Total Costs For Patients Research Articles

Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013

ObjectiveTo evaluate the prevalence of wounds managed by the UK’s National Health Service (NHS) in 2017/2018 and associated health outcomes, resource use and costs.DesignRetrospective cohort analysis of the electronic records...

Comparison of Healthcare Costs Associated With Patients Receiving Traditional Negative Pressure Wound Therapies in the Post-Acute Setting.

ObjectiveA retrospective national insurance claims database analysis evaluated total and wound-related costs for acute and chronic wound patients treated with negative pressure wound therapy (NPWT), comparing a product specific NPWT (NPWT-K) to other NPWT systems (NPWT-O).MethodsPatients with one or more NPWT claims between January 2016 and September 2018 in an outpatient setting with continuous medical and pharmacy benefits for six months before the initial (index) NPWT claims and 12 months post index were assessed. The cohorts were propensity score matched based on age, gender, comorbidities, and payer type. Each cohort included 3,368 patients after matching. Costs were evaluated at 30 days, three months, and 12 months after initial NPWT placement. Hospital admission rates, emergency room (ER) visits, and NPWT device switching were evaluated at 30 days. Differences were analyzed by t-test and chi-square test.ResultsAt 30 days, wound-related costs were $8,583 and $11,334, and total cost to treat was $17,809 and $24,405 for NPWT-K and NPWT-O, respectively (p < 0.0001). NPWT-O patients had higher NPWT, wound-related, and total costs across all time periods, as well as a longer average length of therapy (p = .0039). There was no statistical difference in 30-day hospital admissions (p = 0.089); although 30-day ER visits were higher for NPWT-K (4.9% vs. 3.3%, p = 0.0007). A higher degree of switching from NPWT-O to NPWT-K occurred at 30 days (NPWT-O 2.5% vs. 0.4%, p < 0.0001).ConclusionsThis comparative effectiveness analysis indicates differences remain across NPWT suppliers in wound-related and total cost to treat for patients who receive durable NPWT in the outpatient setting.

Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients.

Objectives: Little is known about the specific comorbidities contributing to higher costs in patients with type-2 diabetes mellitus (T2DM), particularly in older cases. We aimed to evaluate the prevalence, type, and cost of comorbidities occurring in older T2DM patients versus older non-T2DM patients, and the factors associated with high cost (HC) T2DM patients. Methods: Retrospective cohort study using information from the Campania Region healthcare database. People aged ≥65 years who received ≥2 prescriptions for antidiabetic drugs were identified as “T2DM patients.” Comorbidities among T2DM and non-T2DM groups were assessed through the RxRiskV Index (modified version). T2DM individuals were classified according to the total cost distribution as HC or “non-high cost.” Two sub-cohorts of HC T2DM patients were assessed: above 90th and 80th percentile of the total cost. Age- and sex-adjusted logistic regression models were created. Results: Among the T2DM cohort, concordant and discordant comorbidities occurred significantly more frequently than in the non-T2DM cohort. Total mean annual cost per T2DM patient due to comorbidities was €7,627 versus €4,401 per non-T2DM patient. Among T2DM patients identified as being above 90th and 80th percentiles of cost distribution, the total annual costs were >€19,577 and >€2,563, respectively. The hospitalization cost was higher for T2DM cases. Strongest predictors of being a HC T2DM patient were having ≥5 comorbidities and renal impairment. Conclusion: HC patients accrued >80% of the total comorbidities cost in older T2DM patients. Integrated care models, with holistic and patient-tailored foci, could achieve more effective T2DM care.

Healthcare Utilization and Costs associated with Hereditary Hemorrhagic Telangiectasia Patients in a Large US Claims Database

ObjectiveTo assess the health care costs and utilization in patients with hereditary hemorrhagic telangiectasia (HHT) in the United States. Patients and MethodsRetrospective analysis of patients with HHT diagnosed between 2007 and 2017 was performed using deidentified administrative claims data from the OptumLabs Data Warehouse. Adult patients with new (incident) diagnosis of HHT between January 1, 2007, and December 31, 2017, were included. Comparisons were made using the Wilcoxon rank sum test. ResultsThree thousand nine hundred seventy-seven patients with a first diagnosis of HHT between 2007 and 2017 were identified, of which 3590 were matched 1:1 to non-HHT patients with similar baseline characteristics and comorbidities. These 3590 patients with HHT were 63.1% female and 83.9% white with a mean age of 51.1 ± 18.5 years, and a mean follow-up period of 3.2 ± 2.2 years (range, 1.0-11.7 years). Compared with the control group, the cumulative 5-year median total health care cost for patients with HHT was 41.4% higher ($21,118 vs $14,929; P < .001) in those with private commercial insurance and 31.7% higher ($35,462 vs $26,925; P < .001) in those with Medicare Advantage coverage. The median annual health care costs were significantly higher in patients with HHT with commercial insurance and Medicare Advantage in the first year after diagnosis ($4,333 vs $1,804; P < .001), and ($7,322 vs $5,245; P < .001), respectively, and remained higher throughout the duration of follow-up. Further analysis showed that outpatient clinic visits, hospital admission, imaging rates, invasive procedures, iron infusions, and blood transfusions were all significantly higher in the HHT group. ConclusionPatients with HHT have significantly higher health care costs compared with a matched control group. A better understanding of the reasons underlying these cost differences will provide opportunities for patients, providers, and other stakeholders to better manage this rare condition.

