Subsequent Health Care Costs Research Articles

Ultrasound-Guided vs Non-Ultrasound-Guided Angio-Seal Vascular Hemosasis After Endovascular Treatment for Peripheral Artery Disease: An Observational Study.

Ultrasound visualization of vascular closure devices during endovascular access closure leads to a significant decrease in overall and major post interventional access site complications. This non-invasive and often readily available imaging technique could therefore lead to an important decrease in morbidity and subsequent overall health care costs when added to the standard intervention protocol. With the increasing use of endovascular techniques to treat peripheral artery disease, the addition of ultrasound-techniques in closure of endovascular access sites could potentially have a large clinical impact, both on patient outcomes as well as financial outcomes.

RWD159 Assessing the Relationship between Initial Opioid Prescription and Subsequent Pain-Related Healthcare Resource Utilization and Costs Among Patients with Chronic Pain

RWD159 Assessing the Relationship between Initial Opioid Prescription and Subsequent Pain-Related Healthcare Resource Utilization and Costs Among Patients with Chronic Pain

The skåne emergency medicine (SEM) cohort

BackgroundIn the European Union alone, more than 100 million people present to the emergency department (ED) each year, and this has increased steadily year-on-year by 2–3%. Better patient management decisions have the potential to reduce ED crowding, the number of diagnostic tests, the use of inpatient beds, and healthcare costs.MethodsWe have established the Skåne Emergency Medicine (SEM) cohort for developing clinical decision support systems (CDSS) based on artificial intelligence or machine learning as well as traditional statistical methods. The SEM cohort consists of 325 539 unselected unique patients with 630 275 visits from January 1st, 2017 to December 31st, 2018 at eight EDs in the region Skåne in southern Sweden. Data on sociodemographics, previous diseases and current medication are available for each ED patient visit, as well as their chief complaint, test results, disposition and the outcome in the form of subsequent diagnoses, treatments, healthcare costs and mortality within a follow-up period of at least 30 days, and up to 3 years.DiscussionThe SEM cohort provides a platform for CDSS research, and we welcome collaboration. In addition, SEM’s large amount of real-world patient data with almost complete short-term follow-up will allow research in epidemiology, patient management, diagnostics, prognostics, ED crowding, resource allocation, and social medicine.

The complex dynamics of therapeutic leave in Psychiatry

IntroductionTherapeutic leave, the temporary and authorized absence of a patient from a psychiatric inpatient facility, is a practice rooted in the shift of mental illness towards more humane and recovery oriented care. This shift began to gain momentum in the mid-20th century, with the deinstitutionalization movement, which sought to treat psychiatric patients in less restrictive environments and facilitate their integration into the community. Today, therapeutic leave remains relevant in general psychiatry inpatient treatment facilities, and on an international level. It’s additionally used as a way to assess the progress and the stability of the patient outside the controlled environment that is the hospital, and to provide a gradual transition back into independent living and potential stressors of the outside world. But it is administered more on tradition and perceived benefits than on solid scientific grounding, reflecting a practice guided by clinical experience rather than empirical data or guidelines.ObjectivesOur review aims to evaluate the existing body of research on therapeutic leave in general psychiatry inpatient units. We intend to identify the outcomes that have been studied, and assess the extent and nature of their impact.MethodsThis scoping review was conducted through a comprehensive search of academic databases, including Google Scholar, PubMed, Embase, Cochrane Library, and PsycINFO. Search terms were carefully selected to capture relevant publications, and the results were screened for their pertinence to the review’s aims. Studies focused on forensic settings were excluded.ResultsThe literature on therapeutic leave is notably limited, and the prevalence of its utilization in clinical practice remains unclear. Scientific publications primarily address readmission rates, with two indicating an increased risk in patients granted leave during their inpatient treatment. However, one report suggested a potential reduction. Length of stay (LOS) was negatively impacted, with prolonged hospitalization in these patients shown in one report. Post-discharge emergency room visits seem unaffected. A rise in readmission rates and LOS typically suggests higher subsequent healthcare costs. However, findings from another study contradict this expectation, with reduction of costs post-initial inpatient treatment. The literature also explores the hazards linked to therapeutic leave, highlighting that a significant portion, between 30 to 80%, of inpatient suicides transpire during such leave. Additional concerns extend to non-fatal self-harm, as well as the possibility of patients causing harm to others or to property.Conclusions Our review reveals a significant research gap in therapeutic leave’s effects, with a reduced number of outcomes studied and inconclusive findings. Future studies should aim to clarify these outcomes and eventually define therapeutic leave protocols.Disclosure of InterestNone Declared

Ambulatory Care Fragmentation and Total Health Care Costs.

