Total Health Care Costs Research Articles

Reduced healthcare costs for patients with screen-detected colorectal cancer: A Danish nationwide cohort study.

This Danish nationwide retrospective register-based cohort study investigated healthcare costs for patients with screen-detected colorectal cancer (SD-CRC) compared to non-screen-detected CRC (NSD-CRC). Nationwide cohort study. Quarterly healthcare costs including costs of hospital care, out-of-hospital medication, and primary sector contacts were compared between the two groups from two years before diagnosis of CRC until two years after. A quasi-experimental difference-in-differences analysis was performed to estimate the differences per patient in total quarterly healthcare costs between the groups. A total of 13,852 patients were included, 4703 with SD-CRC, 7420 with NSD-CRC, and 1,729 with interval- or post-colonoscopy CRC (I-PC-CRC). The total quarterly healthcare costs per patient were significantly higher in the NSD-CRC group than in SD-CRC. This was consistent across the total period and in 6-month analyses, accruing additional €16,600 of costs for patients with NSD-CRC over two years after diagnosis. Total healthcare costs were significantly higher for patients with NSD-CRC as compared to patients with SD-CRC across all Union for International Cancer Control (UICC) stages, except for UICC stage I. Correspondingly, total costs associated with I-PC-CRC were significantly higher than for SD-CRC. Apart from improving post-treatment outcomes, higher participation rates in the CRC screening programmes present an opportunity for reducing healthcare costs related to patients diagnosed with CRC.

The Economic Burden of Management of Pituitary Adenomas: A Propensity-Score-Matched Cost Analysis.

Pituitary adenomas (PAs) present a notable economic burden on healthcare systems due to their management's reliance on multimodal, often costly interventions. To determine total and relative healthcare costs for PAs at Ontario-based institutions. A retrospective, propensity-score-matched cohort analysis. Ontario, Canada, encompassing public healthcare facilities and covering costs over a 6-year study period. Adults diagnosed with PA (n = 1675) between April 1, 2013, and March 31, 2019, compared to a general population cohort and a hospitalized control cohort matched on demographics and health factors. Analysis of healthcare cost components (inpatient, outpatient, and diagnostic services) and cost trajectories postsurgery for PAs. Primary outcome was total annualized healthcare costs for patients with PA relative to the general and hospitalized cohorts. Relative costs were estimated using a negative binomial regression model. Of 1675 patients with PA, total annualized costs were $49,992. Highest total costs were associated with inpatient hospitalization ($24,796) and physician services/diagnostic evaluations ($20,075). After propensity score matching, patients with PA had 12.7 times higher costs [95% confidence interval (CI) (10.9, 14.8), P < .0001] during the preadmission/admission period, which remained elevated postoperatively (P < .05). Total costs did not differ between patients with PA and the hospitalized cohort [RR 0.97, 95% CI (0.92, 1.03); P = .3271] in the preadmission/admission period; however, follow-up costs were 37% lower for patients with PA in the 1st follow-up year [RR 0.63, 95% CI (0.51, 0.77); P < .0001], and up to 50% lower by the 5th year [RR 0.50, 95% CI (0.36, 0.68); P < .0001]. This study provided a comprehensive assessment of the economic burden of PAs on the publicly-funded healthcare system. Patients with PA had higher annualized total costs across all observed time periods compared to the general population and lower annualized total costs compared to patients admitted to a surgical ward. This study highlights the financial impact of PA management on healthcare resources and provides a basis for future research aimed at cost-efficiency improvements in long-term PA care.

Prophylaxis of HBV reinfection and disease in liver transplanted patients: 2024 update on the role of HBIG and cost-effectiveness evaluation.

Hepatitis B virus (HBV) infection is a major global health concern, with liver transplantation (LT) serving as a critical treatment for end-stage liver disease caused by HBV. However, the risk of HBV reinfection after LT remains significant, necessitating effective prophylaxis. Today, the combination of hepatitis B immune globulin (HBIG) and high-barrier nucleos(t)ide analogues (NUCs) is the standard of care for preventing HBV recurrence post-LT but concerns about the cost of HBIG and access to high-barrier NUCs have led to a reduction in the use, dose, and duration of HBIG in recent years. This review provides an updated analysis of the role of HBIG in preventing HBV recurrence post-LT, alongside a detailed evaluation of its cost-effectiveness, leveraging recent pharmacoeconomic data from Italy. The cost analysis showed that HBIG contributes approximately 12.4% (€ 49,000) to the total lifetime cost of LT-related healthcare (€395,986). Short-term HBIG prophylaxis reduced costs by 11.1%, while lifetime usage increased total costs by only 6.6%. However, the primary cost drivers were renal failure and immunosuppressive therapy. In conclusion, despite advancements in NUCs therapy, HBIG remains a cornerstone of HBV prophylaxis post-LT, particularly in high-risk patients, and discontinuation of HBIG in favor of alternative prophylaxis strategies lacks robust supporting evidence. Tailoring prophylaxis to individual patient needs and risk factors allows for personalized treatment while maintaining efficacy.

Ovarian cancer prevention through opportunistic salpingectomy during abdominal surgeries: A cost-effectiveness modeling study.

