Privately-insured Individuals Research Articles

Health Service Use and Costs During Pregnancy Among Privately Insured Individuals With Congenital Heart Disease

Individuals with congenital heart disease (CHD) are increasingly reaching childbearing age, are more prone to adverse pregnancy events, and uncommonly undergo recommended cardiac evaluations. Data to better understand resource allocation and financial planning are lacking. To examine health care use and costs for patients with CHD during pregnancy. This retrospective cohort study was performed from January 1, 2010, to December 31, 2016, using Merative MarketScan commercial insurance data. Participants included patients with CHD and those without CHD matched 1:1 by age, sex, and insurance enrollment year. Pregnancy claims were identified for all participants. Data were analyzed from September 2022 to March 2024. Baseline characteristics (age, US region, delivery year, insurance type) and pregnancy-related events (obstetric, cardiac, and noncardiac conditions; birth outcomes; and cesarean delivery). Health service use (outpatient physician, nonphysician, emergency department, prescription drugs, and admissions) and costs (total and out-of-pocket costs adjusted for inflation to represent 2024 US dollars). A total of 11 703 pregnancies (mean [SD] maternal age, 31.5 [5.4] years) were studied, with 2267 pregnancies in 1785 patients with CHD (492 pregnancies in patients with severe CHD and 1775 in patients with nonsevere CHD) and 9436 pregnancies in 7720 patients without CHD. Compared with patients without CHD, pregnancies in patients with CHD were associated with significantly higher health care use (standardized mean difference [SMD] range, 0.16-1.46) and cost (SMD range, 0.14-0.55) except for out-of-pocket inpatient and ED costs. After adjustment for covariates, having CHD was independently associated with higher total (adjusted cost ratio, 1.70; 95% CI, 1.57-1.84) and out-of-pocket (adjusted cost ratio, 1.40; 95% CI, 1.22-1.58) costs. The adjusted mean total costs per pregnancy were $15 971 (95% CI, $15 480-$16 461) for patients without CHD, $24 290 (95% CI, $22 773-$25 806) for patients with any CHD, $26 308 (95% CI, $22 788-$29 828) for patients with severe CHD, and $23 750 (95% CI, $22 110-$25 390) for patients with nonsevere CHD. Patients with vs without CHD incurred $8319 and $700 higher total and out-of-pocket costs per pregnancy, respectively. This study provides novel, clinically relevant estimates for the cardio-obstetric team, patients with CHD, payers, and policymakers regarding health care and financial planning. These estimates can be used to carefully plan for and advocate for the comprehensive resources needed to care for patients with CHD.

Preventive Primary Care in the Postpartum Year: The Role of Medicaid Delivery System Reform

Preventive and primary care in the postpartum year is critical for future health and may be increased by primary care focused delivery system reform including implementation of Medicaid Accountable Care Organizations (ACO). This study examined associations of Massachusetts Medicaid ACO implementation with preventive visits in the postpartum year. The Massachusetts All-Payer Claims Database was used to identify births to privately-insured or Medicaid ACO-eligible individuals from January 1, 2016 to February 28, 2019. Comparing these groups before and after implementation, a propensity score weighted difference-in-difference design was used to analyze associations of Medicaid ACO implementation with any preventive care visit and any primary care physician (PCP) preventive visit within one year postpartum, controlling for other characteristics. Analyses were performed in 2023 and 2024. Of the 110,601 births in the study population, 35.5% had any preventive care visit and 23.0% had any preventive PCP visit in the year postpartum, with higher rates of preventive visits among privately-insured individuals. In adjusted difference-in-difference analyses, relative to the pre-period, there was a 2.7 percentage point (pp) decrease (95% confidence interval [CI]: -4.3pp, -1.2pp) and 3.5 pp decrease (95% CI: -4.9pp, -2.0pp) in use of any preventive visits and any PCP preventive visits, respectively, for Medicaid-insured versus privately-insured individuals after ACO implementation. Implementation of Massachusetts Medicaid ACOs was associated with decreases in receipt of preventive visits and preventive PCP visits for Medicaid-insured individuals relative to privately-insured individuals. Medicaid ACOs should consider potential implications of primary care access in the postpartum year for health across the lifecourse.

Receipt and duration of buprenorphine treatment during pregnancy and postpartum periods in a national privately-insured cohort