The magnitude of the relationship between ambulatory care fragmentation and subsequent total health care costs is unclear. To determine the association between ambulatory care fragmentation and total health care costs. Longitudinal analysis of 15 years of data (2004-2018) from the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, linked to Medicare fee-for-service claims. A total of 13,680 Medicare beneficiaries who are 65 years and older. We measured ambulatory care fragmentation in each calendar year, defining high fragmentation as a reversed Bice-Boxerman Index ≥0.85 and low as <0.85. We used generalized linear models to determine the association between ambulatory care fragmentation in 1 year and total Medicare expenditures (costs) in the following year, adjusting for baseline demographic and clinical characteristics, a time-varying comorbidity index, and accounting for geographic variation in reimbursement and inflation. The average participant was 70.9 years old; approximately half (53%) were women. One-fourth (26%) of participants had high fragmentation in the first year of observation. Those participants had a median of 9 visits to 6 providers, with the most frequently seen provider accounting for 29% of visits. By contrast, participants with low fragmentation had a median of 8 visits to 3 providers, with the most frequently seen provider accounting for 50% of visits. High fragmentation was associated with $1085 more in total adjusted costs per person per year (95% CI $713 to $1457) than low fragmentation. Highly fragmented ambulatory care in 1 year is independently associated with higher total costs the following year.

Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization.

Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March-June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018-2022). We used difference-in-differences methodology adjusting for patients' characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by -$1814 per person), number of emergency department visits (by -88.6 per 1000 persons), and number of inpatient admissions (by -32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days' drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.

Mortality and subsequent healthcare use among older patients discharged to a municipality with excess demand for elderly care

There is limited knowledge on how excess demand for elderly care influences patient outcomes. We used a natural experiment to estimate the causal effect of discharging elderly patients from hospital to municipalities with excess demand. In Norway, hospital in-patients are defined as ready-for-discharge when hospital treatment is completed, but the patient needs further care from municipal services. After this, the municipality of residence is obliged to either provide care for the patient or to pay the hospital a fixed fee per day that the patient spends in hospital. Municipal fee-days may thus indicate excess municipal demand. In the current paper, we studied how excess municipal demand, indicated by the number of fee-days accumulated in the municipality 30 days before an acute admission, influenced patient outcomes. To minimize confounding, we compared patients living within the same municipality, admitted during the same type of day, in the same year, but with varying excess demand. Our outcomes were mortality, resource use and healthcare costs at the primary and secondary care level, within 30 days. Between 2012 and 2016, 354,834 individuals (age≥70 years) had a total of 895,892 acute admissions. There was a 2% increased 30-day mortality per standard deviation change in accumulate fee-days (Hazard ratio (HR) of 1.02, 95% confidence interval (CI) 1.01-1.03). Individuals living in small municipalities (population&lt;10,000) had HR of 1.04, (95% CI 1.02-1.07), while individuals living in larger municipalities (population&gt;10,000) had HR of 1.01 (95% CI 1.00-1.03). We found no substantial effect on subsequent healthcare use or costs. Relevance tests supported that fee-days was a good indication of excess demand, and balance tests supported that patients were comparable between periods with different excess demand. In conclusion, our results imply that older patients who are discharged to a municipality with excess demand have slightly elevated mortality, particularly in small municipalities.