Abstract 14555: Trends, and Impact of Atrial Fibrillation in Patients With Cardiac Amyloidosis

Introduction: The prevalence of atrial fibrillation (AF) in patients with cardiac amyloidosis (CA) can be as high as 40%, depending on the amyloid protein involved. There is a lack of data, however, concerning the temporal trends and prognostic implications of AF in these patients. Hypothesis: AF is associated with worse outcomes in patients with CA Methods: We identified 21,661 patients with the primary diagnosis of CA from the 2006 to 2014 National Inpatient Sample, of which 5,279 (25%) had AF. We used trend analysis to assess the temporal trends in the prevalence of AF from 2006 to 2014. We compared overall mortality, stroke, length of stay (LOS), and total cost in patients with those without AF. Results: The prevalence of AF increased from 1.3% in 2006 to 17.7% in 2014 (p&lt;0.0001). Patients with AF were older and had more comorbidities. After propensity matching, overall mortality (8.7% vs 7.5%; p= 0.027) and rates of stroke (21.0% vs 18.0%; p&lt;0.0001) were significantly higher in patients with CA and AF, compared to those with CA alone. There was no difference in median LOS (5 (3,9) vs 5(3,10); p= 0.065) and median total hospital cost ($36163 vs $34706; p= 0.114). The strongest predictors for overall mortality were hemodialysis, stroke, cardiac arrest, and congestive heart failure. Conclusions: Over a decade period, the prevalence of AF increased among CA patients and was associated with a higher risk of stroke and overall mortality.

Indirect Costs of Oral Versus Non-Oral Therapies in Hematologic Malignancies: A Systematic Literature Review

Introduction: The treatment landscape for hematologic malignancies is evolving rapidly, and a range of therapeutic options with differing routes of administration is now available. The shifting dynamics of these novel therapies and increasing total treatment costs highlight the importance of value-based healthcare decisions that take patient, payer, and societal perspectives into account. It is therefore increasingly important to consider both direct and indirect costs when evaluating therapeutic options. Reducing healthcare visits for administration of non-oral therapies (injectable and/or mixed therapies) results in indirect cost savings and is of particular relevance during the current coronavirus disease (COVID-19) pandemic where there are distinct challenges with respect to visiting hospital settings. However, the indirect cost savings of utilizing oral versus non-oral treatments have yet to be fully assessed from a patient and societal perspective. The objective of this review was to assess the differences in indirect non-treatment-related costs between oral and non-oral therapies for hematologic malignancies. Methods: A systematic literature review (SLR) was conducted by searching the Embase®, MEDLINE®, EconLit, and Health Technology Assessment/National Health Service economic evaluation (HTA/NHS EED) databases from inception to June 2020. Additionally, literature searches of proceedings from the 2018-2020 American Society of Clinical Oncology (ASCO), American Society of Hematology (ASH), and The Professional Society for Health Economics and Outcomes Research (ISPOR) conferences were performed to capture recent studies not indexed in the main databases. A manual search of the reference list from all included study publications was also performed. Eligibility criteria for study identification were developed using the Population, Intervention, Comparator, and Outcome (PICO) framework. Eligible studies included cost models and observational studies reporting indirect costs from a patient and/or societal perspective for oral versus non-oral therapies. Results: A total of 4,012 records were identified by the searches. Following title/abstract screening, the full text of 25 publications was reviewed, and 5 studies conducted in the USA (n = 3), Italy (n = 1), and Finland (n = 1) were identified as eligible and selected for qualitative evidence synthesis (Table). Although the SLR protocol included all hematologic malignancies, only studies including patients with multiple myeloma (MM) were identified. The indirect costs reported across the selected studies varied and included costs such as loss of productivity, transportation, and patient and/or caregiver time. Among all 5 studies, total indirect costs for patients with MM were lower for oral versus non-oral regimens. In the USA-based studies, indirect costs were USD 70-1,202 per month for oral regimens versus USD 432-1,526 per month for non-oral regimens. In Europe-based studies, indirect cost estimates were EUR 1,800 versus EUR 17,000 per year for oral versus non-oral regimens (Italian study), and EUR 114 versus EUR 358 per 28-day cycle for oral versus non-oral regimens (Finnish study; averages calculated from ranges in Table). Conclusions: This SLR demonstrates a paucity of data on the indirect costs to patients and society of oral versus non-oral therapies for hematologic malignancies. The studies included in this review assessed differing types of indirect costs, including loss of productivity, transportation costs, and patient and/or caregiver time; however, all indicated that the administration of oral regimens is associated with lower indirect costs compared with non-oral regimens. This finding is compelling given the current global health crisis due to COVID-19, where prioritizing the concept of "value" means assessing more complex issues, such as indirect costs that may have a meaningful impact on patients and society. Disclosures Fazeli: Evidinno Outcomes Research Inc.: Current Employment. Pushkarna:Evidinno Outcomes Research Inc.: Current Employment. Howarth:Evidinno Outcomes Research Inc.: Current Employment. Hux:Evidinno Outcomes Research Inc.: Consultancy. Pourrahmat:Evidinno Outcomes Research Inc.: Current Employment. Chen:Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company.

