Total Health Care Expenditures Research Articles

Clustering analysis for predicting racial disparities in genitourinary cancer–related financial burden.

e13612 Background: Healthcare costs in the United States (US) are significantly impacted by genitourinary (GU) cancers. Prostate cancer treatment alone cost the US more than $22 billion in 2020. We sought to utilize machine learning (ML)-based classification to investigate differences in the total cost of healthcare expenditure among patients with GU cancer in the US. Methods: The study included eligible adult GU cases from the 2019–2021 Medical Expenditure Panel Survey. Renal cell, prostate, urothelial, testicular, and penile cancers were identified using ICD-10 CM codes. Patients were clustered using demographic information such as age, race, sex, marital status, highest degree, insurance status, perceived health status, and perceived mental health status. The analysis accounted for the complex survey design and sampling weights. The cluster groups were taken into account when conducting descriptive and regression analyses. GU cancer cases were divided into low-, medium-, and high-risk healthcare expenditure clusters. Results: The study included a representative sample of 9,061,181 cases of GU cancer in the US between 2019 and 2021. The average age of the sample was 71.6 years (95% CI: 70.7, 72.5). There were 7.9% Hispanic (Hisp), 74.8% non-Hispanic White (NHW), 13.8% non-Hispanic Black (NHB), and 3.5% individuals from Asian or other races. Overall, the mean total healthcare expenditures within low-, med-, and high-risk clusters were $17974 (13816, 22133), $20496 (13100, 27893), and $30512 (21389, 39635), respectively. Regression analysis showed that, after adjusting for sampling weight, cluster, gender, family income, age, insurance status, and survey year, the mean total expenditure was higher by $11209.70 and $13100.81 in med- and high-risk clusters when compared to the low-risk cluster (ref.). Within each race or ethnicity, the proportion of Hisp or NHB individuals was higher in med- and high-risk clusters. Med- and high-risk clusters were more likely to contain people with cognitive impairments, poor health status, and financial difficulties in their families. Conclusions: We used an unsupervised clustering algorithm that can distinguish between GU cases with high and low expenditure based solely on sociodemographic variables. We demonstrate that our findings were consistent for all three data cohorts. This approach can predict the disparity in utilization in any insured population. [Table: see text]

Annual epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data

BackgroundHealth services utilization related to hip osteoarthritis imposes a significant burden on society and health care systems. Our aim was to analyse the epidemiological and health insurance disease burden of hip osteoarthritis in Hungary based on nationwide data.MethodsData were extracted from the nationwide financial database of the National Health Insurance Fund Administration (NHIFA) of Hungary for the year 2018. The analysed data included annual patient numbers, prevalence, and age-standardized prevalence per 100,000 population in outpatient care, health insurance costs calculated for age groups and sexes for all types of care. Patients with hip osteoarthritis were identified using code M16 of the International Classification of Diseases (ICD), 10th revision. Age-standardised prevalence rates were calculated using the European Standard Population 2013 (ESP2013).ResultsBased on patient numbers of outpatient care, the prevalence per 100,000 among males was 1,483.7 patients (1.5%), among females 2,905.5 (2.9%), in total 2,226.2 patients (2.2%). The age-standardised prevalence was 1,734.8 (1.7%) for males and 2,594.8 (2.6%) for females per 100,000 population, for a total of 2,237.6 (2.2%). The prevalence per 100,000 population was higher for women in all age groups. In age group 30–39, 40–49, 50–59, 60–69 and 70 + the overall prevalence was 0.2%, 0.8%, 2.7%, 5.0% and 7.7%, respectively, describing a continuously increasing trend. In 2018, the NHIFA spent 42.31 million EUR on the treatment of hip osteoarthritis. Hip osteoarthritis accounts for 1% of total nationwide health insurance expenditures. 36.8% of costs were attributed to the treatment of male patients, and 63.2% to female patients. Acute inpatient care, outpatient care and chronic and rehabilitation inpatient care were the main cost drivers, accounting for 62.7%, 14.6% and 8.2% of the total health care expenditure for men, and 51.0%, 20.0% and 11.2% for women, respectively. The average annual treatment cost per patient was 3,627 EUR for men and 4,194 EUR for women.ConclusionsThe prevalence of hip osteoarthritis was 1.96 times higher (the age-standardised prevalence was 1.5 times higher) in women compared to men. Acute inpatient care was the major cost driver in the treatment of hip osteoarthritis. The average annual treatment cost per patient was 15.6% higher for women compared to men.