There is indication that the fallopian tubes might be involved in ovarian cancer pathogenesis and their removal reduces cancer risk. Hence, bilateral salpingectomy during hysterectomy or sterilization, so called opportunistic salpingectomy (OS), is gaining wide acceptance as a preventive strategy. Recently, it was discussed whether implementation of OS at other gynecologic surgery, e.g., cesarean section, endometriosis excision or myomectomy and even at non-gynecologic abdominal surgery such as cholecystectomy or appendectomy for women with completed family could be feasible. This modeling analysis evaluated the clinical and economic potential of OS at gynecologic and abdominal surgeries. A state transition model representing all relevant health states (healthy, healthy with hysterectomy or tubal ligation, healthy with other gynecologic or non-gynecologic abdominal surgery, healthy with hysterectomy and salpingectomy, healthy with salpingectomy, healthy with hysterectomy and salpingo-oophorectomy, ovarian cancer and death) was developed and informed with transition probabilities based on inpatient case numbers in Germany (2019). Outcomes for women aged 20-85 years were simulated over annual cycles with 1,200,000 million individuals. We compared four strategies: (I) OS at any suitable abdominal surgery, (II) OS only at any suitable gynecologic surgery, (III) OS only at hysterectomy or sterilization, and (IV) no implementation of OS. Primary outcome measures were prevented ovarian cancer cases and deaths as well as the incremental cost-effectiveness ratio (ICER). Volume of eligible interventions in strategy I was 3.5 times greater than in strategy III (286,736 versus 82,319). With strategy IV as reference, ovarian cancer cases were reduced by 15.34% in strategy I, 9.78% in II, and 5.48% in III. Setting costs for OS to €216.19 (calculated from average OS duration and operating room minute costs), implementation of OS would lead to healthcare cost savings as indicated by an ICER of €-8,685.50 per quality-adjusted life year (QALY) gained for strategy I, €-8,270.55/QALY for II, and €-4,511.86/QALY for III. Sensitivity analyses demonstrated stable results over a wide range of input parameters with strategy I being the superior approach in the majority of simulations. However, the extent of cancer risk reduction after OS appeared as the critical factor for effectiveness. Preventable ovarian cancer cases dropped to 4.07% (I versus IV), 1.90% (II versus IV), and 0.37% (III versus IV) if risk reduction would be <27% (hazard ratio [HR] > 0.73). ICER of strategies I and II was lower than the 2× gross domestic product per capita (GDP/C) (€94,366/QALY, Germany 2022) within the range of all tested parameters, but strategy III exceeded this threshold in case-risk reduction was <35% (HR > 0.65). The study is limited to data from the inpatient sector and direct medical costs. Based on our model, interdisciplinary implementation of OS in any suitable abdominal surgeries could contribute to prevention of ovarian cancer and reduction of healthcare costs. The broader implementation approach demonstrated substantially better clinical and economic effectiveness and higher robustness with parameter variation. Based on a lifetime cost saving of €20.89 per capita if OS was performed at any suitable abdominal surgery, the estimated total healthcare cost savings in Germany could be more than €10 million annually.

P-1010. Clinical and Economic Burden of Changing Initial Antifungal Regimens in Invasive Aspergillosis: A Hospital Perspective

Abstract Background Initial antifungal (AF) regimens (AFR) for Invasive Aspergillosis (IA) are often changed due to treatment failure, intolerability, or drug-drug interactions. We compared outcomes among IA patients who did and did not change their initial IA AFR.Table 1.Adjusted Baseline Characteristics of Patients Who Changed or Did Not Change Their IA Antifungal Regimen*CCI=Charlson comorbidity index; COPD=chronic obstructive pulmonary disease; IA= invasive Aspergillosis; SD=standard deviation*The following covariates were used to calculate propensity scores for Inverse probability of treatment weighting: age group, geographic region, payer type, year of index, asthma, autoimmune conditions, bacteremia, COPD, pneumonia, immunodeficiencies, myelodysplastic syndrome, transplant history, immunosuppressants, cancer, neutropenia, and total healthcare costs.||All covariates were well balanced as indicated by an SMD &amp;lt;0.1 except corticosteroids which was marginally imbalanced with an SMD of 0.108†Solid organ or hematopoietic cell transplant#Partial years data available in IQVIA New Data Warehouse⁋Azathioprine, cyclophosphamide, cyclosporine, methotrexate, mycophenolate, tacrolimus, voclosporin Methods This retrospective cohort study identified US adults with an index hospitalization for IA (ICD-10: B44.0, B44.1, B44.7) between Oct 2015 and Nov 2022 in IQVIA’s New Data Warehouse (pharmacy, outpatient and hospital claims). Patients were placed into two cohorts based on whether they changed AFRs, defined as starting a new AFR with or without discontinuing initial therapy at any subsequent point. Inverse probability of treatment weighting minimized confounding due to baseline differences between patients who changed vs. did not change their AFR. Inpatient length of stay (LOS), all-cause costs (in 2023 US$) and all-cause mortality in IA patients who did and did not change their initial AFR were reported as medians with interquartile ranges (IQR) or frequencies and compared.Table 2.Adjusted* Outcomes of Patients Who Changed or Did Not Change Their IA Antifungal RegimenLOS=length of stay; IA= invasive Aspergillosis; ICU=intensive care unit; IQR=interquartile range; SD=standard deviation*Inverse probability of treatment weighted Results Among 1,192 IA patients, 707 (59.3%) changed their initial AFR (Table 1). Most patients started therapy on an -azole (87% among those who changed vs 95% in those who did not change regimens). Duration of initial AFR for those who did and did not change their regimen was a median of 5 days (IQR=7) vs. 11 days (IQR=24), respectively. Hospital and ICU LOS were longer in the AFR change than the no change cohort (Table 2). Median costs associated with the index hospitalization, including pharmacy costs, were also significantly higher for those who changed AFR compared with those who did not. No statistical difference was seen in inpatient mortality during the index hospitalization between cohorts. Conclusion In this large contemporary cohort of patients with IA, most patients changed AFRs, with many doing so within 1-2 weeks of treatment initiation. Changing regimens was associated with significantly longer hospital and ICU LOS as well as higher inpatient costs. Further study is needed to understand reasons for changing AFRs and to understand changes that might be avoided. New and improved AFs that reduce the need for regimen changes offer the opportunity to reduce the economic and clinical burden associated with changing AFRs. Disclosures Barbara D. Alexander, MD, Basilea: Advisor/Consultant|F2G: Advisor/Consultant|F2G: Grant/Research Support|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Scynexis: Grant/Research Support|TFF Pharmaceuticals: Advisor/Consultant Mark Bresnik, MD, F2G Ltd: Employee Ruthwik Anupindi, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Lia Pizzicato, MPH, F2G Ltd: Grant/Research Support|IQVIA: Employee Mitchell DeKoven, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Belinda Lovelace, PharmD, MS, MJ, F2G, Inc.: Employee Craig I. Coleman, PharmD, F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties

P-1011. Real-World Antifungal Therapy Patterns in US Patients with Invasive Aspergillosis: It’s Complicated

Abstract Background The complexity of antifungal therapy (AFT) in Invasive Aspergillosis (IA) can complicate care. We sought to better understand AFT changes that occur in IA across both in- and outpatient settings of care.Table 1.Baseline Characteristics of Patients Who Changed or Did Not Change Their Invasive Aspergillosis Antifungal Therapy* CCI=Charlson comorbidity index; COPD=chronic obstructive pulmonary disease; IA= invasive Aspergillosis †Partial years data were available in IQVIA New Data Warehouse #Solid organ or hematopoietic cell transplant ¶Azathioprine, cyclophosphamide, cyclosporine, methotrexate, mycophenolate, tacrolimus, voclosporin *The following covariates were used to calculate propensity scores for Inverse probability of treatment weighting: age group, geographic region, payer type, year of index, asthma, autoimmune conditions, bacteremia, COPD, pneumonia, immunodeficiencies, myelodysplastic syndrome, transplant history, immunosuppressants, cancer, neutropenia, and total healthcare costs. ∥All covariates were well balanced as indicated by an SMD &amp;lt;0.1 except corticosteroids which was marginally imbalanced with an SMD of 0.108 Methods This retrospective study was performed using the IQVIA New Data Warehouse (hospital, outpatient, and prescription claims) from Oct 2015-Nov 2022. The index inpatient stay was identified by IA ICD-10 codes. Patients were followed from index hospitalization until end of the study period (Dec 31, 2022), lack of medical or pharmacy activity in the database, or death (whichever occurred first). Patients were stratified by whether they ‘changed’ (defined as discontinuation with restart of a non-first line (L) AFT, switch or modification) or ‘did not change’ their AFT during the post-index period. Inverse probability of treatment weighting was used to minimize confounding due to baseline differences between the change and no change cohorts. Data were reported as frequencies or median with interquartile range.Figure 1.Sankey Diagram of IA Patients Who Required Changes in Antifungal Therapy Results Among 1,192 IA adults, 707 (59.3%) experienced changes to their AFT (60% modified existing AFT, 22.1% stopped 1L AFT and initiated AFT for 2L, and 18% directly switched to a different AFT) (Table 1). Among those who changed AFT, mold active azole use predominated, with voriconazole the most used across all AFT lines (37.3-49.3%), followed by isavuconazole (19.3-26.7%) (Figure 1). Echinocandin use varied between 25.3%-33.6% over 1-4L and amphotericin B use steadily increased over the lines of therapy (13.4-20.7%). Among the 485 (40.6%) patients that completed AFT with no changes, most received azole (62.8% voriconazole, 15.2% isavuconazole) monotherapy. Patients who changed AFT had shorter time on treatment for 1-3L (5-8 days) than those who did not change (11-21 days) (p&amp;lt; 0.047). Conclusion Based on this snapshot of IA treatment patterns, managing AFT for patients with IA is complicated. Most patients require changes to their AFT. Future studies should examine challenges associated with IA treatment and which factors contribute to AFT changes, such as drug toxicities or interactions and refractory infection. Novel oral antifungals that reduce the need for AFT changes when IA patients have limited options are needed. Disclosures Barbara D. Alexander, MD, Basilea: Advisor/Consultant|F2G: Advisor/Consultant|F2G: Grant/Research Support|HealthTrackRx: Advisor/Consultant|HealthTrackRx: Board Member|Scynexis: Grant/Research Support|TFF Pharmaceuticals: Advisor/Consultant Melissa D. Johnson, PharmD MHS AAHIVP, Biomeme: Licensed Technology|Scynexis, Inc: Grant/Research Support|UpToDate: Author Royalties Mark Bresnik, MD, F2G Ltd: Employee Ruthwik Anupindi, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Lia Pizzicato, MPH, F2G Ltd: Grant/Research Support|IQVIA: Employee Mitchell DeKoven, PhD, F2G Ltd: Grant/Research Support|IQVIA: Employee Belinda Lovelace, PharmD, MS, MJ, F2G, Inc.: Employee Craig I. Coleman, PharmD, F2G Ltd: Advisor/Consultant|F2G Ltd: Grant/Research Support