BackgroundResearch gaps exist on the use of medications for opioid use disorder (OUD) among birthing people. MethodsThis retrospective cohort study included people who underwent childbirth deliveries during 2017-2020 and had a diagnosis of OUD identified from a national private insurance claims database. Buprenorphine prescriptions received during the year before childbirth and the year after childbirth were obtained from pharmacy claims. Logistic regressions were used to estimate associations between receipt of buprenorphine and individual and state-level factors. ResultsAmong a sample of 1,523 birthing people diagnosed with OUD, 540 (35.5 %) received buprenorphine during the pregnancy or postpartum periods. About half (51.5 %) of new recipients of buprenorphine received treatment for at least six months and, of those, one-third experienced a treatment interruption. The buprenorphine receipt rate differed significantly by race and ethnicity: 28.8 % of non-Hispanic Black birthing people with OUD and 22.8 % of Hispanic birthing people with OUD received buprenorphine treatment in contrast to 37.7 % of non-Hispanic white birthing people (aOR 0.53 [95 % CI 0.35-0.81] and 0.59 [95 % CI 0.37-0.96], respectively). The buprenorphine use rate increased over time from 29.7 % in 2017 to 42.9 % in 2020. Birthing people living in states with punitive policies related to substance use in pregnancy had the lowest buprenorphine use rate of 22.7 % as compared to 43.0 % in states with least restrictive policies. ConclusionIn this national sample of privately-insured individuals, by 2020, 42.9 % of birthing people with OUD received buprenorphine treatment. Treatment discontinuation and interruptions were common in the period surrounding childbirth.

Body Mass Index and Associated Medical Expenditures in the US Among Privately Insured Individuals Aged 2 to 19 Years in 2018

Nearly 40% of US youth aged 2 to 19 years do not have a body mass index (BMI) in the healthy weight category. However, there are no recent estimates for BMI-associated expenditures using clinical or claims data. To estimate medical expenditures among US youth across all BMI categories along with sex and age groups. This cross-sectional study used IQVIA's ambulatory electronic medical records (AEMR) data set linked with IQVIA's PharMetrics Plus Claims database from January 2018 through December 2018. Analysis was performed from March 25, 2022, through June 20, 2022. It included a convenience sample of a geographically diverse patient population from AEMR and PharMetrics Plus. The study sample included privately insured individuals with a BMI measurement in 2018 and excluded patients with pregnancy-related visits. BMI categories. Total medical expenditures were estimated using generalized linear model regression with γ distribution and log-link function. For out-of-pocket (OOP) expenditures, a 2-part model was used that included logistic regression to estimate the probability of positive expenditures followed by generalized linear model. Estimates were shown with and without accounting for sex, race and ethnicity, payer type, geographic region, age interacted with sex and BMI categories, and confounding conditions. The sample included 205 876 individuals aged 2 to 19 years; 104 066 were male (50.5%) and the median age was 12 years. Compared with those with healthy weight, total and OOP expenditures were higher for all other BMI categories. Differences in total expenditures were highest for those with severe obesity ($909; 95% CI, $600-$1218) followed by underweight ($671; 95% CI, $286-$1055) compared with healthy weight. Differences in OOP expenditures were highest for those with severe obesity ($121; 95% CI, $86-$155) followed by underweight ($117; 95% CI, $78-$157) compared with healthy weight. Having underweight was associated with higher total expenditures at ages 2 to 5 years and 6 to 11 years by $679 (95% CI, $228-$1129) and $1166 (95% CI, $632-$1700), respectively; having severe obesity was associated with higher total expenditures at ages 2 to 5 years, 6 to 11 years, and 12 to 17 years by $1035 (95% CI, $208-$1863), $821 (95% CI, $414-$1227), and $1088 (95% CI, $594-$1582), respectively. The study team found medical expenditures to be higher for all BMI categories when compared with those with healthy weight. These findings may indicate potential economic value of interventions or treatments aimed at reducing BMI-associated health risks.

Determinants, Costs, and Consequences of Common Bile Duct Injury Requiring Operative Repair Among Privately Insured Individuals in the United States, 2003-2020.

Characterize the determinants, all-cause mortality risk, and healthcare costs associated with common bile duct injury (CBDI) following cholecystectomy in a contemporary patient population. Retrospective cohort study using nationwide patient-level commercial and Medicare Advantage claims data, 2003-2019. Beneficiaries ≥18 years who underwent cholecystectomy were identified using Current Procedure Terminology (CPT) codes. CBDI was defined by a second surgical procedure for repair within one year of cholecystectomy. We estimated the association of common surgical indications and comorbidities with risk of CBDI using logistic regression; the association between CBDI and all-cause mortality using Cox proportional hazards regression; and calculated average healthcare costs associated with CBDI repair. Among 769,782 individuals with cholecystectomy, we identified 894 with CBDI (0.1%). CBDI was inversely associated with biliary colic (odds ratio [OR] = 0.82; 95% confidence interval [CI]: 0.71-0.94) and obesity (OR = 0.70, 95% CI: 0.59-0.84), but positively associated with pancreas disease (OR = 2.16, 95% CI: 1.92-2.43) and chronic liver disease (OR = 1.25, 95% CI: 1.05-1.49). In fully adjusted Cox models, CBDI was associated with increased all-cause mortality risk (hazard ratio = 1.57, 95% CI: 1.38-1.79). The same-day CBDI repair was associated with the lowest mean overall costs, with the highest mean overall costs for repair within 1 to 3 months. In this retrospective cohort study, calculated rates of CBDI are substantially lower than in prior large studies, perhaps reflecting quality-improvement initiatives over the past two decades. Yet, CBDI remains associated with increased all-cause mortality risks and significant healthcare costs. Patient-level characteristics may be important determinants of CBDI and warrant ongoing examination in future research.