Factors associated with high costs of patients with metabolic dysfunction-associated steatotic liver disease: an observational study using the French CONSTANCES cohort

Background & aimsDespite its high prevalence in the western world metabolic dysfunction-associated steatotic liver disease (MASLD) does not benefit from targeted pharmacological therapy. We measured healthcare utilisation and identified factors associated with high-cost MASLD patients in France.MethodsThe prevalent population with MASLD (including non-alcoholic steatohepatitis) in the CONSTANCES cohort, a nationally representative sample of 200,000 adults aged between 18 and 69, was linked to the French centralised national claims database (SNDS). Study participants were identified by the fatty liver index (FLI) over the period 2015–2019. MASLD individuals were classified according as “high-cost” (above 90th percentile) or “non-high cost” (below 90th percentile). Factors significantly associated with high costs were identified using a multivariate logistic regression model.ResultsA total of 14,437 predominantly male (69%) participants with an average age of 53 ± SD 12 years were included. They mainly belonged to socially deprived population groups with co-morbidities such as diabetes, high blood pressure, mental health disorders and cardiovascular complications. The average expenditure was €1860 ± SD 4634 per year. High-cost MASLD cost €10,863 ± SD 10,859 per year. Conditions associated with high-cost were mental health disorders OR 1.79 (1.44–2.22), cardiovascular diseases OR 1.54 (1.21–1.95), metabolic comorbidities OR 1.50 (1.25–1.81), and respiratory disease OR 1.50 (1.11–2.00). The 10% high-cost participants accounted for 58% of the total national health care expenditures for MASLD.ConclusionOur results emphasize the need for comprehensive management of the comorbid conditions which were the major cost drivers of MASLD.Graphical

Healthcare and economic cost burden of emergency medical services treated non-traumatic shock using a population-based cohort in Victoria, Australia

ObjectivesWe aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock.DesignWe conducted a population-based cohort study, where EMS-treated...

Abstract 2250: Effects of loneliness on medical expenditures among US cancer survivors

Abstract Background: Social isolation in cancer survivors associates with diminished quality of life and worse survival. However, effects of loneliness on medical expenditure are understudied. We examined associations of loneliness with medical costs, and social/psychological/behavioral determinants of health (SDHs). Methods: We identified 1,866 cancer survivors from the 2021 Medical Expenditure Panel Survey. One has loneliness if answering ‘often’ for any of: feel lack companionship/left out/isolated from others. Two-part regression models assessed marginal effect of loneliness to annual total health care expenditure (cost) in cancer survivors, aged 18-64 (young) and ≥65 years (older), adjusting for age, sex, race, region, education, health insurance, comorbid illnesses, family income, unemployment, and activity limitation. Models were sequentially adjusted for every single SDH. Ordinal regression models assessed associations of loneliness with SDHs. Results: Over one-tenth of young (19%) and older (13%) cancer survivors reported loneliness. Loneliness was associated with higher cost in older cancer survivors (conditional coefficient (CC) 0.46, 0.12-0.81), but not young survivors (-0.14, -0.62-0.36). In both age groups, cancer survivors with loneliness more often reported stress, lack of help, as well as less time talking on the phone and getting together with support persons (Table). In older patients, sequential adjustment for stress, expected help, get-togethers, or church attendance decreased effect of loneliness to cost; among which get-togethers showed the greatest decrease (CC 0.28, -0.03-0.62). Conclusions: Loneliness was associated with higher total medical expenditure in older US cancer survivors. Findings warrant further study of personal or community support to mitigate loneliness, in an effort to reduce healthcare costs and financial burden in older cancer survivors. Age (year) 18-64 (648) ≥65 (1223) Loneliness No (505, 81%) Yes (143, 19%) No (1046, 87%) Yes (177, 13%) Mean Age (years) 56 56 75 74 Female % 64.5 66.4 53.0 59.1 Non-white % 23.1 21.8 15.8 26.4 Federal poverty level < 100%, % 7.4 18.9 8.9 7.2 Comorbidities ≥ 3, % 25.4 44.4 60.4 67.1 Unemployment ≥ 1, % 35.8 45.3 83.3 89.6 < high school % 30.8 33.7 37.7 36.6 Conditional coefficient (95% CI) Ref -0.14 (-0.62-0.36) Ref 0.46 (0.12-0.81) Odds ratio (95% CI) of loneliness to SDHs Stress Ref 8.42 (5.20-13.63) Ref 6.82 (4.72-9.87) Lack of help - family 3.46 (2.32-5.14) 2.61 (1.88-3.60) Lack of help - friends 3.25 (2.00-5.29) 1.92 (1.36-2.72) Lack of help - community 2.45 (1.64-3.66) 2.16 (1.58-2.96) Times of talk on phone 0.55 (0.36-0.85) 0.77 (0.55-1.07) Times of get together 0.34 (0.21-0.55) 0.38 (0.25-0.58) Citation Format: Fangyuan Chen, Ryan Nipp, Xuesong Han, Zhiyuan Zheng, Robin Yabroff, Changchuan Jiang. Effects of loneliness on medical expenditures among US cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2250.