P-456. Reduction in the incidence of chronic hepatitis C, liver cancer, and related healthcare burden following the introduction of interferon-free direct-acting antiviral therapy in Japan: a national claims database study

Abstract Background The World Health Organization aims to eliminate hepatitis C virus (HCV) infections by 2030. Interferon-free direct-acting antiviral (DAA) therapy, available in Japan since 2014, has demonstrated high hepatitis C cure rates and reduced hepatitis C-related hepatocellular carcinoma (HCC). However, DAA therapeutic efficacy on a national scale remains underexplored. In this study, we investigated national trends in HCV prevalence and complications, including liver cancer, during the era of interferon-free DAAs, with particular focus on the impact of coexisting human immunodeficiency virus (HIV) infection. Methods We used the National Database of Health Insurance Claims, covering &amp;gt;98% of the population in Japan, to extract claims data on patients with chronic hepatitis C between 2013 and 2022. We identified patients with chronic hepatitis C annually based on the presence of corresponding diagnostic codes and relevant tests (abdominal ultrasound or HCC tumor markers) within each fiscal year. Next, we analyzed the trends in the prevalence of chronic hepatitis C (stratified by HIV status), DAA therapy, HCC incidence and treatment, and healthcare costs. Results Between 2014 and 2022, 333,020 patients underwent interferon-free DAA therapy in Japan. The number of patients with chronic hepatitis C decreased from 690,336 in 2013 to 414,708 in 2022, representing a 40% prevalence reduction (95% confidence interval: 40%–40%). However, among people living with HIV (PLWH), we observed a 16% decline (10%–20%). Newly diagnosed HCC incidence among patients with chronic hepatitis C declined by 69% (68%–70%) over the 10 years. HCC treatment numbers also declined, with 50%, 80%, and 82% reductions in hepatectomies, radiofrequency ablation, and transarterial chemoembolization therapy, respectively. The total annual healthcare cost of HCV-infected individuals peaked in 2015 (1.1 trillion yen), coinciding with the widespread use of DAAs, and decreased to 65% of the 2013 expenses by 2022. Conclusion The introduction of DAAs significantly reduced the HCV infection-related healthcare burden in Japan. Extensive screening and treatment, particularly in PLWH, are crucial for successful HCV eradication. Disclosures All Authors: No reported disclosures

P-1563. Assessing the Global Economic Burden of Complicated Urinary Tract Infections

Abstract Background Complicated urinary tract infections (cUTIs) arise in patients with structural or functional abnormalities of the genitourinary tract or in those with nonurogenital comorbidities. cUTIs are common in older or catheterized persons and can be associated with high healthcare resource utilization (HCRU). We conducted a systematic literature review to understand the economic burden of cUTI. Methods A systematic literature review was conducted using PubMed, Embase, Cochrane, and EconLit databases to identify observational studies evaluating the burden of cUTI, including acute pyelonephritis and catheter-associated UTI (CAUTI), within the last decade from China, Europe, France, Italy, Germany, Japan, Spain, United Kingdom (UK), and United States (US) (PROSPERO-CRD42023454794). Results Of 1,041 studies identified, 154 from databases were selected for full-text review; a total of 53 met the economic inclusion criteria, reporting direct costs (18 US, 2 China, 2 Spain, 1 Italy) and/or healthcare utilization (28 US, 13 Spain, 4 China, 4 Italy, 3 multicountry/European region, 2 France, 1 UK). No studies of direct cUTI costs were identified for France, Germany, Japan, the UK, or Europe. Mean hospitalization costs per cUTI varied by country, from $2,328 in China to $23,400 for hospital-acquired CAUTI in US children. The highest costs were observed in patients with multi-drug-resistant infections. US national all-cause median 30-day total healthcare costs of cUTIs were estimated at &amp;gt; $6 billion (Table 1). No studies reporting the indirect cost of cUTI were identified, and costs associated with readmissions were reported in only 1 study. Length of stay (LOS) was the most common HCRU outcome reported, and median LOS was similar among studies (7 days). Patients with CAUTI had longer LOS than controls. ICU admissions in patients with extended-spectrum β-lactamase (ESBL)–positive cUTI ranged between 3% and 27.4%. Conclusion Available data indicate that the economic burden associated with cUTI is substantial. However, except for the US, direct costs were missing or reported in only 1 or 2 studies for the countries examined. Similarly, HCRU outcomes were missing or reported in only a few studies, except for the US and Spain. Disclosures Edward I. Broughton, PhD, Pfizer: Ownership Interest Kristi Kuper, PharmD, BCPS, FIDSA, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Maria Fernandez, PhD, MBA, Pfizer: Stocks/Bonds (Public Company) Amer Al-Taie, MSc, Pfizer: Stocks/Bonds (Public Company) Ramy El Mahdy Kotb, MD, Pfizer: Stocks/Bonds (Public Company)

Association of Frailty Index at 66 Years of Age with Health Care Costs and Utilization Over 10 Years in Korea: Retrospective Cohort Study.