Geographical Variation in Health Spending Across the US Among Privately Insured Individuals and Enrollees in Medicaid and Medicare

Little is known about small-area variations in health care spending and utilization across the 3 major funders of health care in the US: Medicare, Medicaid, and private insurers. To measure regional health spending and utilization across Medicare, Medicaid, and the privately insured; to observe whether there are regions that are simultaneously low spending for all 3 payers; and to determine what factors are correlated with regional spending and utilization by payer. Observational cross-sectional analysis of the US health system in 2016 and 2017 for 241 of 306 hospital referral regions (HRRs) and 2 states. Participants include individuals with employer-sponsored coverage from Aetna, Humana, or UnitedHealth; individuals with Medicaid fee-for-service coverage in 2016 and 2017; and individuals with Medicare coverage. The analysis was carried out from January 2020 to May 2022. Spending per beneficiary and inpatient days per beneficiary by payer and overall. The data include 25 381 167 individuals with employer-sponsored coverage, 69 891 299 with Medicaid coverage in 2016 and 2017, and 26 711 426 individuals with Medicare fee-for-service coverage. The percentage of enrollees who identified as female was 54.1% in the Medicaid program, 56.2% in the Medicare program, and 50.4% in private insurance. The mean (SD) age was 26.9 (21.8) years for Medicaid and 75.0 (7.9) years for Medicare enrollees; for private insurance enrollees, just age brackets were reported: 18 to 24 years (15.9%), 25 to 34 years (24.2%), 35 to 44 years (21.3%), 45 to 54 years (20.8%), and 55 to 64 years (17.8%). In 2017, the mean (SD) HRR-level spending per beneficiary was $4441 ($710) for private insurance, $10 281 ($1294) for Medicare, and $6127 ($1428) for Medicaid. Across HRRs, the correlation coefficients and 95% CIs were 0.020 (-0.106 to 0.146; P = .76) for private insurance and Medicare spending, 0.213 (0.090 to 0.330; P < .001) for private insurance and Medicaid, and 0.162 (0.037 to 0.282; P < .01) for Medicare and Medicaid. Just 3 HRRs (Boulder, Colorado; Bloomington, Illinois; and Olympia, Washington) were in the lowest spending quintile for all 3 insurance programs; 4 HRRs were in the highest (The Bronx, New York; Manhattan, New York; White Plains, New York; and Dallas, Texas). By contrast, the correlation coefficients and 95% CIs for utilization, measured in hospital days, were 0.465 (0.361 to 0.559; P < .001) for private insurance and Medicare, 0.527 (0.429 to 0.612; P < .001) for private insurance and Medicaid, and 0.278 (0.157 to 0.390; P < .001) for Medicare and Medicaid. These findings suggest that payer-specific factors are correlated with health spending variation among Medicare beneficiaries, Medicaid beneficiaries, and the commercially insured and that payer-specific policies will be necessary to improve efficiency in the US health sector.

Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Uninsured Compared With Privately Insured Individuals.

There are limited data on uninsured patients presenting with acute myocardial infarction-cardiogenic shock (AMI-CS). This study sought to compare the management and outcomes of AMI-CS between uninsured and privately insured individuals. Using the National Inpatient Sample (2000-2016), a retrospective cohort of adult (≥18 years) uninsured admissions (primary payer-self-pay or no charge) were compared with privately insured individuals. Interhospital transfers were excluded. Outcomes of interest included in-hospital mortality, temporal trends in admissions, use of cardiac procedures, do-not-resuscitate status, palliative care referrals, and resource utilization. Of 402 182 AMI-CS admissions, 21 966 (5.4%) and 93 814 (23.3%) were uninsured and privately insured. Compared with private insured individuals, uninsured admissions were younger, male, from a lower socioeconomic status, had lower comorbidity, higher rates of acute organ failure, ST-segment elevation AMI-CS (77.3% versus 76.4%), and concomitant cardiac arrest (33.8% versus 31.9%; all P<0.001). Compared with 2000, in 2016, there were more uninsured (adjusted odds ratio, 1.15 [95% CI, 1.13-1.17]; P<0.001) and less privately insured admissions (adjusted odds ratio, 0.85 [95% CI, 0.83-0.87]; P<0.001). Uninsured individuals received less frequent coronary angiography (79.5% versus 81.0%), percutaneous coronary intervention (60.8% versus 62.2%), mechanical circulatory support (54% versus 55.5%), and had higher palliative care (3.8% versus 3.2%) and do-not-resuscitate status use (4.4% versus 3.2%; all P<0.001). Uninsured admissions had higher in-hospital mortality (adjusted odds ratio, 1.62 [95% CI, 1.55-1.68]; P<0.001) and resource utilization. Uninsured individuals have higher in-hospital mortality and lower use of guideline-directed therapies in AMI-CS compared with privately insured individuals.