Impoverishing effects of catastrophic health out-of-pocket payments in Nigeria

Out-of-Pocket (OOP) expenditure on healthcare is a major share of total healthcare expenditure in many developing countries, including Nigeria. Households in different income groups in Nigeria spent a larger share of income mainly on consumption and basic needs, hence, OOP expenditure for health constituted a burden with attendant effects on household well-being. Catastrophic headcount and Overshoot mean positive gap and concentration indexes were used to capture the incidence and severity of catastrophic health expenditure. The poverty headcount, poverty gap, normalized poverty gap, and its mean estimate were used to empirically identify the effect of catastrophic health expenditure using the national poverty line of ₦137,430 per year. Data on 22,110 households with non-zero expenditure were obtained from the 2018/2019 Nigeria Living Standard Survey. The incidence and severity of catastrophic health expenditure were higher for poorest and poor income quintiles using total consumption expenditure and total non-food expenditure at various catastrophic thresholds. The results indicated that about one million Nigerians were pushed into poverty due to OOP expenditure. Widening the coverage of the available social health insurance and implementation of alternative means of healthcare financing would minimize the financial burden on many poorest and poor households.

Facts about hospital-insurer contracting.

To use publicly available price transparency data files to establish empirical regularities about hospital-insurer contracting. Retrospective analysis of 10 price transparency data files from HCA Healthcare. Cross-sectional qualitative analysis of 524hospital-insurer contracts across 10 hospitals. We ascertain 4 empirical regularities in these files. First, hospitals contract with many payers, ranging from 35 to 82 across the hospitals in the sample. Second, contract structure varies significantly within and across hospitals: Of the 524 contracts in our sample, the median contract contained 9 contract elements, whereas the mean contract contained 1285 contract elements. Third, most of the contracts in our sample contained multiple contracting methodologies (eg, both fixed fee and percentage of charges). Fourth, these contracts indicated substantial variation for the same service within and across hospitals, validating findings from analyses based on claims data and hospital price transparency files. Hospital-insurer contracts dictate the flow and structure of a significant portion of total health care expenditure in the US. Increased attention by both researchers and policy makers would lead to a greater understanding of this vital-yet understudied-element of the market for hospital services.

Abstract 4: Unveiling the Economic Burden of Stroke in the European Union: Comparisons With the USA

Introduction: Stroke places a significant economic impact on health and social care systems, as well as indirect costs through premature retirement, and absenteeism, reducing productivity and economic output, and necessitating care for patients from friends and family. This study aims to provide novel and up- to-date evidence on the economic burden of stroke across 27 EU countries allowing to draw comparisons with the USA. Methods: Stroke-related costs were estimated for 27 EU countries in 2021. Country-specific resource use was estimated using aggregate data on morbidity, mortality, health, social and informal care, apportioned to stroke using patient-level data based on responses from 140,000 participants. Resource use was valued using country-specific unit costs. To allow for meaningful comparisons with the 2018 American Heart Association (AHA) estimates of stroke costs in the USA, costs are reported in US $ adjusted for price differentials and inflation. Results: In 2021, excluding long-term care costs as not included in AHA estimates, stroke cost the EU health care systems $39 billion (2% of health expenditure). Within this total, there was wide variation in per-capita healthcare costs (ranging from $30 in Malta to $177 in Austria), with that for the EU being $87. In the USA, comparable stroke-related healthcare costs accounted for 2% ($35 billion) of US health expenditure, and $108 per capita (comparable to Belgium - $103). In the EU-27, productivity losses due to early mortality were estimated at $8 billion ($19 per capita), compared to $21 billion in the USA ($65 per capita). Long-term nursing home care costs were є21 billion in the EU-27, driving the proportion of total healthcare expenditure due to stroke to 3%. Unpaid care for stroke patients accounted for $38 billion in the EU-27, with absence from work costing the EU economy an additional $4 billion. The total costs of stroke for the EU-27 were $110 billion. Conclusions: This study provides contemporary estimates of the wide-ranging impact of stroke on all aspects of 27 European countries’ economies, allowing for meaningful comparisons with the USA. The data help inform evidence based polices to reduce the impact of stroke, promoting care access and better health outcomes and economic sustainability.