The Role of clinical pharmacists’ interventions and prevention of medication errors in emergency departments

Clinical pharmacists play a vital role in mitigating medication errors within the high-pressure setting of emergency departments (EDs). This study underscores the significance of their interventions in elevating patient safety and reducing adverse drug events. Medication errors in the ED often stem from factors such as time constraints, incomplete patient information, and complex drug regimens. Clinical pharmacists address these challenges by conducting comprehensive medication reconciliation, assessing drug interactions, and adjusting dosages to align with each patient's specific requirements. Their presence in EDs facilitates real-time verification of medication orders, immediate correction of errors, and close collaboration with the healthcare team. Furthermore, clinical pharmacists provide invaluable drug information and education to patients and medical staff, thereby lowering the risk of inappropriate drug usage and promoting safer administration practices. Existing literature affirms that clinical pharmacist interventions in EDs lead to a notable reduction in medication errors, adverse drug events, and subsequent healthcare costs. In summary, the integration of clinical pharmacists in the ED is indispensable for augmenting patient safety, averting medication errors, and ultimately enhancing patient outcomes. Keywords: medication errors, clinical pharmacists, emergency departments, patient safety, healthcare.

Relationship between medication adherence for opioid use disorder and health care costs and health care events in a claims dataset

IntroductionMedication for opioid use disorder (MOUD) has well-documented benefits for treating OUD, though its efficacy depends on patient adherence. We know little about outcomes of MOUD nonadherence compared to treatment regimens without MOUD, and this article aims to address the gap. This analysis focused on office-based MOUD treatment (buprenorphine and naltrexone) to evaluate the long-term impact of adherence on subsequent health care costs and health care events. MethodsWith claims data from 2017 to 2019, we used propensity score (PS) weighting to create three comparable cohorts of patients: 1) Adherent: filled MOUD prescription & ≧80 % of days covered by MOUD (N = 1045); 2) Nonadherent: filled MOUD & < 80 % of days covered (N = 1116), 3) did not fill MOUD (N = 16,784). The study defined three time intervals based on a patient's most recent MOUD episode: A 6-month baseline period before initiation of MOUD or random index date for those with MOUD; a 6-month treatment period, during which adherence or nonadherence was established; and a 12-month follow-up period to evaluate outcome measures. The study used generalized PS methodology to examine the effect of proportion of days covered (PDC) as a continuous measure of adherence. ResultsAmong patients who filled MOUD, adherence to MOUD was significantly predicted by having less severe OUD, being older, having fewer inpatient visits and lower outpatient costs before the start of treatment. Adherent patients displayed significantly lower health care costs in the follow-up period compared to nonadherent MOUD patients, and lower odds of experiencing health care events. The nonadherent MOUD group displayed significantly higher odds of health care events compared to patients who had no evidence of receiving MOUD in claims data (NO-MOUD). Among patients prescribed MOUD, each 10 % increase in PDC was associated with a significant decrease in inpatient/outpatient costs and in odds of health care events. ConclusionsThis analysis aligns with previous findings about the importance of maintaining long-term adherence to MOUD in supporting patient outcomes. The results also suggest a novel finding that despite confounder control via PS methods, nonadherent patients display poorer outcomes compared to similar NO-MOUD patients.

Association of the Range of Outpatient Services Provided by Primary Care Physicians with Subsequent Health Care Costs and Utilization.

Broader primary care practice range of services (ROS), defined as the diversity of professional services delivered, is associated with lower utilization. ROS provided by individual primary care physicians (PCPs) varies considerably with unclear implications for patients. Create a PCP-ROS measure covering six categories of outpatient services, including expanded codes for mental health counseling services and point of care ultrasound (POCUS) technology in physician offices. Determine whether PCP-ROS is associated with total Medicare expenditures, inpatient admissions, acute hospital utilization (AHU), and emergency department (ED) visits. Examine physician and practice characteristics associated with PCP-ROS. Retrospective cohort study. 4,569,711 Medicare fee-for-service beneficiaries and 27,008 PCPs observed during the evaluation of the Comprehensive Primary Care Plus (CPC +) initiative. PCP-ROS, hospitalizations, AHU (includes observation stays as well as inpatient admissions), ED visits, and total Medicare expenditures. Physicians varied substantially in the range of services provided. Broader PCP-ROS was significantly, independently associated with 1 - 3% lower Medicare expenditures (p ≤ 0.01), inpatient admissions (p ≤ 0.027), AHU (p ≤ 0.025), and ED visit rates (p ≤ 0.000). PCP-ROS score was associated with improved patient outcomes, independent of physician provision of procedures (such as laceration repair or skin excisions). Physicians in practice sites affiliated with a hospital or health system had narrower PCP-ROS than independent physicians by 0.3 to 0.4 (p < 0.001). Internal medicine specialty was associated with narrower PCP-ROS than family medicine by 0.3 (p < 0.001). Patients cared for by primary care physicians who provide a broader range of services subsequently experience lower acute care utilization and expenditures than do those cared for by physicians with narrower ROS. Practice leaders and professional associations should consider how best to ensure that primary care physicians efficiently and effectively provide the office-based professional services most needed by their patients.