144. Little evidence of same-day, oral antibiotic prescribing at ambulatory surgery centers

BackgroundThe objective of our study was to describe oral antibiotic prescriptions associated with procedures in ambulatory surgery centers (ASC) to evaluate if there are major national opportunities to improve antibiotic use in this setting.MethodsWe identified surgical procedures in ASCs and oral antibiotic prescriptions in the IBM® MarketScan® Commercial 2018 database, a large convenience sample of privately-insured individuals aged < 65 years. We excluded visits with same-day hospitalizations and those with infectious diagnoses that may warrant antibiotic treatment. We included only antibiotic prescriptions dispensed on the same day as an ASC visit. We calculated the number of visits and oral antibiotic prescriptions and the percent of visits with oral antibiotic prescriptions overall, and by patient age group (< 18 and 18–64 years), antibiotic class, and procedure type. We also calculated median antibiotic course length. Across-group comparisons were evaluated using chi-square tests.ResultsIn 2018, 918,127 ASC visits with surgical procedure codes were captured, of which 37,032 (4.0%) were associated with same-day oral antibiotic prescriptions. The percent of visits with antibiotic prescriptions was significantly higher among children compared to adults (9.4% vs 3.8%; p< 0.01); however, adults accounted for 89% of prescriptions. Respiratory/nasal and urinary tract system procedures were most frequently associated with antibiotic prescriptions (Figure). Median course length was 5 (interquartile range 3–7) days. The most common antibiotic class was cephalosporins (49.6% of prescriptions), followed by penicillins (12.6%) and fluoroquinolones (10.9%).Figure. Percent of ambulatory surgery center visits with same-day antibiotic prescriptions by procedure category, IBM® MarketScan® Commercial Database, 2018 ConclusionOnly 4% of ASC procedures were associated with same-day oral antibiotic prescriptions, suggesting antibiotics are not commonly prescribed in ASCs on the day of surgical procedures. Additionally, the observed 5-day median duration may suggest that some of these courses are intended for treatment rather than prophylaxis. Our estimates represent lower bounds for oral antibiotic prescriptions in this setting, as we only captured same-day prescriptions. However, our findings suggest that ASC facilities may not be high-impact targets for national, public health antibiotic stewardship efforts.Disclosures All Authors: No reported disclosures

Impact of payer status and hospital volume on outcomes after head and neck oncologic reconstruction

BackgroundHigh-volume centers improve outcomes in head and neck cancer (HNCA) reconstruction, yet it is unknown whether patients of all payer status benefit equally. MethodsWe identified patients undergoing HNCA surgery between 2002 and 2015 using the National Inpatient Sample. Outcomes included receipt of care at high-volume centers, receipt of reconstruction, and post-operative complications. Multivariate regression analysis was stratified by payer status. Results37,442 patients received reconstruction out of 101,204 patients who underwent HNCA surgery (37.0%). Privately-insured and Medicaid patients had similar odds of receiving high-volume care (OR = 0.99, 95% CI = 0.87–1.11) and undergoing reconstruction (OR = 0.96, 95% CI = 0.86–1.05). Medicaid beneficiaries had higher odds of complication (OR = 1.36, 95% CI = 1.22–1.51). The discrepancy in complication odds was significant at low-volume (OR = 1.44, 95% CI = 1.12–1.84) and high-volume centers (OR = 1.30, 95% CI = 1.15–1.47). ConclusionsMedicaid beneficiaries are as likely to receive care at high-volume centers and undergo reconstruction as privately-insured individuals. However, they have poorer outcomes than privately-insured individuals at both low- and high-volume centers.

Contemporary Patterns of Third-line Treatments for Privately Insured Individuals With Overactive Bladder in the United States

To evaluate utilization of third-line overactive bladder (OAB) treatments including percutaneous tibial nerve stimulation (PTNS), sacral nerve stimulation (SNS), and intradetrusor botulinum toxin A (BTX) among privately insured patients and examine factors associated with their use. Using MarketScan claims (2015-2017), we identified patients who underwent third-line OAB treatments based on procedure codes. Factors of interest included location, age, health plan, among others. We fit multivariable logistic regression models to estimate associations between pertinent factors with receipt of PTNS and SNS relative to BTX and associations between provider type and practice location with each treatment modality. We identified 7383 patients (mean age 50.9) in our cohort. SNS was used most frequently (n=3602, 48.8%), while PTNS was used least frequently (n=955, 12.9%). PTNS patients were more likely to reside in metropolitan areas (vs BTX: OR 1.6, 95%CI 1.3-2.1; vs SNS: OR 2.2, 95%CI 1.7-2.8), be aged 55 years or older (vs BTX: 54% vs 47%, OR 1.6, 95%CI 1.2-2.1; vs SNS: 54% vs 45%, OR 1.6, 95%CI 1.2-2.0), and be covered under a health maintenance organization (vs BTX: 17% vs 10%; vs SNS: 17% vs 10%, P <.01). Urologists were most likely to perform SNS, and gynecologists were most likely to perform BTX. 91% of PTNS procedures were performed in office settings. Among patients receiving third-line OAB treatment, PTNS was used infrequently. PTNS utilization was concentrated within urban areas, and among older patients and those covered by cost-conscious health maintenance organizations.