The association between healthcare expenditures and potentially inappropriate medication use in hospitalized older adults in Ethiopia

BackgroundEvidence shows that potentially inappropriate medication (PIM) use in older adults significantly increases the utilization of healthcare resources. PIM is widely prescribed in older adults, however little is known about its association with healthcare resource utilization in Africa, particularly Ethiopia. Therefore, the primary aim of this study was to examine the presence of an association between healthcare expenditure and the frequency of PIM used.MethodsThis observational study was conducted from 06 September 2021 to 30 December 2022. A total of 151 hospitalized older adult patients were included in the study. The data collection format was designed to capture relevant information. STATA V.15.0 was used for analysis. Descriptive statistics and a generalized linear model regression were conducted. Statistical significance was set at a p-value < 0.05. The findings are presented in tables, figures, and text.ResultsThe total healthcare expenditure was higher in PIM users (385,368.6 ETB) than in non-PIM users (131,267.7 ETB). The median expenditures for medical supplies (p = 0.025), investigations (p = 0.033), and total healthcare expenditure (p = 0.023) were significantly higher in patients with two and more PIMs than in those with no or one PIM. However, after model adjustment, the total healthcare expenditure was not significantly different across the frequency of PIMs used. Number of medications (adjusted B = 0.068, 95% CI: 0.035, 0.101, p < 0.001) and taking blood and blood-forming organ class of medication (adjusted B = 0.151, 95% CI: 0.005, 0.297, p = 0.042) were associated with higher total healthcare expenditure, whereas the total healthcare expenditure was significantly lower in those patients with diseases of the nervous system (adjusted B = -0.307, 95% CI: -0.502, -0.112, p = 0.002) and respiratory system (adjusted B = -0.196, 95% CI: -0.327, -0.065, p = 0.003).ConclusionThe total healthcare expenditure is nearly three times higher in PIM users. However, its association with the frequency of PIM use was not statistically significant in the final model. Deprescribing medications after evaluating the benefit-risk ratio may help to reduce the healthcare expenditures of older adult patients. Further similar, adequately powered, comparative study is also warranted to identify the actual effect of PIM use on healthcare expenditures in the local context.

The influence of gender inequality on women’s cancer mortality in European countries: a quantitative study

Abstract Aim This study investigates the impact of gender inequality on cancer mortality among European women across 27 countries from 2013 to 2020. Subject and methods The study explores the link between gender inequality and cancer mortality, employing pooled ordinary least squares regression. It evaluates socioeconomic gaps, healthcare access disparities, risky behaviours, and elements like screening, education, and life expectancy. The study also investigates how healthcare spending, employment, self-perceived health, and leisure activities influence mortality. Results The study shows that breast and cervical cancer screenings (BCS) significantly reduce cancer-related deaths among European women (CDW), with a negative impact of −0.0875. Similarly, tertiary education and participation in education and training (WEP) show a negative impact of −0.0021. Absolute life expectancy for women at birth (LEW) demonstrates a negative impact of −5.2603, all contributing to decreased cancer-related deaths. Conversely, certain variables have a contradictory positive impact on CDW. Total healthcare expenditure (HCE) has a positive impact of +0.0311, and full-time equivalent employment (FER) of +0.3212. Women engaging in activities (WLW) has a positive impact of +0.6572. Self-perception of good health (WHG), refraining from smoking or harmful drinking (NSN) (+0.2649), and an active lifestyle with consumption of fruits and vegetables (PAF) (+0.2649) also impact positively, collectively contributing to increased cancer mortality among women. Conclusion The study highlights the importance of combating gender inequality to decrease cancer deaths in European women. Strategies include closing healthcare gaps and enhancing health education. Complex links between smoking, alcohol, and cancer mortality require further research. Interventions targeting disparities, healthcare access, and risky behaviours can notably lower cancer mortality.

One-Year Medication Treatment Patterns, Healthcare Resource Utilization, and Expenditures for Medicaid Patients with Schizophrenia Starting Oral Atypical Antipsychotic Medication

