Total Healthcare Resource Utilization Research Articles

Clinical characteristics and healthcare resource utilization in patients with chronic obstructive pulmonary disease in Hong Kong

ObjectivesChronic obstructive pulmonary disease (COPD) is a significant cause of mortality, with its prevalence projected to rise in Asia. The primary objective of this study was to describe clinical characteristics, maintenance treatment, and healthcare resource utilization (HCRU) among patients with COPD in Hong Kong. Secondary objectives were to assess patient demographics and clinical characteristics by eosinophil (EOS) levels, and compare the demographics, clinical characteristics, and treatment patterns of patients on multiple-inhaler triple therapy (MITT). MethodsThis study analyzed a cohort of patients with COPD who had entered a previously initiated prospective cohort study involving patients with COPD and/or asthma at the Prince of Wales Hospital between 2017 and 2019. ResultsPatients with COPD were enrolled (N = 220, mean age 74.3 years, 97 % male). Twelve months prior to baseline assessment, 66 % of patients were on MITT, 17 % on long-acting muscarinic antagonists (LAMAs)/long-acting beta-agonists (LABAs), and 7 % on inhaled corticosteroids (ICS)/LABA. Compared with ICS/LABA or LAMA/LABA, more patients on MITT experienced ≥1 exacerbation (26.7 %, 10.5 %, 39.7 %, respectively). Patients on MITT also had a higher mean (SD) COPD Assessment Test score (9.4 [5.9]) and modified Medical Research Council Dyspnea Scale score (1.7 [0.7]) and incurred the most COPD-related and total HCRU costs. Compared with patients with EOS ≤300 cells/μL, those with EOS >300 cells/μL had a higher number of exacerbations. ConclusionsPatients with COPD in Hong Kong treated with MITT presented more severe disease profiles and incurred higher costs. These data can be used for decision making in patients with moderate-to-severe COPD in Hong Kong.

Assessing the impact of the COVID-19 pandemic on newly diagnosed metastatic lung cancer healthcare resource utilization and costs in the United States.

164 Background: The COVID-19 pandemic has derailed normal operations in the healthcare delivery systems in the US and globally, providing prioritized care to patients seeking acute management of the novel coronavirus and its complications. Simultaneously, cancer screening tests have decreased, resulting in decreased rates of cancer diagnoses and referrals to oncologists. The purpose of this study was to assess metastatic lung cancer-related and total healthcare resource utilization (HCRU) and costs during the pandemic/post-pandemic period compared with the pre-pandemic period. Methods: A retrospective claims study using de-identified medical and pharmacy insurance adjudicated claims from national and sub-national health plans and self-insured employer groups was initiated in patients greater than 18 years of age with commercial, commercial self-pay, and Medicare Advantage insurance. Analyses were conducted from January 1, 2019 to February 29, 2020, the pre-pandemic period, and compared to March 1, 2020 to April 30, 2021, the pandemic/post-pandemic period. Multivariable logistic regression models were used to assess the probability of having a hospital, ER or hospice/palliative visit. Multivariable linear regression models were used to see differences in the utilization of outpatient visits. Multivariable Generalized Linear Models with a log transformation and gamma distribution were used to see if there were differences in healthcare costs. Results: 3,230 (pre-pandemic period) and 2,922 (pandemic/post-pandemic period) patients with newly diagnosed metastatic lung cancer were included in the study. The mean age of the patients in the pre-pandemic period was 61.1 years and 61.3 years in the pandemic/post-pandemic period. The odds of receiving outpatient and inpatient hospice/palliative care, inpatient and ER care were lower in the pandemic/post-pandemic period. After controlling for all variables, (OR=0.813; 95% CI: 0.729, 0.906), p=0.0002. Per patient per month (PPPM) metastatic lung cancer-related and total costs were higher in the pandemic/post-pandemic time period. After controlling for all variables, (Cost ratio=1.059; 95% CI: 1.023, 1.096), p=0.0011. Conclusions: This is the first study assessing the impact of the COVID-19 pandemic on HCRU and costs in patients with newly diagnosed metastatic lung cancer.