Comparison of Management and Outcomes of Acute Heart Failure Hospitalization in Medicaid Beneficiaries Versus Privately Insured Individuals

Medicaid expansion in terms of its eligibility and federal funding has led to improved healthcare access in previously uninsured individuals. However, proposed lower Medicaid rates have unintentionally led to lower utilization of substantial life-saving therapies and poor outcomes compared with private insurance. We examined heart failure (HF) management, in-hospital mortality, and resource utilization in Medicaid and privately insured individuals hospitalized with HF. The authors screened the National Inpatient Sample from January 2012 to September 2015 for HF hospitalizations with Medicaid or private insurance as the primary payer. The authors identified a total of 226,265 and 292,070 patients with HF hospitalizations with Medicaid and private insurance, respectively. In propensity-matched cohort of 155,790 hospitalizations in each group, Medicaid beneficiaries with HF hospitalization had lower rates of intra-aortic balloon pump/left ventricular assist device/extracorporeal membrane oxygenation utilization (0.6 vs 0.9%; odds ratio [OR] 0.64; 95% confidence interval [CI] 0.59 to 0.69), heart transplantation (0.15 vs 0.44%; OR 0.35; 95% CI 0.30 to 0.40), implantable cardioverter-defibrillator/cardiac resynchronization therapy/permanent pacemaker (3.3 vs 3.9%; OR 0.84; 95% CI 0.81 to 0.87), and had higher rates of in-hospital mortality (1.9 vs 1.7%; OR 1.12; 95% CI 1.07 to 1.19) compared with privately insured individuals (p <0.001 for both). In conclusion, Medicaid recipients with HF hospitalizations had a lower rate of device utilization, heart transplantation, and a higher rate of in-hospital mortality compared with the privately insured sector. Further studies are needed to explore and understand the variation in the outcomes of HF hospitalizations stratified by insurance status.

The impact of underinsurance on bladder cancer diagnosis, survival, and care delivery for individuals under the age of 65years.

Health insurance is a key mediator of health care disparities. Outcomes in bladder cancer, one of the costliest diseases to treat, may be especially sensitive to a patient's insurance status. The Surveillance, Epidemiology, and End Results registry and the National Cancer Data Base were used to identify individuals younger than 65years who were diagnosed with bladder cancer from 2007 to 2014. The associations between the insurance status (privately insured, insured by Medicaid, or uninsured) and the following outcomes were evaluated: diagnosis with advanced disease, cancer-specific survival, delay in treatment longer than 90days, treatment in a high-volume hospital, and receipt of neoadjuvant chemotherapy (NAC). Compared with those with private insurance, uninsured and Medicaid-insured individuals were nearly twice as likely to receive a diagnosis of muscle-invasive bladder cancer (odds ratio [OR] for uninsured individuals, 1.90; 95% confidence interval [CI], 1.70-2.12; OR for Medicaid-insured individuals, 2.03; 95% CI, 1.87-2.20). They were also more likely to die of bladder cancer (adjusted hazard ratio [AHR] for uninsured individuals, 1.49; 95% CI, 1.31-1.71; AHR for Medicaid-insured individuals, 1.61; 95% CI, 1.46-1.79). Delays in treatment longer than 90days were more likely for uninsured (OR, 1.36; 95% CI, 1.12-1.65) and Medicaid-insured individuals (OR, 1.22; 95% CI, 1.03-1.44) in comparison with the privately insured. Uninsured patients had lower odds of treatment at a high-volume facility, and Medicaid-insured patients had lower odds of receiving NAC (P<.001 for both). Compared with privately insured individuals, uninsured and Medicaid-insured individuals experience worse prognoses and poorer care quality. Expanding high-quality insurance coverage to marginalized populations may help to reduce the burden of this disease.

Utilization of over-the-counter analgesics in two private medical insurance schemes in South Africa.