Impact of Severity of Acute Graft-Versus-Host Disease on Healthcare Resource Utilization, Cost and Outcomes

Introduction: Acute GVHD (aGVHD) contributes to poor outcomes and increased healthcare resource utilization (HRU) after allogeneic stem cell transplantation (allo-HCT). However, HRU and the economic burden of aGVHD based on severity of the disease and organ involvement is not well characterized. We examined the HRU, cost and mortality associated with aGVHD severity from initial hospitalization (index admission) up to 100 days post allo-HCT. Methods: Study cohort included 290 adult (≥ age 18) recipients of a first allo-HCT at the University of Florida between 1/2010 and 1/2019. The electronic medical records were reviewed for all patients who developed aGVHD as well as 116 patients without aGVHD who lived at least 1 month after HCT. Clinical measures that characterize the severity of aGVHD and extent of organ involvement were collected from electronic medical records. Medical costs and total hospital days were retrieved from administrative data that allocate costs to services based on departmental input for resource use and were adjusted to 2018 dollars. Wilcoxon rank sum test was used to compare number of inpatient days and total cost. Chi-squared test was used to compare ICU admission rate. Multivariable linear regression was fitted on log transformed cost. Results are shown as cost multipliers that represent ratios on original cost scale. Results: Of the 290 patients, 174 developed aGVHD within 100 days of allo-HCT. A higher proportion of patients with aGVHD had a Karnofsky performance status &amp;lt;80%, underwent matched unrelated donor HCT, and received calcineurin based GVHD prophylaxis. The mean number of days in the hospital for patients with aGVHD compared to those without aGVHD was 28 vs. 22 days, P&amp;lt;0.001 (Figure 1A). The mean number of hospital days for patients with grade I-II compared to those without aGVHD was 25 days vs. 22 days (P= 0.04) and for grade III-IV the mean number of days in the hospital compared to those without aGVHD was 48 days vs. 22 days (p &amp;lt; 0.001). In addition, presence of Lower gastrointestinal (GI) aGVHD was associated with more mean number of days in the hospital compared with those without aGVHD (43 vs. 22 days, P&amp;lt; 0.001). The ICU admission rates in patients with and without aGVHD were 13.2% and 6%, respectively (P=0.07) (Figure 1B). Analysis of ICU admissions based on grade of aGVHD revealed a significantly higher rate of ICU admission among patients with higher grade (grade III-IV) acute GVHD compared to those without aGVHD (22.3% vs. 6.0%, P=0.002). The early mortality rate in the first 100 days in aGVHD patients was twice that of the no aGVHD patients (14.9% vs. 7.8%; P=0.09). Compared to patients without aGVHD, early mortality was significantly higher in patients with aGVHD grade III-IV (7.8% vs. 33.9%; P&amp;lt; 0.001) and lower GI aGVHD (7.8% vs. 25.7%; P=0.001). Development of aGVHD was associated with a significantly higher total (inpatient and outpatient) cost. The mean total cost for patients with and without aGVHD were $226,545 and $165,622, respectively (P&amp;lt;0.001). Mean total costs associated with grades I, II and III-IV aGVHD were $183,693 (p = 0.44), $201,737 (p = 0.04) and $286,551 (&amp;lt;0.001), respectively (compared to $165,622 for those without aGVHD). Acute GVHD with GI involvement was significantly associated with higher mean total cost compared with aGVHD without GI involvement ($255,283 vs. $177,151, P&amp;lt;0.001). Among aGVHD cohort with GI involvement (Lower and/or upper GI), the mean cost was higher in patients with lower GI (LGI) compared with those without LGI aGVHD ($280,290 vs. $203,879, P=0.04). A multivariable analysis of risk factors for HCT cost identified presence of aGVHD, younger age at HCT, higher comorbidity index, and donor other than matched related donor as being associated with significantly higher costs (Table 1). Conclusion: HRU, cost, and clinical outcomes were associated with the severity of aGVHD. Development of higher grades of aGVHD and LGI aGVHD were associated with a poor clinical outcome and considerably increased healthcare economic burden. Given these clinical and economic risks it is imperative that new therapeutic strategies are developed for this patient population. Disclosures Farhadfar: Incyte pharmaceutical: Other: Member of GVHD advisory forum; CSL Behring: Research Funding. Leather:CSL Behring: Research Funding. Itzler:CSL Behring: Current Employment, Current equity holder in private company. Wingard:CSL Behring: Research Funding.

