OR staff using standard hospital EMR and materials management workflows. Outcome measures included costs of surgical supplies, length of stay and number of cases captured using the Ochsner Health system data analytics platform (Tableau, Seattle, WA). Results 1023 knee replacement surgeries were reviewed over 3 years by 3 surgeons at 3 different hospitals within the Ochsner Health system. There was an average of $479/surgery in medical surgical supply costs for automated surgeries and $557/surgery for traditional surgeries. There was an average of $2,444/surgery in billable medical supply costs for automated surgeries and $4,660/surgery for traditional surgeries. Discussion Deploying innovative technology to create a real time dynamic communication and transparency platform can create significant supply cost savings. An average of $78 in medical surgical supply cost savings and $2216 in billable medical supply cost savings can be achieved by automating many of the surgical workflows and processes.

Longitudinal medication profile and cost savings in Parkinson's disease patients after bilateral subthalamic nucleus deep brain stimulation.

Deep brain stimulation of the subthalamic nucleus (STN DBS) has been shown to reduce antiparkinsonian medication in Parkinson's disease. We aimed to investigate the changes in long-term medication profile with STN DBS. Antiparkinsonian medication data for 56 patients were collected from as early as 3years before STN DBS up to 10years after. Cost spending on medication changes was analyzed. Mean levodopa equivalent daily dose (LEDD) was projected 10years into the future based on preoperative data to create a comparator group wherein the patients did not undergo STN DBS. Use of neuroleptics and antidepressants was also recorded. LEDD requirement was significantly reduced by a mean of 31 ± 2% over 10years after DBS, from 1049 ± 381mg at pre-DBS baseline, to 713 ± 392mg at 1year post-DBS, and 712 ± 385mg at 10years post-DBS. This was associated with a mean reduction of 35 ± 3% in medicine cost. Modeled LEDD requirements for not having STN DBS were in the range of 1489mg to 2721mg at 10years post-DBS (109-282% higher than the observed mean LEDD in DBS cohort). The proportion of patients increased from 5% before STN DBS to 14% at 10year post-DBS for neuroleptics, and 11-23% for antidepressants. STN DBS led to LEDD reduction and antiparkinsonian medication cost savings in our South-East Asian cohort. Medication reduction with STN DBS in our cohort over the 10-year period was comparable to those reported in Western populations.

PCN145 THE IMPACT OF INCREASING MT-SDNA USE AMONG COLORECTAL CANCER SCREENERS IN A US EMPLOYER POPULATION

With a predominantly employer-based health insurance system in the United States, it is important for employers to consider the impact of appropriate utilization of options for colorectal cancer screening. Adherence to screening guidelines is associated with decreased colorectal cancer incidence, morbidity, and mortality. Not only do employer-based payers incur direct medical costs, but also indirect medical costs, such as productivity loss. The aim of our analysis was to quantify the impact of increasing mt-sDNA use among CRC screeners from the US employer perspective. A budget impact model was developed to simulate increased use of mt-sDNA from 6% to 28% among mt-sDNA, FIT and colonoscopy screeners over the course of 10 years. Screening modality utilization was based on laboratory data and the employee population was assumed to be ages 50-64. Indirect medical costs were based on an assumed 16 hours of lost productivity due to bowel prep and colonoscopy procedures, as well as the average hourly wage per US employee from the Bureau of Labor and Statistics. Baseline direct medical costs were extracted from Medicare CPT codes, the literature, and the Healthcare Cost and Utilization Project. All costs originated from or were adjusted to 2019 USD and Medicare costs were scaled to the Commercial population by applying a cost index. With a hypothetical employee population of 100K, it was projected that the incremental direct medical cost savings were $165K from CRC screening, surveillance colonoscopies, adverse events due to colonoscopies, and CRC treatment; and the indirect cost savings were $556K. Overall, the incremental direct medical and indirect costs yielded a cumulative savings of $721K and a per employee per month savings of $0.06. Increased utilization of mt-sDNA averts direct and indirect medical costs from a US employer perspective.

Tyrosine Kinase Inhibitors and the Relationship With Adherence, Costs, and Health Care Utilization in Commercially Insured Patients With Newly Diagnosed Chronic Myeloid Leukemia: A Retrospective Claims-Based Study.

To examine the association among tyrosine kinase inhibitor (TKI) out-of-pocket costs, adherence, and health care costs and utilization in a large group of commercially insured patients with chronic myeloid leukemia (CML). Patients with CML aged 18 to 64 years were identified using IBM MarketScan Commercial Database between April 1, 2011 and December 31, 2014. Patients were required to be continuously enrolled 3 months before and 12 months after TKI (imatinib, dasatinib, or nilotinib) initiation. TKI adherence is estimated using the proportion of days covered (PDC), defined as the percentage of the PDC by the prescription fill during the 12-month study period (adherent patients have PDC ≥80%). Health care cost differences between adherent and nonadherent patients were estimated using generalized linear models. Health care utilization was compared using negative binomial regression models. All models were controlled for potential confounding factors. The study sample consisted of 863 patients, where 355 (41.1%) patients were classified as adherent. Over the study period, nonadherent patients incurred US$10,974 more in medical costs (P<0.001), and US$1663 more in non-TKI pharmacy costs (P<0.01). Adherent patients incurred US$28,184 more in TKI pharmacy costs (P<0.001) that resulted in US$18,305 more in overall total health care costs (P<0.001). Adherent patients, however, were estimated to be less likely to have all-cause hospitalizations (incidence rate ratio, 0.32; P<0.001), or CML-specific hospitalizations (incidence rate ratio, 0.31; P<0.01). Patients with CML with better adherence experienced fewer hospitalizations, resulting in medical service cost savings. These lower medical costs, however, were more than offset by higher TKI medication costs observed during the first year of TKI therapy.

Health and Economic Impact of Routine Pediatric Pneumococcal Immunization Programs in Canada: A Retrospective Analysis.

ObjectiveA model was developed to estimate the historical impact (including total societal health and economic benefit) of pneumococcal conjugate vaccine (PCV) programs in the overall Canadian population between 2005 and 2015, inclusively.MethodsHistorical incidence of invasive pneumococcal disease (IPD), pneumonia, and acute otitis media (AOM) were obtained from epidemiologic databases supplemented with published and unpublished data. Two scenarios were considered: (1) the observed historical incidence from 2005 to 2015 in the setting of PCV use; (2) a hypothetical scenario in which we estimated the number of disease cases assuming no PCV use. Disease cases averted as a result of PCV programs were calculated by subtracting the number of observed historical cases from the number of estimated cases expected in the absence of PCV use.ResultsPCV programs were estimated to have saved 6631 lives and averted 14,990 IPD cases, 735,700 pneumonia episodes, and 3,697,993 AOM episodes. Positive clinical outcomes resulted in total cost savings of CAD $1.76 billion over 11 years. Vaccination costs were offset by the direct medical cost savings from fewer cases of IPD, pneumonia, and AOM.ConclusionsCanadian PCV programs have provided significant health benefits and resulted in a substantial value for money. Net savings achieved over the reviewed period would have provided funding for $1.76 billion in other health care costs or public health initiatives. These findings highlight the importance of considering the total value of a vaccination program, rather than vaccine acquisition costs only, when assessing the value of immunization programs.Electronic supplementary materialThe online version of this article (10.1007/s40121-020-00294-6) contains supplementary material, which is available to authorized users.