Oral atypical antipsychotic (OAAP) medications are the most commonly prescribed treatment for the management of schizophrenia symptoms. This retrospective study, using Medicaid claims data (2016–2020), followed patients for 12 months after initiating OAAP therapy. Study outcomes included OAAP adherence, switching, augmentation, healthcare resource utilization (HRU), and expenditures. All-cause and schizophrenia-related HRU and expenditures were compared between adherent and nonadherent cohorts. Among 13,007 included patients (39.1 ± 12.8 years of age, 57.0% male, 36.1% Black, 31.8% White, 9.7% Hispanic), 25.7% were adherent to OAAPs (proportion of days covered [PDC] ≥ 0.8). During the 1-year follow-up period, Black individuals were in possession of an OAAP for an average of 166 days compared to 198 and 202 days for White and Hispanic patients, respectively. Approximately 16% of patients switched OAAP medications and 3.2% augmented therapy with an OAAP added to their index medication. Nearly 40% of patients were hospitalized during follow-up and 68.4% had emergency department (ED) visits. A greater proportion of nonadherent patients had all-cause inpatient (41.7% vs. 34.1%, p < 0.001) and ED visits (71.7% vs. 58.8%, p < 0.001) compared to adherent patients. Annual total healthcare expenditures were $21,020 per patient; $3481 higher for adherent versus nonadherent patients. Inpatient expenditures comprised 44.6% and 30.6% of total expenditures for nonadherent and adherent patients, respectively. Hospitalized patients’ total expenditures were $23,261 higher compared to those without a hospitalization. Adherence to OAAP medication is suboptimal and associated with increased utilization of costly hospital and ED resources. Efforts to improve therapies and increase medication adherence could improve clinical and economic outcomes among individuals with schizophrenia.

Real-World Amount of Clotting Factor Concentrates Dispensed and Annual Medical Expenditures for Japanese Patients with Hemophilia B.

Until extended half-life (EHL) factor IX (FIX) concentrates became available in Japan in 2010, patients with hemophilia B received intravenous FIX replacement therapy with standard half-life (SHL) FIX concentrates. To investigate the amount of factor dispensed and the associated medical expenditures for the treatment of hemophilia B in the real-world clinical setting in Japan. This retrospective study comprised patients with hemophilia B (N=197) who had filled prescriptions for FIX concentrates reported in Japan's Medical Data Vision database from 2015 to 2019. Patients were included if they had 2 or more prescriptions for the same FIX concentrates within the first 6 months of the study period and the interval between prescriptions was at least 2 weeks. Since 2015, there was a decrease in the proportion of patients using SHL FIX concentrates and a corresponding increase in international units of dispensed EHL FIX concentrates. Median annualized dispensed dosages (IU/kg body weight) of EHL FIX concentrates were lower than for SHL concentrates for outpatient use only. Annual total health care expenditures per patient and annual expenditures for prescribed FIX concentrates increased each year during the study period. Following a switch from an SHL to an EHL concentrate, the median amount of prescribed FIX concentrate decreased slightly, although median total health care expenditures and FIX concentrate expenditures increased. In the real-world setting in Japan, medical expenditures and the proportion of patients prescribed EHL FIX concentrates for the treatment of hemophilia B have increased.

Frailty Predicts Worse Outcomes in Tumor Lysis Syndrome

DISCUSSION Tumor lysis syndrome (TLS) is a potentially life-threatening complication that occurs in the setting of rapid tumor cell destruction. The Hospital Frailty Risk Score (HFRS) is a valuable tool to identify frailty in older individuals, signifying a decline in physiological reserves and coping ability due to age-related deterioration, and it has gained recognition as a crucial factor linked to adverse events, including mortality, hospitalization, and diminished functional outcomes. We aimed to assess the impact of HFRS on individuals admitted with a primary diagnosis of TLS. Using weighted data from the Nationwide Inpatient Sample (NIS) database from 2016 to 2020, we assessed the outcomes (mortality, hospital utilization, total healthcare charges, complications) of individuals admitted with a primary diagnosis of TLS stratified by the presence and absence of Frailty (determined by the combination of 109 ICD-10 codes each with a different score) (table 1). Baseline characteristics were analyzed using T-test and Chi-Square, and a multivariate regression analysis was used to estimate outcomes between races, adjusted for patient and hospital confounders. Data analysis was performed using STATA® Version 17.0/SE Software, with statistical significance set at p &amp;lt; 0.05. A total of 4,340 were admitted with a primary diagnosis of TLS from 2016 to 2020, among these, we selected 1,330 admissions aged 75 years or older; these admissions included 59% (N=785) with frailty, and 41% (N=545) without frailty. Frailty was associated with increased length of stay (adjusted mean difference (aMD) = 2.5 days, 95%CI: 1.2 - 3.8 days), and total healthcare expenditures (aMD = 22,541 U.S. dollars (USD), 95%CI: 2,175 - 42,908 USD). Pertaining to the outcomes, a 9- fold increase in the odds of mortality were noted among individuals with frailty, as opposed to those without frailty (adjusted Odds Ratio (aOR) = 8.93, 95%CI: 1.79 - 44.74). Our study depicts the significant impact of frailty on individuals hospitalized with TLS, revealing associations with elevated mortality rates, prolonged length of hospital stay, and increased healthcare costs. Considering a considerable portion of cancer patients fall within the elderly demographic and often present with multiple comorbidities, the Hospital Frailty Risk Score (HFRS) is a potential valuable tool for assessing the appropriateness of chemotherapy in conjunction with other scores like the Eastern Cooperative Oncology Group (ECOG). Moreover, the HFRS may aid in prognosticating disease outcomes, offering clinicians valuable insights to inform treatment decisions and improve patient care.