Economic Burden of Osteoporosis-Related Fractures in the US Medicare Population.

BackgroundOsteoporosis-related fractures are an important public health burden.ObjectiveTo examine health care costs in Medicare patients with an osteoporosis-related fracture.MethodsMedicare fee-for-service members with an osteoporosis-related fracture between January 1, 2010, to September 30, 2014 were included. A nonfracture comparator group was selected by propensity score matching. Generalized linear models using a gamma distribution were used to compare costs between fracture and nonfracture cohorts.ResultsA total of 885 676 Medicare beneficiaries had fracture(s) and met inclusion criteria. Average age was 80.5 (±8.4) years; 91% were White, and 94% female. Mean all-cause costs were greater in the fracture vs nonfracture cohort ($47 163.25 vs $16 034.61) overall and for men ($52 273.79 vs $17 352.68). The highest mean costs were for skilled nursing facility ($29 216), inpatient costs ($24 190.19), and hospice care ($20 996.83). The highest incremental costs versus the nonfracture cohort were for hip ($71 057.83 vs $16 807.74), spine ($37 543.87 vs $16 860.49), and radius/ulna ($24 505.27 vs $14 673.86). Total medical and pharmacy costs for patients who experienced a second fracture were higher compared with those who did not ($78 137.59 vs $44 467.47). Proportionally more patients in the fracture versus nonfracture cohort died (18% vs 9.3%), with higher death rates among men (20% vs 11%).Conclusion and RelevanceThe current findings suggest a significant economic burden associated with fractures. Early identification and treatment of patients at high risk for fractures is of paramount importance for secondary prevention and reduced mortality.

Treatment patterns, health resource consumption, and costs of patients with migraine in an Italian real-world setting

Objective This study aimed to describe the demographic and clinical characteristics of migraineurs prescribed ≥1 migraine prophylactic therapy, and to analyze their therapeutic pathways, healthcare resource consumption, and related costs. Methods This retrospective analysis was based on administrative databases from two regions and three local health units in Italy. Adult patients with ≥1 discharge diagnosis for migraine or ≥1 prescription for migraine-specific drugs, or ≥1 emergency room visit for migraine from 1 January 2010 to 31 December 2016 were included if they had received ≥1 migraine prophylactic therapy between 1 January 2011 and 31 December 2015 (enrollment period). The first date of the last migraine prophylactic treatment was considered as the index date (ID). Patients were characterized 1-year prior ID and followed-up for 1 year afterwards. Results Of the 166,362 identified migraineurs, 32,794 (mean age: 45.9 ± 13.9 years, 19.2% male) who received migraine prophylaxis were included in the analysis. At ID, 31,629 patients had received 1 prophylactic treatment with antidepressants (51.2%), neuromodulators (28.1%), beta blockers (12.4%), other migraine preparations (7.8%), and botulinum toxin A (0.5%). Focusing on patients with one prophylactic treatment at ID, 85.4% did not have any previous therapeutic failures whereas 14.6% had ≥1 previous failure. During follow-up, 5% of patients made a therapeutic switch after a mean period of 103.4 ± 97.9 days. Total mean annual cost for patients receiving migraine prophylaxis was 1193.64€ during characterization and 1303.86€ during follow-up periods. Conclusion This real-world study gave insights on the characterization of migraineurs and patterns of prophylaxis utilization in Italian clinical settings, showing an underuse of prophylactic agents.