The long-term economic impact of frailty measured at the beginning of elderhood is unknown. The objective of our study was to examine the association between an individual's frailty index at 66 years of age and their health care costs and utilization over 10 years. This retrospective cohort study included 215,887 Koreans who participated in the National Screening Program for Transitional Ages at 66 years of age between 2007-2009. Frailty was categorized using a 39-item deficit accumulation frailty index: robust (<0.15), prefrail (0.15-0.24), and frail (≥0.25). The primary outcome was total health care cost, while the secondary outcomes were inpatient and outpatient health care costs, inpatient days, and number of outpatient visits. Generalized estimating equations with a gamma distribution and identity link function were used to investigate the association between the frailty index and health care costs and utilization until December 31, 2019. The study population included 53.3% (n=115,113) women, 32.9% (n=71,082) with prefrailty, and 9.7% (n=21,010) with frailty. The frailty level at 66 years of age was associated with higher cumulative total costs (robust to frail: $19,815 to $28.281; P<.001), inpatient costs (US $11,189 to US $16,627; P<.001), and outpatient costs (US $8,625 to US $11,654; P<.001) over the next 10 years. In the robust group, a one-year increase in age was associated with increased total health care costs (mean change per beneficiary per year: US $206.2; SE: $1.2; P<.001), inpatient costs (US $126.8; SE: $1.0; P<.001), and outpatient costs (US $74.4; SE: $0.4; P<.001). In the frail group, the increase in total health care costs was greater compared to the robust group (difference in mean cost per beneficiary per year: US $120.9; SE: $5.3; P<.001), inpatient costs (US $102.8; SE: $5.22; P<.001), and outpatient costs (US $15.6; SE: $1.5; P<.001). Similar results were observed for health care utilization (P<.001). Among the robust group, a one-year increase in age was associated with increased inpatient days (mean change per beneficiary per year: 0.9 d; P<.001) and outpatient visits (2.1 visits; P<.001). In the frail group, inpatient days increased annually compared to the robust group (difference in the mean inpatient days per beneficiary per year: 1.5 d; P<.001), while outpatient visits increased to a lesser extent (difference in the mean outpatient visits per beneficiary per year: -0.2 visits; P<.001). Our study demonstrates the potential utility of assessing frailty at 66 years of age in identifying older adults who are more likely to incur high health care costs and utilize health care services over the subsequent 10 years. The long-term high health care costs and utilization associated with frailty and prefrailty warrants public health strategies to prevent and manage frailty in aging populations.

Real-world assessment to estimate multiple attributes related to treatment cost driver for mantle cell lymphoma in Japan by econometric modeling

This study was conducted using a nationwide health care database of Japan between 1 April 2008 and 30 September 2022 to evaluate the economic burden on patients with mantle cell lymphoma (MCL). Structural equation modeling (SEM) is an advanced multivariate analysis framework used to assess the relationships between observed and latent variables within predefined causal models. In this study, SEM was employed to identify cost drivers and estimate variables related to MCL treatment cost. A total of 2,838 patients having at least one confirmed diagnosis of MCL participated in this study. As for the index regimen, a combination of bendamustine rituximab was the most frequently used (n = 328), followed by rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisolone-like regimen (n = 112), and others. The median of total health care cost (unadjusted and adjusted) were 32,228 USD and 31,918 USD, respectively. The mean (SD) of the frequency of bleeding treatment was 23 (35) per year, and that of outpatient visits was 19 (12) per year. SEM analysis revealed Bruton tyrosine kinase inhibitor-based treatment as a cost driver (β: 0.398 [0.340; 0.457], p < 0.001). Key health care resource utilization (HCRU) factors associated with an increased cost were the total length of hospitalization (β: 0.598 [0.551; 0.646], p < 0.001) and number of outpatient visits (β: 0.132 [0.083; 0.180], p < 0.001). This real-world study delivers insights for optimizing MCL care in Japan.

Patient satisfaction with a clinically integrated sleep apnea care model vs. the current sleep care paradigm

IntroductionSleep apnea can have severe negative health effects, including cardiovascular diseases, metabolic disorders, and decreased quality of life. Continuous positive airway pressure (CPAP) therapy is highly effective and the gold standard treatment for sleep apnea; however, traditionally fragmented sleep healthcare has resulted in low levels of treatment adoption and adherence. A recent white paper analysis of traditional health plan claims found that a comprehensive model significantly outperformed traditional health plans with higher rates of adoption (80 vs. 49%), adherence (62 vs. 25%), and persistence (53 vs. 11%) to CPAP therapy, which resulted in lower total healthcare costs. To understand the patient experience in these models of care, this study compared patient satisfaction between the traditional sleep care approach and a clinically integrated, comprehensive sleep care program.MethodsA survey was developed to understand differences in the patient experience with the two different care models with respect to: access to sleep care, including time from initial appointment to seeing a sleep specialist, referral and insurance process; ease of sleep testing process and receiving a diagnosis; adoption, quality of education, and training with CPAP; ongoing adherence support with CPAP, and quality of life. Data were compared using descriptive statistics and Chi-square analyses.ResultsA significantly higher proportion of patients in the comprehensive model were satisfied with all measured points in the patient's journey. Notably, twice as many patients in the comprehensive model were very satisfied with: ease of navigating the testing process, time between diagnosis and CPAP adoption, insurance navigation for CPAP approval, and availability and level of ongoing CPAP support. Comprehensive care patients experienced fewer work disruptions due to sleep apnea: only 7% missed work in the past 3 months, compared to 58% in the traditional model.DiscussionOverall, the study highlights the benefits of a comprehensive care model in improving patient satisfaction with their sleep apnea journey and overall quality of life for individuals with sleep apnea. Pairing this positive patient experience data with prior data from the same treatment model shows that removing obstacles within a patient's journey positively impacts satisfaction while simultaneously improving adherence rates and reducing total healthcare costs.

Societal costs of decreased visual acuity: A Finnish cohort study with 15 years of registry data follow-up.