IntroductionIn South Africa there is an easy access to over-the-counter (OTC) medicines and expenditure is high. Certain OTC products are available to the public in general stores, while others may only be available at pharmacies. It is also common for OTC medicines to be prescribed by a doctor for treatment of minor illnesses. Individuals with medical insurance usually have cover for these products, but typically only to a limited extent.AimTo investigate the utilization patterns in two medical insurance schemes of OTC analgesic products in the Anatomical Therapeutic Chemical (ATC) category N02BE51 which includes medicines containing paracetamol and varying combinations of codeine, caffeine and antihistamines.MethodologyData were obtained for two benefit plans, one with generous, high benefits (HI), the other with lower benefits (LO). Data covered utilization of OTC medicines in the N02BE51 group, indicating whether the medicines were purchased at a pharmacy or dispensed by a doctor. Doctors were further categorised as contracted/network or non-network providers. Product costs and volumes were analysed according to access directly by the beneficiary, recommendation by a pharmacist, or prescription from a doctor.ResultsCompared to doctors, pharmacists issued more-expensive products. Average costs were higher in the HI plan compared to the LO plan. Pharmacists showed a preference for dispensing larger and more expensive pack sizes. Doctors showed better cost containment: the average cost of products in HI was twice that of LO. Doctors dispensing directly to patients issued smaller pack sizes and lower-priced products. Contracted network doctors did not appear to impact on costs.ConclusionAmong the privately-insured individuals studied, the avaiIability, cost and formulation of N02BE51 OTC products appeared to be poorly regulated, whether by the consumer, pharmacist, medical insurance scheme or legislation. Doctors demonstrate better cost containment by prescribing less costly, smaller pack-size alternatives compared to pharmacists.

Infectious Diseases Specialty Intervention Is Associated With Better Outcomes Among Privately Insured Individuals Receiving Outpatient Parenteral Antimicrobial Therapy.

Outpatient parenteral antimicrobial therapy (OPAT) can be managed by specialists in infectious diseases (ID) or by other physicians. Better management of OPAT can reduce the likelihood of readmission or emergency department (ED) use. The relative success of ID specialists and other physicians in managing OPAT has received little study. We analyzed a national database of insurance claims for privately insured individuals under age 65, locating inpatient acute-care stays in 2013 and 2014 that were followed by OPAT. Through propensity scoring, patients who received outpatient ID intervention (ID-led OPAT) were matched 1-to-1 with those who did not (Other OPAT). We estimated regression models of hospital and ED admissions and of total healthcare payments over the first 30 days after discharge. The final analytic sample of 8200 observations was well balanced on clinical and demographic characteristics. Soft-tissue infection and osteomyelitis were the most common infections in the index event, each affecting more than 40% of individuals. Relative to those with Other OPAT, people with ID-led OPAT had lower odds of an ED admission (odds ratio [OR] 0.449, 95% confidence interval [CI] 0.311-0.645) or hospitalization (OR 0.661, 95% CI 0.557-0.791) over 30 days, and they accumulated $1488 less in total healthcare payments (95% CI -2 688.56--266.58). Among privately insured individuals below age 65, ID consultations during OPAT are associated with large and significant reductions in the rates of ED admission and hospital admission in the 30 days after index events, as well as lower total healthcare spending.

PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST

You have accessJournal of UrologySexual Function/Dysfunction: Peyronie's Disease I1 Apr 2018PD44-07 PEYRONIE'S DISEASE: THE IMPACT OF COLLAGENASE CLOSTRIDIUM HISTOLYTICUM ON DIAGNOSIS, TREATMENT, AND COST Andrew Sun, Shufeng Li, and Michael Eisenberg Andrew SunAndrew Sun More articles by this author , Shufeng LiShufeng Li More articles by this author , and Michael EisenbergMichael Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2131AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Peyronie's disease (PD) is characterized by fibrous penile plaque formation that interferes with sexual function and quality of life. Many treatments have been proposed, the most recent being collagenase clostridium histolyticum (CCH) injections (FDA approved in 2014). Currently only verapamil, CCH, and surgical approaches are recommended by AUA guidelines. Given mixed evidence for efficacy of verapamil, invasive nature of surgery, and novel mechanism of CCH, there is significant interest in CCH use. We sought to evaluate the impact of CCH on the prevalence, treatment, and cost of PD. METHODS Optum is a national database with information from adjudicated and paid insurance claims of privately-insured individuals, covering between 6 and 7 million males from 2004 to 2016. We extracted data on PD diagnosis (ICD-9 607.95 and ICD-10 N48.6) and treatments. Both individual years and eras before and after CCH use (2004-2013 vs 2015-2016) were analyzed for prevalence of PD, overall rate of PD treatment, rate of penile injections, rate of CCH use, rate of surgical PD procedures, and cost associated with treatment. Analyses were conducted using SAS (version 9.3). RESULTS The annual prevalence of PD rose from 0.03% in 2004 to 0.08% in 2011 and remained stable thereafter. Among men >50, the prevalence remained between 13-14% after 2011. However, annual rates of PD treatment increased from an average of 11.1% for 2004-2013 to a high of 14.8% in 2015. Corresponding to this, annual penile injection rates increased from an average of 5.5% from 2004-2013 to 9.5% for 2015-2016. By 2016, CCH was 74.9% of all penile injections. Average annual rates of penile plication (3.3% vs 3.4%), penile grafting (1.0% vs 0.51%), and penile prosthesis (12.1% vs 12.1%) among men with a PD diagnosis remained stable for the same eras. The average annual cost of PD treatment per man increased from $1824.16 in 2004 to $4010.92 in 2016 (inflation adjusted). This was most pronounced from 2013 to 2016 where an average increase of $361.41 per year was observed, versus $122.50 for the years prior. CONCLUSIONS The prevalence of PD stabilized in 2011 and did not increase after CCH became available in 2014. Over the same period, the proportion of men receiving treatment for PD increased, associated with more injections and CCH use. In addition, the cost of treating PD increased more rapidly after CCH became available. Further research into CCH use is needed to assess if the increase in treatment has improved outcomes of men with PD. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e883 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Andrew Sun More articles by this author Shufeng Li More articles by this author Michael Eisenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP85-01 RISK OF MELANOMA WITH PHOSPHODIESTERASE TYPE 5 INHIBITOR USE AMONGST PATIENTS WITH ERECTILE DYSFUNCTION, PULMONARY HYPERTENSION AND LOWER URINARY TRACT SYMPTOMS