Postoperative complications and hospital costs following small bowel resection surgery.

Postoperative complications after major gastrointestinal surgery are a major contributor to hospital costs. Thus, reducing postoperative complications is a key target for cost-containment strategies. We aimed to evaluate the relationship between postoperative complications and hospital costs following small bowel resection. Postoperative complications were recorded for 284 adult patients undergoing major small bowel resection surgery between January 2013 and June 2018. Complications were defined and graded according to the Clavien-Dindo classification system. In-hospital cost of index admission was calculated using an activity-based costing methodology; it was reported in US dollars at 2019 rates. Regression modeling was used to investigate the relationships among a priori selected perioperative variables, complications, and costs. The overall complication prevalence was 81.6% (95% CI: 85.7-77.5). Most complications (69%) were minor, but 22.9% of patients developed a severe complication (Clavien-Dindo grades III or IV). The unadjusted median total hospital cost for patients with any complication was 70% higher than patients without complications (median [IQR] USD 19,659.64 [13,545.81-35,407.14] vs. 11,551.88 [8,849.46-15,329.87], P < 0.001). The development of 1, 2, 3, and ≥ 4 complications increased hospital costs by 11%, 41%, 50%, and 195%, respectively. Similarly, more severe complications incurred higher hospital costs (P < 0.001). After adjustments were made (for the Charlson Comorbidity Index, anemia, surgical urgency and technique, intraoperative fluid administration, blood transfusion, and hospital readmissions), a greater number and increased severity of complications were associated with a higher adjusted median hospital cost. Patients who experienced complications had an adjusted additional median cost of USD 4,187.10 (95% CI: 1,264.89-7,109.31, P = 0.005) compared to those without complications. Postoperative complications are a key target for cost-containment strategies. Our findings demonstrate a high prevalence of postoperative complications following small bowel resection surgery and quantify their associated increase in hospital costs. Australian Clinical Trials Registration number: 12620000322932.

Cost-Sharing Effects on Hospital Service Utilization Among Older People in Fukuoka Prefecture, Japan

Background: The cost-sharing impact on hospital service utilization of different services is a critical issue that has not been well addressed worldwide. This study aimed to investigate the cost-sharing effects based on income status on hospital service utilization of different services among elderly people in Japan and provide a comprehensive examination and discussion for the reasonability of a cost-sharing system. Methods: The data were extracted from the Latter-Stage Elderly Healthcare Insurance database in the fiscal year 2016. A total of 610 182 insured people aged ≥75 years old, with 155 773 hospitalization patients, were identified. Hospitalization rate, length of stay (LOS), and total hospitalization cost were used to test the statistical significance among patients categorized by income levels. Generalized linear models for total hospitalization cost were constructed based on bed types to further assess different hospital service utilization. Results: For medical chronic care and psychiatric beds, which both required long-term care treatment, much higher hospitalization rates were observed in the patients with low- and middle-income levels than patients with high-income level. The LOS and total hospitalization cost of the patients with low- and middle-income levels were significantly higher than the patients with high-income level treated in medical chronic care and psychiatric beds. For psychiatric beds, the total hospitalization cost for patients with low-income level was significantly higher than that for patients with highincome level.Conclusion: The cost-sharing policy in Japan, especially the cap for out-of-pocket needs further determination. The importance of community-based care services needs to be emphasized, and the collaboration between hospitals and community-based care facilities should be enhanced.

Effects of Prophylactic Antibiotics on Length of Stay and Total Costs for Pediatric Acute Pancreatitis: A Nationwide Database Study in Japan.

Acute pancreatitis (AP) guidelines for adult patients do not recommend routine prophylactic use of antibiotics because of no clinical merit on mortality, infectious complications, or length of stay. Although the mortality of pediatric AP is low, no studies have explored the rationale for antibiotic use in pediatric patients. The aim of this study was to evaluate the effects of early prophylactic antibiotics on length of stay and total costs in pediatric patients. Using the Japanese Diagnosis Procedure Combination database from 2010 to 2017, we used the stabilized inverse probability of treatment weighting method using propensity scores to balance the background characteristics in the antibiotics group and the control group, and compared length of stay and total costs between the groups. We found significant differences between the antibiotics group (n = 652) and the control group (n = 467) in length of stay (11 days vs 9 days; percent difference, 15.4%; 95% confidence interval, 5.0%-26.8%) and total costs (US $4085 vs US $3648; percent difference, 19.8%; 95% confidence interval, 8.0%-32.9%). Prophylactic antibiotics were associated with longer length of stay and higher total costs. Our results do not support routine use of prophylactic antibiotics in pediatric AP populations.