Differences in Outcomes of Hemophagocytic Lymphohistiocytosis (HLH) Based on Etiology: A Five Year Nationwide Analysis

Background: Hemophagocytic lymphohistiocytosis (HLH) is a rare, under-diagnosed, potentially lethal condition marked by dysregulated hyperinflammation and widespread multi-organ dysfunction. There is currently no literature describing the differences in HLH outcomes according to its commonly reported risk factors. Therefore, authors of this study aimed to identify potential differences in the outcomes of HLH among various etiologies as well as update literature on the prevalence of risk factors for HLH in the United States. Methods: Using weighted data from the Nationwide Inpatient Sample (NIS) database from 2016 to 2020, we assessed prevalence of known HLH risk factors (infection, malignancy, auto-immune, and inflammatory syndromes) and HLH outcomes (mortality, length of hospital stay, total healthcare charges, complications) stratified by HLH etiology (infection, malignancy, auto-immune, inflammatory). Baseline characteristics were analyzed using T-test for continuous variables and Chi-Square for categorical variables, and a multivariate regression analysis was used to estimate outcomes between races. Data analysis was performed using STATA® Version 17.0/SE Software, with statistical significance set at p &amp;lt; 0.05. Results: Among a total of 2,685 individuals admitted with a primary diagnosis of HLH, 52% (N=1,350) had an infection (27% bacterial, 28% viral,14% fungal, and 1% parasitic), 22% were with malignancy (N=525)(14% lymphoma, 2% leukemia, 3% plasma cell proliferation, 3% myeloproliferative disease, and 4% solid tumors), 16% had a history of autoimmune disease (N=380), and 7% had an inflammatory syndrome (N=175). 25% had no ICD-10 codes for common risk factors of HLH. Among patients with HLH and autoimmune disease, we noted a predominance of females (77%, p&amp;lt;0.001). Individuals with HLH and cancer had more comorbid conditions (Charlson index: 3 in 58%, p&amp;lt;0.001). Pertaining to outcomes, when compared to those with cancer, individuals with infection had a 3-fold increase in respiratory failure (adjusted Odds Ratio (aOR)=3.12, 95%CI: 1.13-8.61), while those with autoimmune disease had reduced odds of acute kidney injury (aOR=0.30, 95%CI: 0.10-0.87). There were no significant differences in the length of hospital stay, the total healthcare expenditures, mortality and the other complications (cardiac arrest, acute kidney injury, respiratory failure, disseminated intravascular coagulation, and acute liver failure) among HLH secondary to cancer versus other risk factors. Discussion: Our study findings demonstrate that infection is the most common trigger for secondary HLH in the U.S., followed by malignancy. This is consistent with existing literature. Individuals who develop HLH associated with the infection have a 3-fold higher odds of acute respiratory failure compared to those with HLH resulting from other cancer. This warrants increased vigilance, and the potential need for a lower threshold for mechanical ventilation to mitigate adverse outcomes in patients with HLH secondary to infection.

Comparing super-utilizers and lower-utilizers among commercial- and Medicare-insured adults with sickle cell disease

AbstractSickle cell disease (SCD) is a rare but costly condition in the United States. Super-utilizers have been defined as a subset of the population with high health care encounters or expenditures. Although super-utilizers have been described in other disease states, little is known about super-utilizers among adults with SCD. This study aimed to characterize the differences in expenditures, overall health care encounters, and pain episode encounters between super-utilizers (top 10% expenditures) and lower-utilizers with SCD (high, top 10%-24.9%; moderate, 25%-49.9%; and low, bottom 50% expenditures). A retrospective longitudinal cohort of adults with SCD were identified using validated algorithms in MarketScan and Medicare claim databases from 2016 to 2020. Encounters and expenditures were analyzed from inpatient, outpatient, and emergency department settings. Differences in encounters and expenditures between lower-utilizers and super-utilizers were compared using logistic regression. Among super-utilizers, differences in encounters and expenditures were compared according to incidences of pain episode encounters. The study population included 5666 patients with commercial insurance and 8600 with Medicare. Adjusted total annual health care expenditure was 43.46 times higher for super-utilizers than for low-utilizers among commercial-insured and 13.37 times higher in Medicare-insured patients. Among super-utilizers, there were patients with few pain episode encounters who had higher outpatient expenditures than patients with a high number of pain episode encounters. Our findings demonstrate the contribution of expensive outpatient care among SCD super-utilizers, in which analyses of high expenditure have largely focused on short-term care. Future studies are needed to better understand super-utilizers in the SCD population to inform the effective use of preventive interventions and/or curative therapies.