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy II1 Apr 2018MP85-01 RISK OF MELANOMA WITH PHOSPHODIESTERASE TYPE 5 INHIBITOR USE AMONGST PATIENTS WITH ERECTILE DYSFUNCTION, PULMONARY HYPERTENSION AND LOWER URINARY TRACT SYMPTOMS Eugene Shkolyar, Shufeng Li, Jean Tang, and Michael Eisenberg Eugene ShkolyarEugene Shkolyar More articles by this author , Shufeng LiShufeng Li More articles by this author , Jean TangJean Tang More articles by this author , and Michael EisenbergMichael Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2861AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Phosphodiesterase type 5 inhibitors (PDE5i), a treatment for erectile dysfunction (ED), pulmonary hypertension (pHTN) and lower urinary tract symptoms (LUTS), have been implicated in melanoma development. Prior studies have been limited to men prescribed PDE5i for ED. We sought to determine the association between PDE5i use and melanoma development amongst all patients with ED, pHTN and LUTS. We also sought to determine if PDE5i use had any impact on melanoma treatment once diagnosed. METHODS Retrospective cohort study of subjects contained within the Truven Health MarketScan claims database, which provides information on insurance claims in the US for privately-insured individuals, from 2007 to 2015. Individuals taking PDE5i were identified through pharmacy claims. A comparison group of subjects diagnosed with conditions for which PDE5i are prescribed was assembled. Cox proportional hazard models were used to estimate the hazard ratio (HR) (95% CI) of incident melanoma, basal cell carcinoma, squamous cell carcinoma. RESULTS Of 610,881 subjects prescribed PDE5i, 636 developed melanoma (0.10%). There was an association between increased PDE5i tab use and melanoma (HR 1.05, 95% CI 1.05-1.09). This association was also present between PDE5i use and basal cell carcinoma (HR 1.04, 95% CI 1.02-1.07), and squamous cell carcinoma (HR 1.04, 95% CI 1.01-1.07). In patients with pHTN and LUTS prescribed PDE5i, there was no relationship between exposure and melanoma incidence (HR 0.74, 95% CI 0.48-1.13) and (HR 1.03, 95% CI 0.97-1.10), respectively. We found no association between PDE5i use and melanoma amongst female study subjects. There was no difference in melanoma treatment intensity when accounting for PDE5i use, however men taking PDE5i diagnosed with melanoma had longer follow-up times and a higher number of clinic visits (p < 0.0001). CONCLUSIONS There is a slight association between higher volume PDE5i use and development of melanoma, basal cell carcinoma, and squamous cell carcinoma. This association amongst all skin cancers implies that confounding and increased interaction with healthcare providers may account for the observed association. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e1169 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Eugene Shkolyar More articles by this author Shufeng Li More articles by this author Jean Tang More articles by this author Michael Eisenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

028 Increased Risk of Incident Cancer in men with Peyronie's Disease: Analysis of United States Claims Data

Peyronie′s disease (PD) is inherited in autosomal dominant fashion in a subset of men. Recent work examining genetic risk factors identified genes involved in human carcinogenesis. Here, we examine the risk of cancer among a large sample of men with PD. We analyzed subjects contained within the Truven Health MarketScan claims database from 2007-2014. This U.S. database provides information of insurance claims filed for the care of privately-insured individuals with employment-based insurance. Men with PD or erectile dysfunction (ED) were identified through diagnosis (ICD-9) codes. An age and follow-up time matched control cohort of men was also created. men with any claim with a diagnosis code for cancer before the index date or within 1 year after the index date were excluded (ICD9 140–209, excluding skin squamous cell, basal cell, and non-invasive cancers). The incidence of cancer was compared among each group utilizing a Cox regression model.