0550 Positive Airway Pressure for Obstructive Sleep Apnea in Diastolic Heart Failure Patients Reduces Healthcare Resource Utilization

Abstract Introduction Although diastolic heart failure (HFpEF) patients frequently have comorbid obstructive sleep apnea (OSA), which has been associated with poor prognosis, the impact of positive airway pressure (PAP) therapy remains unclear. This retrospective study sought to investigate the association between 1 year adherence to PAP therapy and healthcare resource utilization (HCRU) in patients with newly diagnosed OSA and comorbid HFpEF. Methods A national sample of administrative claims data linked to objective PAP therapy usage was used for this analysis. Eligible patients either had two healthcare encounters or one hospitalization with a diastolic heart failure ICD-10 diagnosis code the year prior to being diagnosed with OSA and initiated on PAP therapy. HCRU was measured as a composite outcome of hospitalizations and emergency room (ER) visits. Propensity score matching was used to create well-balanced groups with differing PAP adherence levels to assess the association with 1 year HCRU outcomes. Risk-adjusted models were used to generate the number needed to treat (NNT) that referred to the number of patients that need to become adherent to PAP from non-adherent to avoid 1 visit. Results 4,237 patients with OSA and comorbid HFpEF were included. With propensity score matching, 963 PAP adherent and 963 non-adherent patients remained. After 1 year of PAP therapy, adherent patients had fewer visits than non-adherent patients (1.16 visits per subject vs. 1.75, p < 0.001), driven by a 57% reduction in hospitalizations and a 36% reduction in ER visits for adherent patients. Total HCRU costs were lower in adherent patients than in non-adherent patients ($12,732 vs. $15,610, p< 0.01). Converting 1 patient from non-adherent to adherent would avoid 1.25 visits (either ER visit or hospitalization), with an NNT of 0.8. Conclusion HFpEF patients with OSA that are adherent to PAP therapy for 1 year have fewer hospitalizations and ER visits than patients that are not adherent. More importantly, HCRU costs were lower in adherent patients, highlighting the clinical and economic benefits of treating OSA with PAP therapy in HFpEF patients. Support (if any) Funding Source: ResMed

Abstract 15002: Real-World Healthcare Resource Utilization Among US Patients With Atrial Fibrillation Receiving Dronedarone versus Ablation as 1st-Line Therapy

Introduction: Catheter ablation is used increasingly as a 1st-line (1L) alternative to antiarrhythmic drugs (AAD) including dronedarone in patients with atrial fibrillation (AF). Healthcare resource utilization (HCRU)-related costs with dronedarone vs 1L ablation are unknown. Methods: We conducted a retrospective, observational cohort study using Optum Clinformatics Data Mart® from Jan 2012-Jan 2022 among US adults with AF and no prior rhythm control therapy who received new AAD therapy with dronedarone (index: date of incident dronedarone fill) vs those who received 1L ablation, or a non-dronedarone AAD followed by ablation within 3 mo (index: date of first recorded ablation or AAD). Patients were required to have ≥24 mo of pre-index data, and ≥3 mo follow-up. Patients in the 1L ablation cohort were propensity score matched 2:1 to the dronedarone cohort. Mean payer costs per patient per month (PPPM) during the 24-mo post-index period were calculated for total HCRU, inpatient visits, emergency room (ER) visits, outpatient physicians’ office visits, and all outpatient visits, and compared by zero-inflated negative binomial (ZINB) regression model. Results: Post-matching, the dronedarone (n=1440) and 1L ablation (n=2253) cohorts had similar baseline characteristics (mean age at index: 68.4 vs 67.7 years; male: 57.7% vs 59.3%; mean time from AF diagnosis to index: 80.2 vs 91.6 days; Charlson comorbidity index: 2.3 vs 2.2; CHADS2-VASc score: 3.4 vs 3.2). Mean PPPM costs were lower with dronedarone vs 1L ablation for all-cause total HCRU, inpatient visits, any outpatient visit, ER visit, and outpatient office visit (Table). ZINB analyses showed significant cost differences for all-cause total HCRU and any outpatient visit events. Conclusion: In patients with AF and no prior rhythm control therapy, 1L dronedarone was associated with lower total HCRU and outpatient visit costs during 24-mo follow-up vs 1L ablation; future studies will assess cost-effectiveness.

Healthcare Economics of High Frequency Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy.