Effects of chiropractic use on medical healthcare utilization and costs in adults with back pain in Ontario, Canada from 2003 to 2018: a population-based cohort study

BackgroundAdults with back pain commonly consult chiropractors, but the impact of chiropractic use on medical utilization and costs within the Canadian health system is unclear. We assessed the association between chiropractic utilization and subsequent medical healthcare utilization and costs in a population-based cohort of Ontario adults with back pain.MethodsWe conducted a population-based cohort study that included Ontario adult respondents of the Canadian Community Health Survey (CCHS) with back pain from 2003 to 2010 (n = 29,475), followed up to 2018. The CCHS data were individually-linked to individual-level health administrative data up to 2018. Chiropractic utilization was self-reported consultation with a chiropractor in the past 12 months. We propensity score-matched adults with and without chiropractic utilization, accounting for confounders. We evaluated back pain-specific and all-cause medical utilization and costs at 1- and 5-year follow-up using negative binomial and linear (log-transformed) regression, respectively. We assessed whether sex and prior specialist consultation in the past 12 months were effect modifiers of the association.ResultsThere were 6972 matched pairs of CCHS respondents with and without chiropractic utilization. Women with chiropractic utilization had 0.8 times lower rate of cause-specific medical visits at follow-up than those without chiropractic utilization (RR5years = 0.82, 95% CI 0.68-1.00); this association was not found in men (RR5years = 0.96, 95% CI 0.73–1.24). There were no associations between chiropractic utilization and all-cause physician visits, all-cause emergency department visits, all-cause hospitalizations, or costs. Effect modification of the association between chiropractic utilization and cause-specific utilization by prior specialist consultation was found at 1-year but not 5-year follow-up; cause-specific utilization at 1 year was lower in adults without prior specialist consultation only (RR1year = 0.74, 95% CI 0.57–0.97).ConclusionsAmong adults with back pain, chiropractic use is associated with lower rates of back pain-specific utilization in women but not men over a 5-year follow-up period. Findings have implications for guiding allied healthcare delivery in the Ontario health system.

Association between physiotherapy utilization and medical healthcare utilization and costs in adults with back pain from Ontario, Canada: a population-based cohort study.

This study examined the association between physiotherapy utilization and subsequent medical healthcare utilization and costs in a population-based sample of adults with back pain in Ontario. We conducted a population-based cohort study of Ontario respondents with back pain (≥18 years) of the Canadian Community Health Survey 2003 to 2010 cycles, linked to health administrative data up to 2018. Physiotherapy utilization was defined as self-reported consultation with a physiotherapist in the past 12 months. A propensity score-matched cohort was conducted to match adults with and without physiotherapy utilization, accounting for potential confounders. We assessed associations using negative-binomial and linear (log-transformed) regression to evaluate outcomes of healthcare utilization (back pain-specific and all-cause) and costs, respectively, at 1- and 5-year follow-up. There were 4343 pairs of matched respondents. Compared with those who did not receive physiotherapy, adults who received physiotherapy were more likely to have back pain-specific physician visits (RR women (5years) = 1.48, 95% CI 1.24-1.75; RR men (5years) = 1.42, 95% CI 1.10-1.84). Women who received physiotherapy had 1.11 times the rate of all-cause physician visits (RR 1year = 1.11, 95% CI 1.02-1.20), and men who received physiotherapy had 0.84 times the rate of all-cause hospitalizations (RR 5years = 0.84, 95% CI 0.71-0.99) than those who did not. There was no association between physiotherapy utilization and healthcare costs. Adults with back pain who received physiotherapy are more likely to have back pain-specific physician visits up to 5-year follow-up than those who did not. Physiotherapy utilization is linked to some sex-based differences in all-cause healthcare utilization but not differences in costs. Findings inform interprofessional collaboration and allied healthcare delivery for back pain in Ontario.