PD14-06 THE INCIDENCE AND FINANCIAL IMPACT OF SCROTAL PAIN AND ITS MANAGEMENT ON THE US HEALTHCARE SYSTEM IN THE UNITED STATES BETWEEN 2007 AND 2014

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Value of Care: Cost and Outcomes Measures I1 Apr 2017PD14-06 THE INCIDENCE AND FINANCIAL IMPACT OF SCROTAL PAIN AND ITS MANAGEMENT ON THE US HEALTHCARE SYSTEM IN THE UNITED STATES BETWEEN 2007 AND 2014 Yash Khandwala, Chiyuan Zhang, and Michael L. Eisenberg Yash KhandwalaYash Khandwala More articles by this author , Chiyuan ZhangChiyuan Zhang More articles by this author , and Michael L. EisenbergMichael L. Eisenberg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.707AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Scrotal pain is a common complaint in urologic practice. To date, there is little data on the prevalence and treatment patterns of the disease. Moreover, little is known about the financial burden on the medical system. Thus, we sought to characterize scrotal pain and its impact among men in a large US insurance claims database. METHODS We analyzed subjects from the Truven Health MarketScan claims database from 2007 to 2014. This US database provides information of insurance claims filed for the care of privately-insured individuals with employment-based insurance through a participating employer. Clinical encounters for scrotal pain were identified using ICD-9 codes. The total number of visits and patient demographics were enumerated. Codes for the pharmaceuticals prescribed for scrotal pain were also extracted and analyzed. RESULTS In 2007, 0.83% of all men older than 18 years of age (87,333 men) in our cohort were seen for scrotal pain increasing to 0.98% (154,840 men) in 2014. The mean number of visits per year for each patient who was evaluated at least once for their scrotal pain remained relatively constant, 1.38 visits per person in 2007 (62,943 total visits) and 1.40 in 2014 (117,419 total visits) with a mean patient age around 41 years. The mean cost of medications prescribed per year for each man with scrotal pain was $185.23 and the mean overall cost for these patients was $754.06 per year, which equates to roughly $116M in 2014. In 2007, the majority of pain medications prescribed for scrotal pain were opiates and NSAIDS at 14.5% and 11.0% of all men with scrotal pain, respectively. Opiate prescription increased to 43.4% and NSAIDS increased to 35.9% in 2014. Muscle relaxant and anticonvulsant prescription also increased substantially from 3.2% to 15.79% and 0.7% to 3.9%, respectively over the same time interval. CONCLUSIONS The incidence of scrotal pain has risen over the past 8 years affecting nearly 1% of all men and contributing to the high economic burden of this disease. The utilization of prescription medication is increasing with more men being prescribed opiates over the period of observation. Given the rising prevalence of scrotal pain and changing treatment patterns, greater epidemiologic understanding of this disease is necessary to ensure optimal management of these patients. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e279 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yash Khandwala More articles by this author Chiyuan Zhang More articles by this author Michael L. Eisenberg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Treatment patterns and economic burden of metastatic and recurrent locally-advanced head and neck cancer patients

Objective:To characterize treatment patterns and measure the economic burden associated with metastatic (mHNC) and recurrent, locally-advanced head and neck cancer (rHNC).Methods:Administrative claims from Medicare- and privately-insured individuals during 2004–2008 were used in this retrospective database study of patients with advanced HNC. Patients diagnosed with HNC were matched 1:1 to cancer-free controls to measure the incremental economic burden of HNC. Outcomes of interest were measured during the 6 months following the date of a secondary tumor diagnosis for metastatic patients or the date of a diagnosis indicating rHNC. To assess treatment patterns, HNC patients were evaluated for the use frequency of treatments (radiotherapy, chemotherapy and surgery). Costs were reported in 2008 US$ from a third-party payer perspective and were analyzed using generalized linear models and two-part regression models adjusting for differences in age and baseline Charlson Comorbidity Index (excluding cancer diagnoses) between the HNC and control cohorts. Components of cost included inpatient, outpatient and other medical services as well as pharmacy costs.Results:The mHNC cohort consisted of 1042 patients and the rHNC cohort included 324 patients. The most common treatments for mHNC patients were supportive care (90.2%), radiation therapy (48.5%), surgery (41.9%) and chemotherapy (38.3%). Patients with rHNC frequently received HNC-related supportive care (71.0%), radiation therapy (67.9%) and chemotherapy (27.2%); HNC-related surgery was infrequent (12.7%) during the study period. The 6-month incremental adjusted total costs were $60,414 per patient for mHNC and $21,141 per patient for rHNC (p < 0.0001). Approximately 46–58% of the incremental cost was attributable to outpatient visits, 27–37% to inpatient costs and 11–13% to pharmacy, depending on the HNC cohort.Limitations:The identification of mHNC/rHNC was based on diagnosis codes and treatment patterns with the limitation of the claims database.Conclusions:Metastatic and recurrent, locally-advanced HNC patients frequently receive cancer-related treatments and incur substantial economic burden.

Utilization Characteristics of Spinal Interventions

Several investigators have identified an explosive increase in spinal injection utilization rates in the Veterans Administration and Medicare populations. Furthermore, utilization of spinal injection procedures appears to vary by geographic location, subspecialty, and practice setting. Medicare claims analysis has shown that a small percentage of physicians perform a disproportionately large number of injections. While Medicare utilization has been well-characterized, the utilization patterns for privately-insured individuals are not clearly known.