To examine what direct and indirect societal costs are associated with decreased visual acuity (VA). Nationally representative sample of 8028 Finnish adults aged 30 years or older with survey data and clinical examination including VA assessment was evaluated. These data were linked with multiple national registers to capture health care services utilization during 1999-2013. All direct and indirect costs were calculated using prevalence-based bottom-up approach and adjusted for age, sex, and comorbidities with generalized linear models. The results in 2019 cost level are presented according to VA groups at baseline per person, and with population estimates. Total direct health care costs ranged from 1996 €/year/person for those with VA ≥1.0 to 3277 €/year/person for those with weak (0.32-0.5) VA. The increase in direct costs was notable even before the onset of visual impairment. Indirect costs showed monotonously increasing trend with decreasing VA. At the population level, the additional annual direct costs associated with decreased VA were estimated at 1.9 billion €. Only 2% or less of the additional costs are due to increased direct eye-related secondary health care usage. Estimated additional annual national indirect costs were 1.2 billion €. In addition to those with visual impairment or blindness, health care need, and societal costs are elevated even among those with adequate VA. We conclude, that focusing on prevention of VA decrease would not only help sustain the patients' quality of life but could also reduce the future societal costs.

Association Between Diagnostic Delay and Economic and Clinical Burden in Axial Spondyloarthritis: A Multicentre Retrospective Observational Study.

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition associated with considerable pain and impaired health-related quality of life (HRQoL) for affected patients. Despite the documented increase in healthcare resource utilization (HRU) related to axSpA, few studies have explored the impact of diagnostic delays on these outcomes. This study sought to determine the association between diagnostic delay of axial spondyloarthritis (axSpA) and costs in the 3years after diagnosis. This is a retrospective, observational study based on routine follow-up data from adult patients with confirmed axSpA diagnosis in three tertiary Spanish hospitals. Sociodemographic and clinical variables were collected at diagnosis. Direct and indirect healthcare costs were estimated from healthcare resource use (HRU) and productivity losses. The correlation between diagnostic delay and total healthcare costs was analyzed. Eighty-two patients (62.2% men; mean age: 39.3 years at diagnosis) were included, mostly with radiographic axSpA (r-axSpA) (67.1%). The mean (standard deviation, SD) diagnostic delay was 10.1 (9.3) years, with a median (interquartile range, IQR) of 5.4 (2.3, 17.2) years. The mean total healthcare cost per patient accumulated over 3years was €25,812.6 (direct: €16,384.7; indirect: €9427.9). Patients with longer diagnostic delay (> 5.4years) had 57% higher total healthcare cost (€31,717.7 vs. €20,188.7, p = 0.029) and higher disease activity at diagnosis (BASDAI score 4.7 vs. 3.4, p = 0.007) and after 3years (3.9 vs. 2.9, p = 0.042) compared to those with shorter delay (≤ 5.4years). The diagnostic delay in axSpA remains high and is associated with an increase in healthcare costs post-diagnosis. Actions to reduce diagnostic delay should be prioritized by healthcare systems to potentially improve outcomes and reduce long-term costs.

Mechanical Circulatory Support in Patients Without Cardiogenic Shock Undergoing Percutaneous Coronary Intervention.

The use of mechanical circulatory support devices for high-risk percutaneous coronary intervention (PCI) has increased over the past decade despite limited data of benefit. We sought to examine the association between intravascular microaxial left ventricular assist device (LVAD) versus intra-aortic balloon pump use in patients without cardiogenic shock (CS) undergoing PCI. This retrospective study analyzed claims data from a large, insured population who underwent PCI without CS from April 1, 2016 to July 31, 2022. Using inverse probability treatment weighting, we assessed for the association between device type and clinical outcomes. The primary outcome was all-cause mortality. Secondary outcomes included stroke, bleeding, incident dialysis, repeat revascularization, and total health care costs during the index admission and at 30 days. We identified 2879 patients without CS who underwent PCI with either an intra-aortic balloon pump or microaxial LVAD. The mean±SD age was 68.2±12.5 years, and 27% (n=764) were women. After propensity weighting, intravascular LVAD use was not associated with a significant difference in either in-hospital (odds ratio [OR] 1.30 [95% CI, 0.88-1.91]; P=0.19) or 30-day mortality (OR, 1.19 [95% CI, 0.84-1.69]; P=0.33) compared with intra-aortic balloon pump use. Compared with those receiving an intra-aortic balloon pump, the mean total costs for the index admission ($96 716 versus $71 892; P<0.001) and at 30 days (+$16 671 [95% CI, $6639-$28 103]; P=0.001) were significantly higher in those receiving an intravascular LVAD. There was no significant association between device type and stroke, bleeding, incident dialysis, and repeat revascularization at any time point (all P>0.05). In patients without CS undergoing PCI, intravascular LVAD use was associated with higher costs but not associated with lower mortality. Randomized data are needed to improve device selection for patients without CS undergoing PCI.

Health Care Resource Use and Costs of Rivaroxaban Versus Warfarin Among Nonvalvular Atrial Fibrillation Polypharmacy Patients With Obesity.