Complex economic effects of balanced nutrition for athlete-schoolchildren in ethno-intellectual sports

The present research conducts an intricate economic analysis on targeted nutritional interventions for a specific demographic: 60 athlete-schoolchildren between the ages of 11 and 13 in Central Asia. These children are actively engaged in the ethno-intellectual sport of Togyz Kumalak which from an ethnohistorical perspective is a part of the socio-cultural heritage of the nomadic societies of Central Asia. Spanning a timeframe of 12 months, this multi-faceted study was articulated in a three-stage design framework. The initial stage involved a baseline assessment of the children’s nutritional statuses, utilizing anthropometric measurements and dietary recall surveys as empirical tools. Medical experts and biologists collaborated to identify the economic implications of nutrient imbalances that could lead to metabolic disorders and subsequent healthcare costs. The second stage encompassed the formulation and execution of nutritional interventions that were economically vetted for sustainability and impact. These interventions were derived from the baseline data and involved dietary supplementation, counseling, and a well-balanced nutritional regimen designed in consultation with coaches, trainers, and parents. During this stage, economic considerations were central to the discourse as experts across disciplines expounded on the optimal ratio of vital macro- and micronutrients, adequate caloric content, and even distribution of nutrients throughout the day. Such a comprehensive approach to diet structuring amplifies the economic viability by elucidating how a balanced nutritional intake can enhance athletic and intellectual performance, impact competition outcomes positively, and improve post-training recovery – thereby potentially mitigating of long-term healthcare expenditures. The study culminated in a rigorous post-intervention assessment that employed both cost-effectiveness analysis (CEA) and cost-benefit analysis (CBA) methodologies. The results revealed not only a statistically significant improvement in the nutritional statuses of the children but also confirmed the cost-effectiveness and scalability of the interventions implemented. The economic aspects were augmented by metrics that interlinked the immediate benefits of the interventions with broader economic considerations, such as the potential reduction in healthcare-related costs over time. Research contributes profoundly to public health dialogues, offering insights into the optimization of resources to heighten the general well-being and performance, particularly in the specialized arena of ethno-intellectual sports like Togyz Kumalak. It successfully straddles the crossroads of health economics, cultural sports, and public health, emphasizing the potential for integrative approaches in the amelioration and proliferation of community-centered health programs. This multifaceted economic analysis thus serves as a robust model for scalable and economically viable public health strategies that satisfy both individual health and community development needs.

Defining the psychiatric and financial burden of mental and substance use disorders in cancer patients.

To identify the proportion of Emergency Department (ED) visits in cancer patients associated with a mental and substance use disorder (MSUD) and the subsequent healthcare costs. Nationally representative data on ED visits from 2009 to 2018 was obtained from the Nationwide Emergency Department Sample (NEDS). We identified cancer-related visits with or without a MSUD using the Clinical Classifications Software diagnoses documented during the ED visit. Survey-adjusted frequencies and proportions of ED visits among adult cancer patients with or without a MSUD was evaluated. Survey-adjusted multivariable logistic regression models were used to examine demographic and clinical predictors of the presence of an MSUD and the likelihood of hospital admission for patients with a primary MSUD. Among 54,004,462 ED visits with a cancer diagnosis between 2009 and 2018, 11,803,966 (22%) were associated with a MSUD. Compared to a primary diagnosis of cancer, patients who presented to the ED with a chief complaint of MSUD were more likely to be female (54% vs. 49%), younger (median: 58 vs. 66), more likely to have Medicaid insurance, and more likely to be discharged home. The three most common MSUD diagnoses among cancer patients were alcohol-related disorders, anxiety disorders, and depressive disorders. The total costs associated with a primary MSUD from 2009 to 2018 was $3,133,432,103, of which alcohol-related disorders claimed the largest majority. Younger age (OR per 10-year increase: 0.86, 95% CI: 0.85, 0.86) and female sex (OR: 1.34, 95% CI: 1.33-1.35) were associated with higher odds of having an MSUD. Our findings demonstrate a high burden of psychiatric and substance use illness in the cancer population and provide the rationale for early psychosocial intervention to support these patients.

Prompt initiation of triple therapy following hospitalization for a chronic obstructive pulmonary disease exacerbation in the United States: An analysis of the PRIMUS study.