Pre-operative Hypoalbuminemia Is Associated with Complications Following Proximal Humerus Fracture Surgery: An Analysis of 919 Patients.

Proximal humerus fractures are among the most common presenting fractures to orthopedic surgeons in the USA. Hypoalbuminemia is accepted as a nutrition marker associated with post-operative complications following common orthopedic interventions. Thus, the authors sought to (1) describe the national demographic trends of patients undergoing surgical fixation for proximal humerus fracture and (2) investigate the association between pre-operative hypoalbuminemia, a malnutrition marker, and post-operative complications within 1year of surgical intervention. The PearlDiver Humana Claims Database was queried to identify a nationally representative cohort of patients who underwent surgical intervention for proximal humerus fractures from 2008 to 2015. Demographic and comorbid characteristics were collected. Pearson's χ-squared analysis was used to compare rates of 90-day and 1-year outcomes between hypoalbuminemia (albumin ≤ 3.5mg/dL) and control groups. Multivariate logistic regression was then used to determine the isolated effect that hypoalbuminemia had on post-operative outcomes. Of the 3337 patients identified, 919 (27.5%) had available serum albumin data. Seventy (7.6%) patients had hypoalbuminemia. Hypoalbuminemia was more likely to be associated with post-operative sepsis (7.1% vs. 1.5%, respectively) and pneumonia (15.7% vs. 4.6) compared with controls. Additionally, hypoalbuminemia was associated with increased 90-day rates of discharge to extended care (4.3% vs. 0.8), emergency room visits (38.6% vs. 21.7), and total cost ($24,051.96 ± 24,972.74 vs. $15,429.74 ± 24,492.30). Our study suggests hypoalbuminemia is associated with an increased risk of complications, specifically pneumonia and sepsis, and total health care costs in patients undergoing surgery for proximal humerus fractures. These findings provide insight for individualized patient care that will aid in evaluating the potential risk of surgical complications in an effort to improve outcomes and reduce costs.

COST ANALYSIS OF INTRA-AORTIC BALLOON PUMP SUPORT DEVICE IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK

SESSION TITLE: Cardiovascular Disease SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Intra-aortic balloon pumps (IABP) are the most commonly used mechanical support devices in patients with cardiogenic shock after a ST segment elevation myocardial infarction (STEMI) worldwide (1). Recently, the usage of IABP has been scrutinized after the IABP-SHOCK II trial in 2012 failed to demonstrate improvement in short or long term all-cause-mortality in patients treated with IABP versus medical therapy with STEMI and cardiogenic shock (CS). The European Society of Cardiology’s STEMI guidelines update in 2017 recommended against routine use of IABP in patients with STEMI and CS (3). Furthermore, ACCF/AHA STEMI guidelines have downgraded their level of recommendation from a Level I to a Level IIB recommendation. As cardiogenic shock contributes significantly to the economic health care burden with greater than a $2.7 billion in annual hospitalization cost, we conducted a cost analysis of IABPs versus medical therapy (vasopressors and inotropes) in this subpopulation. METHODS: A retrospective analysis was performed through chart review from January 2016 to September 2019. Using Premier Healthcare database, patient encounters with ICD 10 codes for cardiogenic shock, acute myocardial infarction and the procedural code for mechanical support device were selected. Each chart was individually reviewed and the presence of cardiogenic shock (defined as systolic blood pressure <90 and diastolic blood pressure <60) was confirmed in addition to STEMI and presence or absence of an IABP. The primary outcome measured was total hospital cost. RESULTS: The initial ICD 10 search yielded a total of 802 cases; after eliminating those that did not meet criteria, 91 in the IABP group and 50 in the medical therapy group remained. The average total cost of hospital stay per patient was higher in the IABP group than the medical therapy group; $52,271.44 vs $37,907 (p-value=.023). The observed/expected (O/E) cost was also higher in the IABP group with an O/E ratio of 1.54 vs 1.31. The medical therapy group appeared to have a greater severity of illness with an expected mortality of 48% versus 44% in the IABP group. The observed mortality was hence higher in the medical therapy group (48% versus 44% IABP). The two subgroups however had comparable O/E mortality ratios (2.38 medical therapy vs 2.31 IABP) suggesting similar outcomes when adjusting for severity of patient disease. CONCLUSIONS: Our data demonstrated an additional $14,364.44 in total hospital cost in patients treated with IABP versus medical therapy. The observed/expected mortalities were comparable in the two groups, consistent with prior studies suggesting no survival benefit with IABP utilization. CLINICAL IMPLICATIONS: Our study suggests that IABP may not be cost effective in comparison to medical therapy in patients with STEMI complicated by cardiogenic shock . DISCLOSURES: No relevant relationships by Lisa Ezegbu, source=Web Response No relevant relationships by Rhea Farquhar, source=Web Response no disclosure on file for Mitul Kanzaria; Speaker/Speaker's Bureau relationship with Abbvie Please note: $1001 - $5000 Added 06/14/2020 by Frances Loftus, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with GSK Please note: $1-$1000 Added 06/14/2020 by Frances Loftus, source=Web Response, value=Honoraria No relevant relationships by Natalie Millet, source=Web Response No relevant relationships by URMIL PATEL, source=Web Response no disclosure on file for Giselle Raitz