The Reality of Cost Sharing in Japan.

Financial pressure on younger generation is mounting in Japan, a super-ageing society with staggering economy. The revision on the co-insurance rate for 70-74 with "Standard" category was implemented to mitigate such pressure, seeking better balance across generations in sharing the burden of healthcare cost. It raised the rate from 10% to 20% over the period of five years from 2014 to 2018. This report examined how it changed the share of cost sharing (cost sharing as percentage to total healthcare expenditure), among the 70-74 with "Standard" category in Citizens Health Insurance programme in 44 prefectures. It specifically focused on change in the population's actual share of cost sharing (ASCS) that better reflect the genuine amount of payment actually made by the patients themselves. The average ASCS increased from 7.28% (2013) to 10.78% (2019), resulting wider gap from the statutory planned share of cost sharing (i.e., the statutory co-insurance rate of 10% in 2013, and 20% in 2019). Also found was increased variance among prefectural ASCS, which may suggest a possibility of un-designed effect by the revision, of encouraging a move towards ability and willingness to pay. In terms of cost containment effect, Japan needs to consider various non-conventional options, including review of the current use of healthcare resources. First and foremost, however, the true state of cost sharing should be recognized in terms of ASCS and shared more widely as a reality. Such effort is essential in discussion of how to keep embracing the country's life line, UHC.

Health Care Expenditures for Black and White US Adults Living Under Similar Conditions

Evidence suggests that racial disparities in health outcomes disappear or diminish when Black and White adults in the US live under comparable living conditions; however, whether racial disparities in health care expenditures concomitantly disappear or diminish is unknown. To examine whether disparities in health care expenditures are minimized when Black and White US adults live in similar areas of racial composition and economic condition. This cross-sectional study used a nationally representative sample of 7062 non-Hispanic Black or White adults who live in 2238 of 2275 US census tracts with a 5% or greater Black population and who participated in the Medical Expenditure Panel Study (MEPS) in 2016. Differences in total health care expenditures and 6 specific categories of health care expenditures were assessed. Two-part regression models compared expenditures between Black and White adults living in the same Index of Concentration at the Extremes (ICE) quintile, a measure of racialized economic segregation. Estimated dollar amount differences in expenditures were calculated. All analyses were weighted to account for the complex sampling design of the MEPS. Data analysis was performed from December 1, 2019, to August 7, 2023. Self-reported non-Hispanic Black or non-Hispanic White race. Presence and amount of patient out-of-pocket and insurance payments for annual total health care expenditures; office-based, outpatient, emergency department, inpatient hospital, or dental visits; and prescription medicines. ICE quintile 5 (Q5) reflected tracts that were mostly high income with mostly White individuals, whereas Q1 reflected tracts that were mostly low income with mostly Black individuals. A total of 7062 MEPS respondents (mean [SD] age, 49 [18] years; 33.1% Black and 66.9% White; 56.1% female and 43.9% male) who lived in census tracts with a 5% or greater Black population in 2016 were studied. In Q5, Black adults had 56% reduced odds of having any health care expenditures (odds ratio, 0.44; 95% CI, 0.27-0.71) compared with White adults, at an estimated $2145 less per year, despite similar health status. Among those in Q5 with any expenditures, Black adults spent 30% less on care (cost ratio, 0.70; 95% CI, 0.56-0.86). In Q3 (most racially and economically integrated), differences in total annual health care spending were minimal ($79 annually; 95% CI, -$1187 to $1345). In this cross-sectional study of Black and White adults in the US, health care expenditure disparities diminished or disappeared under conditions of both racial and economic equity and equitable health care access; in areas that were mostly high income and had mostly White residents, Black adults spent substantially less. Results underscore the continuing need to recognize place as a contributor to race-based differences in health care spending.

Racial Disparities in the Outcome of Tumor Lysis Sydrome (TLS) - a Five Year Population Based Analysis