BACKGROUND: Severe exacerbations requiring hospitalization contribute a substantial portion of the morbidity and costs of chronic obstructive pulmonary disease (COPD). Triple therapy (inhaled corticosteroid + long-acting β-agonist + long-acting muscarinic antagonist) is a recommended option for patients who experience recurrent COPD exacerbations or persistent symptoms. Few real-world studies have specifically examined the effect of prompt initiation of triple therapy, specifically among patients hospitalized for a COPD exacerbation. OBJECTIVE: To assess whether prompt initiation of triple therapy following a severe COPD exacerbation was associated with lower risk of subsequent exacerbations and lower health care use and costs and the effects of each 30-day delay of initiation. METHODS: Adults aged 40 years or older with COPD were identified in the Merative MarketScan Databases between January 1, 2010, and December 31, 2019, and were required to meet the following criteria: open or closed triple therapy (date of first closed prescription or last component of open=index treatment date), more than 1 inpatient admission with a primary COPD diagnosis (ie, severe exacerbation) in the prior 12 months (index exacerbation), 12 months of continuous enrollment before (baseline) and after (follow-up) index exacerbation, and absence of select respiratory diseases and cancer. Patients were stratified based on timing of open or closed triple therapy after the index exacerbation: prompt (≤30 days), delayed (31-180 days), or very delayed (181-365 days). Multivariable regression controlled for baseline characteristics (age, sex, insurance type, index year, comorbidities, prior treatment, and prior exacerbations) and estimated the odds of subsequent exacerbations, change in the number of exacerbations, and change in health care costs during 12-month follow-up associated with each 30-day delay of triple therapy initiation. RESULTS: A total of 6,772 patients met inclusion criteria (2,968 [43.8%] prompt, 1,998 [29.5%] delayed, and 1,806 [26.7%] very delayed). The adjusted odds of any exacerbation and a severe exacerbation during 12-month follow-up increased by 13% (odds ratio [95% CI]: 1.13 [1.11-1.15]) and 10% (1.10 [1.08-1.12]), respectively, for each 30-day delay in triple therapy initiation, and the mean number of exacerbations increased by 5.4% (95% CI = 4.7%-6.1%). There was a 3.0% increase (95% CI = 2.2%-3.8%) in mean all-cause costs and a 3.7% increase (95% CI = 2.9%-4.6%) in total COPD-related costs for each 30-day delay of triple therapy initiation. CONCLUSIONS: Longer delays in triple therapy initiation after a COPD hospitalization result in greater risk of subsequent exacerbations and higher health care resource use and costs. Adequate post-discharge follow-up care and earlier consideration of triple therapy may improve clinical and economic outcomes among patients with COPD. DISCLOSURES: This study was funded by AstraZeneca. Dr Evans is employed by Merative, formerly IBM Watson Health, and Mr Tkacz was employed by IBM Watson Health at the time of this study; Merative/IBM Watson Health received funding from AstraZeneca to conduct this study. Mr Pollack, Dr Staresinic, Dr Feigler, and Dr Patel are employed by AstraZeneca. Dr Touchette, Dr Portillo, and Dr Strange are paid consultants to AstraZeneca. Dr Strange also participates in research grants paid to the Medical University of South Carolina by AstraZeneca, CSA Medical, and Nuvaira, and is a consultant to GlaxoSmithKline, Morair, and PulManage regarding COPD.

Comparison of utilization and cost of healthcare services and pharmacotherapy following implantation of vagus nerve stimulation vs. responsive neurostimulation or deep brain stimulation for the treatment of drug-resistant epilepsy: analyses of a large United States healthcare claims database