The economic burden of nonvalvular atrial fibrillation (NVAF) is substantial. Many patients with NVAF are obese and manage other health conditions requiring multiple medications. This real-world study compared health care resource use (HRU) and costs for rivaroxaban and warfarin in patients with NVAF who had polypharmacy and obesity. We used health care claims databases (Merative MarketScan commercial and Medicare supplemental claims) to identify patients initiating the direct oral anticoagulant rivaroxaban or warfarin with ≥1 diagnostic claim for atrial fibrillation, presence of polypharmacy (based on 3 categories for the number of concurrent medications: 1-4, 5-9, ≥10), and obesity. Cohorts were balanced for demographic and baseline characteristics using propensity score matching. All-cause and NVAF-related HRU rates and costs were compared between treatments using rate ratios and adjusted mean differences per patient per year. Eligible patients totaled 95 875, with 19 990 patients in each treatment cohort following propensity score matching. All-cause HRU rates were significantly lower with rivaroxaban versus warfarin, and hospital stays were reduced by 3.1 days with rivaroxaban. Mean (95% CI) all-cause total medical and total health care costs per patient per year were significantly reduced with rivaroxaban versus warfarin (-$4499 [-$5660 to -$3305] and -$1627 [-$2790 to -$438], respectively). NVAF-related HRU was reduced with rivaroxaban versus warfarin, but total NVAF-related medical costs were not significantly different between treatment groups ($144 [-$756 to $1079] per patient per year). Subgroup and sensitivity analysis results were generally consistent with the main analysis. Among patients with NVAF, polypharmacy, and obesity, rivaroxaban was associated with a reduction in HRU and all-cause costs compared with warfarin.

Glycogen Storage Disease Type Ia: A Retrospective Claims Analysis of Complications, Resource Utilization, and Cost of Care.

Background: Glycogen storage disease type Ia (GSDIa) is a rare inherited disorder resulting in potentially life-threatening hypoglycemia, metabolic abnormalities, and complications often requiring hospitalization. Objective: This retrospective database analysis assessed the complications, resource utilization, and costs in a large cohort of patients with GSDIa. Methods: We conducted a retrospective cohort study of GSDIa patients and matched non-GSDIa comparators utilizing the PharMetrics® Plus database. International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes in any billing position for inpatient and outpatient claims (January 2016-February 2020) were identified for complications related to GSDIa. Healthcare use and costs were assessed by setting of care (inpatient, outpatient, physician office, emergency department, and pharmacy). Results: Overall, 557 patients with GSDIa and 5570 matched comparators (male, 63%; adults, 67%) were identified. The most frequent complications in patients with GSDIa vs comparators included anemia due to enzyme disorders (odds ratio, 4.0 × 103; 95% confidence interval, 555.9-2.8 × 104), hepatocellular adenoma (305.9; 41.6-2.2 × 104), liver transplantation (164.6; 21.8-1.2 × 103), and gastrostomy (152.2; 61.1-379.2), as well as acidosis (45.5; 29.4-70.3), hepatomegaly (43.6; 29.1-65.3), hyperuricemia (23.6; 11.9-46.9), and hypoglycemia (20.2; 14.3-28.7). Chronic complications (eg, gout, osteoarthritis, chronic kidney disease, and neoplasms) were more common in adults with GSDIa, whereas acute complications (eg, poor growth, gastrostomy, seizure, and hypoglycemia) were more common in children with GSDIa. Patients with GSDIa more often required hospitalization (0.53 vs 0.06 hospitalizations per patient per year) vs comparators, including 2 or more hospitalizations (26.6% vs 2.3%), longer length of stay (3.1 vs 0.4 days), and more annual visits in all care settings, including 4.3 times more visits in the emergency department. Mean annual total healthcare costs were higher for GSDIa patients vs comparators ( 4410). Discussion: In this large, retrospective database analysis, complications observed among patients with GSDIa were consistent with prior reports and demonstrate the chronic and progressive nature of the disease. Resource utilization was substantial in GSDIa patients, and mean annual total healthcare costs were almost 8 times higher than those of comparators. Conclusions: GSDIa is associated with numerous potentially serious and sometimes fatal complications, extensive resource utilization, and high management costs.

Healthcare utilization and costs following molecular diagnostic testing among patients with vaginitis.

Aim: Vaginitis and other vaginal discharge syndromes lead to high healthcare utilization. Molecular tests like syndromic multiplex real-time (RT) polymerase chain reaction (PCR)-based tests are highly sensitive and specific at diagnosing the infectious causes of vaginitis. This study compared the healthcare resource utilization (HCRU) and direct all-cause healthcare costs among patients with vaginitis in the US receiving next-day syndromic multiplex RT-PCR tests with those receiving other PCR tests or no diagnostic test of interest. Patients & methods: This retrospective study utilized claims data from IQVIA PharMetrics® Plus database to identify adult patients with a diagnosis for vaginitis (first claim=index) from January 2021 to April 2023, with 6months of continuous enrollment prior to (baseline) and after index (follow-up). Pairwise comparisons were conducted between RT-PCR and 1:1 propensity matched Other PCR and No Test subcohorts for all-cause HCRU and costs during follow-up. Results: Each of the RT-PCR, Other PCR and No Test subcohorts included 1946 matched patients. Mean(SD) follow-up total cost was significantly lower for the RT-PCR than the No Test subcohort ($5607[$15,122] vs $6680[$20,751], p=0.0023). Mean(SD) overall outpatient and other medical service costs were lower for RT-PCR versus Other PCR (outpatient: $2964[$9666] vs $3174[$7113], p=0.0110; other medical: $1961[$9244] vs $2099[$6475], p=0.0002) and No Test subcohorts (outpatient: $2964 [$9666] vs $4067[$12,341], p<0.0001; other medical: $1961[$9244] vs $2973[$11,685]; p<0.0001). A lower proportion had any outpatient service HCRU in RT-PCR versus Other PCR subcohort (92.6% vs 94.2%, p=0.0349). A lower proportion had any other medical service claim in RT-PCR versus Other PCR (78.3% vs 83.2%, p<0.0001) and No Test subcohorts (78.3% vs 83.0%, p=0.0001). Physician office, emergency room (ER), prescription use and costs were similar between the subcohorts. Conclusion: The use of syndromic multiplex RT-PCR diagnostics with next day test results in patients with vaginitis was associated with lower outpatient costs and total healthcare costs than those in the no test cohort over 6months. These findings indicate that use of syndromic multiplex RT-PCR diagnostics may contribute to improved patient management compared with clinical diagnosis alone.