DISCUSSION Tumor lysis syndrome (TLS) is a potentially life-threatening complication that occurs in the setting of rapid tumor cell destruction. While several studies have explored the risk factors and management strategies for TLS [1], the impact of racial disparities on the incidence, severity, and outcomes of this syndrome remains understudied. We aim to investigate the impact of race on the outcomes of TLS. Using weighted data from the Nationwide Inpatient Sample (NIS) database from 2016 to 2020, we assessed the outcomes (mortality, hospital utilization, total healthcare charges, complications) of individuals admitted with a primary diagnosis of TLS among races (non-Hispanic Whites, non-Hispanic Blacks, Hispanics, and Others including Native Americans, Asians, and other races/ethnicities). Baseline characteristics (table 1) were analyzed using T-test and Chi-Square, and a multivariate regression analysis was used to estimate outcomes between races, adjusted for patient and hospital confounders. Data analysis was performed using STATA® Version 17.0/SE Software, with statistical significance set at p &amp;lt; 0.05. A total of 4340 were admitted with a primary diagnosis of TLS from 2016 to 2020. Among these, Blacks were the most prevalent (46%), followed by others (34%), Hispanics and whites (33% each). There was no significant difference in comorbid conditions between races. Moreover, no significant differences in the total healthcare expenditures or length of hospital stays were found among races. Pertaining to TLS outcomes, When compared to Whites, Blacks had a statistically significant increase in mortality (OR 2.35, 95%CI: 1.14-4.87). Considering manifestations of TLS, Others (Native Americans, Asians, and other races/ethnicities) had an increased likelihood of cardiac arrest (OR 9.14, 95%CI: 1.11-75.6). No statistically significant difference between races was found for gastrointestinal (GI) bleeding, acute kidney injury (AKI) or sepsis. Our study highlights racial disparities in the outcomes of individuals hospitalized with TLS, including increased mortality in Blacks, and cardiac arrests in Others (Native Americans, Asians, and other races/ethnicities). Interestingly, there were no statistically significant differences in GI bleeding, or sepsis, which are commonly associated with increased mortality in TLS. Further investigations are warranted, particularly through prospective or retrospective studies, to elucidate the underlying factors contributing to these disparities.

The potential use of Lucilla sericata larvae in the local treatment of wounds in diabetic foot syndrome – a literature review

Introduction: The increasing prevalence of diabetes poses a heightened risk of vascular complications in the lower limbs. The costs associated with wound management are substantial, accounting for approximately 1-3% of total healthcare expenditures in developed countries. Implementing and maintaining preventative, interdisciplinary, and comprehensive care have become prioritized objectives for scientific societies.&#x0D; Purpose: This study conducts a literature review and analysis concerning the application of Lucilia sericata larvae in the local treatment of wounds in diabetic foot syndrome.&#x0D; Method: Literature analysis spanning from 2012 to 2023 was conducted, utilizing PubMed and Termedia databases with keywords such as diabetic foot ulcer, Lucilia sericata, and maggot debridement therapy. Exclusion criteria comprised studies that treated wounds locally using methods other than larval therapy.&#x0D; Conclusions: Larval therapy in patients with diabetic foot syndrome accelerates wound debridement by stimulating reparative processes within the wound. The use of Lucilia sericata larvae may contribute to the reduction of antibiotic therapy duration, decreased hospitalization rates, and lowered amputation risks.

Effectiveness of an Integrated Ambulatory Care Program in Health Care and Medication Use in Patients With Multimorbidity and Polypharmacy.

Multimorbidity increases risks, such as polypharmacy, inappropriate prescription, and functional decline. It also increases medical care utilization by older adults, placing a burden on health care systems. This study evaluated the effectiveness of an integrated ambulatory care program for health care and medication use in patients with multimorbidity and polypharmacy. We conducted a retrospective clinical review of adults with multimorbidity and polypharmacy who attended an integrated ambulatory care program at a 1193-bed university hospital between July 1 and September 30, 2019. This program involves multidisciplinary teamwork, comprehensive assessments, medication reviews, and case management. Outcomes, including the frequency of outpatient visits, emergency department visits, hospitalizations, chronic prescription medications, potentially inappropriate medications (PIMs), health care costs, and total medical expenditure, were compared before and after the program. The mean age of participants (n = 134) at baseline was 74.22 ± 9.75 years. The mean number of chronic diagnoses was 9.45 ± 3.38. Participants included 72 (53.7%) women. At the 1-year follow-up, participants showed a significant decrease in the annual frequency of outpatient visits (19.78 ± 9.98 to 13.90 ± 10.22, P < .001), emergency department visits (1.04 ± 1.70 to 0.73 ± 1.40, P = .029), and chronic disease medications (10.71 ± 3.96 to 9.57 ± 3.67, P < .001) across all age groups. There was also a reduction in the annual number of PIMs (from 1.31 ± 1.01 to 1.12 ± 0.93, P = .002) among patients aged 65 years. However, no effects were observed on annual hospitalization, duration of hospital stay, or total health care expenditure, possibly due to the high disease-related treatment cost for certain participants. Expanding integrated ambulatory care programs in Taiwan may help patients with multimorbidity reduce their use of outpatient and emergency services, chronic prescriptions, and PIMs.