Aim Vagus nerve stimulation (VNS), responsive neurostimulation (RNS), and deep brain stimulation (DBS) all are options for drug-resistant epilepsy (DRE). However, little is known about how the choice of neurostimulation impacts subsequent healthcare costs. Materials and methods We used a large US healthcare claims database to identify all patients with epilepsy who underwent neurostimulation between 2012 and 2019. Eligible patients were identified and stratified based on procedure received (VNS vs. RNS/DBS). VNS patients were matched by propensity scoring to RNS/DBS patients. Use and cost of healthcare resources and pharmacotherapy were ascertained over the 24-month period following neurostimulation, incorporating all-cause and epilepsy-related measures. Disease-related care was defined based on diagnoses of claims for medical care and relevant pharmacotherapies. Results Seven hundred and ninety-two patients met all selection criteria. VNS patients were younger, were prescribed a higher pre-index mean number of anti-seizure medications (ASMs), and had higher pre-index levels of use and cost of epilepsy-related healthcare services. We propensity matched 148 VNS patients to an equal number of RNS/DBS patients. One year following index date (inclusive), mean total all-cause healthcare costs were 50% lower among VNS patients than RNS/DBS patients, and mean epilepsy-related costs were 55% lower; corresponding decreases at the two-year mark were 41% and 48%, respectively. Limitations Some clinical variables, such as seizure frequency and severity, quality of life, and functional status were unavailable in the database, precluding our ability to comprehensively assess differences between devices. Administrative claims data are subject to billing code errors, inaccuracies, and missing data, resulting in possible misclassification and/or unmeasured confounding. Conclusions After matching, VNS was associated with significantly lower all-cause and epilepsy-related costs for the two-year period following implantation. All-cause and epilepsy-related costs remained statistically significantly lower for VNS even after costs of implantation were excluded.

Cost-Effectiveness Analysis of Frontline Treatment with Polatuzumab Vedotin in Diffuse Large B-Cell Lymphoma

Introduction: The POLARIX trial (NCT03274492) recently demonstrated that substituting polatuzumab vedotin (pola), a CD79b-targeted antibody-drug conjugate, for vincristine in standard R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemoimmunotherapy for first-line therapy can prolong progression-free survival in patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). However, the medication cost of pola-R-CHP (pola, rituximab, cyclophosphamide, doxorubicin, and prednisolone) regimen is substantially higher than that of R-CHOP treatment. It remains unknown whether the lower rate of treatment failure with pola-R-CHP can be translated into reduced subsequent healthcare costs, increased life years (LYs), and improved quality of life, which may offset the higher medication cost. This study aimed to investigate the cost-effectiveness of substituting pola for vincristine in first-line therapy for patients with newly diagnosed DLBCL from a US payer perspective. Methods: We developed a decision analytic model to project lifetime quality-adjusted life years (QALYs) gained, LYs gained, and direct healthcare costs in newly diagnosed DLBCL patients. The model utilized a hypothetical cohort of patients at 65 years (the median age of disease onset). Direct healthcare costs were adjusted to 2021 US dollars, and an annual rate of 3% was used to discount future costs and benefits. Incremental cost-effectiveness ratios (ICERs) were calculated, and a willingness-to-pay (WTP) threshold of USD 150,000 per QALY gained was used as the acceptable level for determining cost-effectiveness. Sensitivity analyses and scenario analyses were conducted to assess the uncertainty of the base-case scenario and input parameters. Results: Pola-R-CHP, compared to standard R-CHOP, was associated with an incremental cost of USD 90,439, an improvement of 0.89 QALYs and 1.14 LYs, leading to an ICER of USD 101,510/QALY. The model was most sensitive to the survival benefit provided by pola-R-CHP, the age of the patients at initial treatment, and the price of pola. The ICER would increase significantly if pola-R-CHP is ineffective in providing long-term remissions. Furthermore, the ICER value increased as patients were older at the beginning of the treatment. When patients were older than 76.5 years at initial treatment, the ICER would exceed the WTP threshold of USD 150,000/QALY. To make the pola-R-CHP regimen cost-effective in all age groups (up to 80 years old), the current price of pola, which was estimated to be USD 19,307 for 170 mg per treatment cycle, needed to be reduced by 20%. In the probabilistic sensitivity analysis, 48% and 73% of the iterations produced ICERs below WTP thresholds of USD 100,000/ QALY and USD 150,000/ QALY, respectively. Conclusion: Our study findings suggest that pola-R-CHP, compared to the standard R-CHOP regimen, could be a cost-effective strategy in treatment-naïve DLBCL patients aged 65 years from a US payer perspective. However, several noticeable factors that could affect the cost-effectiveness profile of pola-R-CHP therapy should be considered in decision-making. The follow-up period of the POLARIX trial was relatively short, and mature survival data would be required to fully evaluate the value of pola in the treatment of newly diagnosed DLBCL.