Reimbursement policy in a healthcare system with priorities: fee for priority versus bundled priority

Abstract This paper studies a healthcare system under two priority charging schemes. The first is a fee-for-priority (FFP) scheme under which the patients can choose to buy the priorities or not at their admission or readmission to the healthcare provider (HCP). The second is a bundled priority (BP) scheme under which the HCP receives a lump sum priority payment from patients for the entire episode of priority visits (regardless of the number of readmissions). Under both schemes, a certain proportion of revenue of the HCP (the reimbursement) is used to improve the service quality for patients. A two-stage Stackelberg game is established that captures the non-cooperative interactions between the HCP and patients, where the HCP is the leader who sets a price of priority and patients are the followers who decide whether to buy the priorities or not. We first characterize the Pareto-dominant equilibrium strategy of patients under the FFP and BP schemes, and we find that the total cost (including delay disutility and priority fee) of patients can be reduced if the patient pool is large. Although patients' minimum cost, including waiting cost and priority payment, is obtained under both the FFP and BP schemes, the prices are more flexible under the former than the latter. Finally, we demonstrate that implementing the FFP scheme can induce higher social welfare than the BP scheme.

Retrospective analysis of 2 997 inpatients with skin and soft tissue injuries

Retrospective analysis of 2 997 inpatients with skin and soft tissue injuries

Lifetime Cost of Hearing Aids in Germany

Hearing aids are the standard treatment of hearing loss, which is covered by the statutory health insurance (SHI) in Germany. In chronic cases, hearing aid therapy causes periodic costs until the patient's death. This analysis examines the average lifetime cost of adult patients with regard to the age at initial treatment and presents them both from the perspective of the SHI and the insured. In the base case, we consider the supply of hearing aids free of charge. A treatment pathway is developed and used to identify the cost components incurred over the lifetime. Subsequently, the present value lifetime cost of monaural and binaural hearing aid supply are calculated. The binaural (monaural) hearing aid supply for an adult (first hearing aids received between 18 and 88 years) causes average present value lifetime cost of € 4518 (€ 2536) from the perspective of the statutory health insurance. The patient bears an average of € 4610 (€ 3672) total cost. There are specific lifetime costs for each individual age of initial treatment. Generally, lifetime cost decreases with the patient's increasing age at initial treatment. Patients finance a substantial part of the hearing aid treatment. If the patient decides for high-end hearing aids instead of hearing aids free of charge, the total patient cost increases to an average of € 7953 for binaural supply. Due to continuous technical progress and development of hearing systems, rising expenses for hearing aid supply can be assumed.

Obesity Trends Amongst Hospitalized Patients with Spinal Cord Stimulator Implants.

Chronic pain remains an important public health problem as it continues to increase healthcare-related cost. Comorbidities like obesity have been associated with efficacy of spinal cord stimulator (SCS) therapy and worse outcomes. The goal of this study is to investigate the trends of obesity amongst hospitalized patients with SCS therapy as well as healthcare utilization outcomes. Using the International Classification of Diseases (ICD) ninth and tenth procedure and diagnosis code, we investigated the National Inpatient Sample (NIS) for patients with SCS implants between 2011 and 2015. Patients received a diagnosis of obesity based on the following categories: classI, II and III obesity. Age, gender, and comorbid conditions of patients with obesity were matched 1:1 on propensity score to those without obesity diagnosis. Our primary outcome was defined as trend of obesity diagnosis. Our secondary outcome, healthcare utilization, included in-hospital cost, length of stay, and discharge location. Between 2011 and 2015, a total of 3893 patients with SCS implants were identified (average age 56 ± 15years, 58% female, 0.70 ± 1.1 Charlson Comorbidity Index, CCI). Of this cohort, 640 patients were identified as obese. The proportion of patients with obesity diagnosis increased significantly from 13.75% in 2011 to 19.36% in 2015 (p < 0.001). After 1:1 matching on propensity score, 597 patients with obesity were successfully matched to 597 patients without obesity. The total hospital cost for SCS patients with obesity (median $104,845, IQR $74,648-144,292) was not significantly different from patients without obesity diagnosis (median $111,092, IQR $68,990-145,459) (p = 0.161). The data from our study suggests that there is an increasing rate of obesity diagnosis amongst patients with SCS therapy. However, there was no difference in healthcare utilization between patients with and without obesity. Additional studies may provide more insight into our findings.