The Economic Burden of Herpes Zoster in Individuals Aged 50 Years or Older and Those With Underlying Conditions in Italy.

Risk of herpes zoster (HZ) infection increases with age and immunosuppression. We estimated the impact of HZ and post-herpetic neuralgia (PHN) on direct costs and health care resource utilization (HCRU) in patients ≥50 years, including those with comorbidities, as limited information exists in Italy. This retrospective analysis used reimbursement data from local health authorities in Italy (January 2009-June 2022). Cases of HZ and PHN identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes and drug prescriptions were characterized and followed up for 1 year before and after the index date. The direct HCRU costs for patients with HZ/PHN were compared with those for patients without HZ/PHN. Of the total 193 259 patients with HZ/PHN identified (mean age, 61.6 years), 145 923 were ≥50 years old (immunocompromised: 29.9%; ≥1 chronic condition: 76.1%). During follow-up, 18.8% of patients ≥50 years of age with HZ progressed to PHN complications, and 3618 hospital admissions were reported (median length of stay, 9 days). Drug prescriptions and all-cause hospitalizations were the main contributors to total annual direct health care costs, estimated at M€272 for patients with HZ/PHN, whose burden increased with age. Higher health care costs were observed in patients with HZ/PHN vs patients without HZ/PHN. Moreover, average health care costs were up to 4× higher for patients with HZ and PHN compared with those without PHN. HZ causes a significant economic impact on the health care system, driven mainly by high costs of medications and hospitalizations among older adults and those with comorbidities, particularly when complicated by PHN.

Informal Caregiving: Health System Cost Implications.

Informal caregiving is seen as a low-cost substitute for care provided by health care professionals. However, caregiving is known to negatively impact caregivers' health and, subsequently, their health care use and costs. This could potentially offset the caregivers' contributions to the health care system. We examined the impact of caregiving on costs associated with caregivers' use of publicly funded health care services in Ontario, Canada, in comparison with non-caregivers. We included Ontarians who participated in the Canadian Community Health Survey-Healthy Aging Supplement Survey of 2008/09 and linked responses to health care administrative databases. A difference-in-differences design was used to capture differences in caregivers' and non-caregivers' total health care costs 1 and 2 years before and after caregiving start date. Generalized Linear Models were used to model the total health care costs. The sample size was 4275 with 1265 caregivers and 3010 non-caregivers. We found that while health care utilization increased over time, it increased by a lesser amount for caregivers than non-caregivers. Adjusted total health care costs for caregivers were 11.32% (SE = 0.05, ρ = 0.02) lower than non-caregivers 2 years into caregiving. Our study reveals a critical gap in policy, practice, and research driven by a lack of routine data collection and caregiver identification. It also highlights the need for additional longitudinal research focusing on caregivers' objective health.

Evaluation of the Critical Pathway for Laparoscopic Cholecystectomy from the Perspective of Pain Course

Purpose: The critical pathway is a standardized practice guideline for providing quality healthcare. It improves patient outcomes by providing comprehensive treatment. Although many studies have explored the effectiveness of the critical pathway in laparoscopic cholecystectomy, no study has reported how it affects pain levels during a patient’s hospital stay. This study aimed to evaluate the effectiveness of the critical pathway in reducing pain severity.Methods: Between January 2022 and December 2023, 723 patients underwent laparoscopic cholecystectomy. The patients were categorized into two groups: 407 patients in the critical pathway group and 316 in the non-critical pathway group. Patient outcomes, namely the length of hospital stay, postoperative hospital stay, total healthcare cost, unplanned emergency room visits within 30 days, pain score, and number of analgesics administered, were analyzed and compared between the groups.Results: The length of hospital stay was 3.43 ± 1.02 and 3.73 ± 1.78 days for the critical pathway and non-critical pathway groups, respectively (&lt;i&gt;p&lt;/i&gt;=.007). The total healthcare cost was 3981.77 ± 747.02 US$ and 4929.10 ± 1710.33 US$ for the critical pathway and non-critical pathway, respectively &lt;i&gt;p&lt;/i&gt;&lt;.001). No significant difference was observed in unplanned 30-day emergency room visits between the two groups. The average pain during the hospital stay was 3.17 ± 0.68 and 3.29 ± 0.75 points in the critical pathway and non-critical pathway groups, respectively (&lt;i&gt;p&lt;/i&gt;=.023).Conclusion: The critical pathway is an effective protocol for achieving rapid postoperative recovery. The results showed that reduced pain and faster discharge are possible through the critical pathway. In addition, despite the shorter hospitalization period in the critical pathway group, no significant difference was observed in unplanned 30-day emergency room visits between the two groups. This is a promising outcome for the widespread application of the critical pathway in laparoscopic cholecystectomy.