Misuse of Prescription Medications among Individuals with Mobility Disability

Background The ability of walking a quarter mile is predictive of subsequent disability, mortality, and health care costs. Individuals with mobility disability are at increased risk of chronic conditions and unmet care needs. Thus they may misuse prescription medications to self-medicate. Objectives We aimed to explore the difference of misuse of four types of prescription medications (sedatives, tranquilizers, painkillers, depression medications) and overall misuse by mobility status and identify the correlates of overall misuse. Methods A national probability sample from the survey Midlife in the United States (MIDUS) was used to assess the difference in misuse by mobility status during 2011–2014. To assess the correlates of misuse, mobility status, usual source of care, unmet care needs, insurance coverage, sociodemographic variables, and clinical conditions were added to a survey weighted logistic regression model with backward selection. Results Compared to those without mobility disability, individuals with mobility disability had higher risk of misuse in most types of medications and in overall misuse. Mobility disability, lower education, unmarried status, the emergency room or public health clinic as the most often used care, pain, and depressed affect were identified as correlates of overall misuse of studied medications. Conclusions Individuals with mobility disability are a vulnerable group susceptible to medication misuse, which warrants the urgent need for interventions to ameliorate misuse and reduce risks in this population.

Comparing and validating medication complexity from insurance claims against electronic health records.

BACKGROUND: Patient effort to comply with complex medication instructions is known to be related to nonadherence and subsequent medical complications or health care costs. A widely used Medication Regimen Complexity Index (MRCI) has been used with electronic health records (EHRs) to identify patients who could benefit from pharmacist intervention. A similar claims-derived measure may be better suited for clinical decision support, since claims offer a more complete view of patient care and health utilization. OBJECTIVE: To define and validate a novel insurance claims-based medication complexity score (MCS) patterned after the widely used MRCI, derived from EHRs. METHODS: Insurance claims and EHR data were provided by HealthPartners (N = 54,988) (Bloomington, Minnesota) and The Johns Hopkins Health System (N = 28,589) (Baltimore, Maryland) for years 2013 and 2017, respectively. Yearly measures of medication complexity were developed for each patient and evaluated with one another using rank correlation within different clinical subgroupings. Indicators for the presence of individually complex prescriptions were also developed and assessed using exact agreement. Complexity measures were then correlated with select covariates to further validate the concordance between MCS and MRCI with respect to clinical metrics. These included demographic, comorbidity, and health care utilization markers. Prescribed medications in each system's EHR were coded using the previously validated MRCI weighting rules. Insurance claims for retail pharmacy medications were coded using our novel MCS, which closely followed MRCI scoring rules. RESULTS: EHR-based MRCI and claims-based MCS were significantly correlated with one another for most clinical subgroupings. Likewise, both measures were correlated with several covariates, including count of active medications and chronic conditions. The MCS was, in most cases, more associated with key health covariates than was MRCI, although both were consistently significant. We found that the highest correlation between MCS and MRCI is obtained with patients who have similar counts of pharmacy records between EHRs and claims (HealthPartners: P = 0.796; Johns Hopkins Health System: P = 0.779). CONCLUSIONS: The findings suggest good correspondence between MCS and MRCI and that claims data represent a useful resource for assessing medication complexity. Claims data also have major practical advantages, such as interoperability across health care systems, although they lack the detailed clinical context of EHRs. DISCLOSURES: The Johns Hopkins University holds the copyright to the Adjusted Clinical Groups (ACG) system and receives royalties from the global distribution of the ACG system. This revenue supports a portion of the authors' salary. No additional or external funding supported this work. The authors have no conflict of interest to disclose.

PREVALENCE OF COMORBIDITY AMONG INCIDENT OSTEOARTHRITIS PATIENTS AND MATCHED CONTROLS

Purpose: Comorbidity has a negative impact on quality of life, mortality, health care utilization, and subsequent health care costs. The presence of multiple (discordant) diseases in one person can result in conflicting treatment plans, making comorbidity difficult to manage. Osteoarthritis (OA) is among the leading chronic diseases to cause pain and disability, yet relatively little research is done into its comorbidity patterns. If certain comorbidities occur more often prior to diagnosis of OA, this could indicate that they contributed to development of OA or shared certain risk factors.