P74. Adult spinal deformity patients with metabolic syndrome have significantly higher costs

BACKGROUND CONTEXT Adult spinal deformity (ASD) correction involves complex, invasive procedures. However, it is unknown how metabolic syndrome affects the cost efficiency of ASD surgery. PURPOSE Investigate the differences in ASD surgery cost for metabolic syndrome patients. STUDY DESIGN/SETTING Retrospective review of a single center ASD database. PATIENT SAMPLE A total of 557 ASD patients. OUTCOME MEASURES Complications, revisions and costs. METHODS ASD patients (scoliosis ≥20°, SVA≥5cm, PT ≥25°, or TK ≥60°) ≥18, undergoing ≥4 level fusions were included. Descriptive analysis assessed mean baseline demographic, radiographic and surgical data were assessed. Patients diagnosed with: BMI >30, diabetes mellitus, and HTN were classified metabolic syndrome patients (MetS). Independent samples T-tests assessed baseline differences in SVA, PT, PI-LL, and levels fused between MetS and non-MetS patients. Total surgery costs for MetS and non-MetS ASD patients were compared. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims. Complications and comorbidities (CC) and major complications and comorbidities (MCC) were assessed according to CMS.gov manual definitions. RESULTS A total of 557 patients met inclusion criteria. Baseline demographics and surgical details: age 60.8 ± 13.2, 67.5% female, BMI 28.3 ± 6.67, 6.2% anterior approach, 81.0% posterior approach, 12.8% combined approach, 10.4 ± 3.9 levels fused, op time 423.5 ± 166.4 minutes, EBL 2061.4 ± 1631.5 cc, LOS 7.6 ± 5.4 days. 11 MetS patients were included. There was no significant difference in BL SVA (54.2° vs 70.3°), PT (26.7° vs 23.7°), PI-LL (16.4° vs 21.2°), or levels fused between groups (10.5 vs 10.6) (all p>0.05). Twenty-seven percent of MetS patients experienced a CC or MCC, with 18% undergoing revisions within 90 days (vs 13.2% and 3.2% for non-MetS, p CONCLUSIONS Metabolic syndrome is a growing concern among health care providers. In metabolic syndrome patients undergoing corrective adult spinal deformity surgery, the total costs of surgery was 28.4% higher for metabolic syndrome patients ($68,004.06 vs $48,726.40). Optimizing modifiable factors like diabetes or BMI in preoperative patients may have an impact on cost effectiveness. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

EARLY INTENSIVE MEDICAL THERAPY FOR TYPE 1 DIABETIC PATIENTS ASSOCIATED WITH REDUCED LONG-TERM COSTS AND IMPROVED SURVIVAL

Background: Intensive medical therapy (IMT) for type 1 diabetic (T1DM) patients has been associated with cardio and renal-protective outcomes, when compared to standard medical therapy (SMT). However, the costly nature of IMT has reduced its widespread adoption amongst medical providers in the United States. It remains unclear whether/for which patients IMT may offer a cost-effective therapeutic option. Methods: A decision analytic Markov state transition model was created to simulate the life of T1DM patients with chronic kidney disease (CKD). Two patient groups were created (1,000 patients each) whereby patients underwent either IMT or SMT. State transitions to end-stage renal disease requiring dialysis, transplantation, and death were modeled, as well as associated costs. Base case patients were defined as being 35 years old with an initial GFR of 60ml/min. Markov parameters were extracted from literature review (1-4). Results: Survival-Sensitivity analysis demonstrated that IMT improved survival for all patients, regardless of GFR; base case patients who underwent IMT gained 2.9 additional years of life compared to those who underwent SMT. Cost-Sensitivity analysis demonstrated that IMT was cost-effective for initial GFR > 56.5ml/min. Conclusion: IMT improves survival and is associated with lower total life-time medical costs for patients with mild CKD (stage 1 and stage 2). Early implementation of IMT is strongly encouraged to not only lower medical complications of T1DM, but also to lower total healthcare costs.