Painful diabetic peripheral neuropathy (pDPN) is a debilitating complication of long-term diabetes. High-frequency spinal cord stimulation (HF-SCS) was recently shown to be an effective treatment option, but the associated healthcare resource utilization (HCRU) on real-world patient populations with pDPN is unknown. Using IBM MarketScan databases, we identified patients with HF-SCS implantation between January 2016 and December 2019 who had a diagnosis of diabetes or diabetic neuropathy within two years before implant. Cost data were collected for the six months before HF-SCS implantation (baseline) and for the periods of one, three, and six months post-implantation. The six-month explant rate was calculated. A total of 132 patients met inclusion criteria. The median total cost at baseline was $19 220 and was $1356 at one month post-implant, $4858 at three months post-implant, and $13 305 at six months post-implant. The median baseline out-of-pocket cost was $1477 and was $710 at six months post-implant. The average total cost reduction from baseline to six months post-implant was $5118 (P < .001), or $853 per month. The median device acquisition cost was $35 755. The explant rate within six months was 2.1%. High frequency spinal cord stimulation significantly reduces total HCRU in patients with pDPN, and based on the average monthly cost reduction of $853, we estimate that the therapy recoups acquisition costs within 3.5 years. As policy increasingly focuses on value-based care, it will be critical to consider the cost and outcomes of innovative therapies.

Comparing the cost-effectiveness of the Otago Exercise Programme among older women and men: A secondary analysis of a randomized controlled trial.

ObjectiveUsing stratified analyses, we examined the cost-effectiveness of the Otago Exercise Programme (OEP), from a health care system perspective, among older women and men who have previously fallen.MethodsThis study was a secondary stratified analysis (by women and men), of a 12-month prospective economic evaluation of a randomized clinical trial (OEP compared with usual care). Three hundred and forty four community-dwelling older adults (≥70; 172 OEP (110 women; 62 men), 172 usual care (119 women; 53 men)) who sustained a fall in the past 12 months and received a baseline assessment at the Vancouver Falls Prevention Clinic, Canada were included. A gender by OEP/usual care interaction was examined for the falls incidence rate ratio (IRR). Outcome measures stratified by gender included: falls IRR, incremental cost-per fall prevented (ICER), incremental cost per quality adjusted life year (QALY, ICUR) gained, and mean total health care resource utilization costs.ResultsMen were frailer than women at baseline. Men incurred higher mean total healthcare costs $6794 (SD: $11906)). There was no significant gender by OEP/usual care interaction on falls IRR. The efficacy of the OEP did not vary by gender. The adjusted IRR for the OEP group demonstrated a 39% (IRR: 0.61, CI: 0.40–0.93) significant reduction in falls among men but not women (32% reduction (IRR: 0.69, CI: 0.47–1.02)). The ICER showed the OEP was effective in preventing falls and less costly for men, while it was costlier for women by $42. The ICUR showed the OEP did not impact quality of life.ConclusionFuture studies should explore gender factors (i.e., health seeking behaviours, gender related frailty) that may explain observed variation in the cost-effectiveness of the OEP as a secondary falls prevention strategy.Trial registrationsClinicalTrials.gov Protocol Registration SystemIdentifier: NCT01029171; URL: https://clinicaltrials.gov/ct2/show/NCT01029171Identifier: NCT00323596; URL: https://clinicaltrials.gov/ct2/show/NCT00323596

POSA387 Healthcare Resource Utilization and Direct Medical Costs in French Patients Receiving Treatment for Hypogammaglobulinemia: A National Cohort Study

The Objectives: of this study were to describe and compare the healthcare resource utilization (HCRU) and direct medical costs among French patients receiving subcutaneous immunoglobulins (SCIgs) for hypogammaglobulinemia. SCIgs are either weekly conventional (cSCIg) or monthly hyaluronidase-facilitated SCIg (fSCIg). This retrospective cohort included newly treated patients (absence of Ig-administration during the previous 6 months) with primary (PID) or secondary (SID) immunodeficiency receiving SCIgs over 2016-2018 within the French National Healthcare database. SCIg-related HCRU/costs (health insurance perspective, discounted to €2019), at-home (nurse [NV] and pump provider visits [PPV], drug doses) and in-hospital were analyzed. These variables were compared using Poisson models adjusted for patient characteristics. Overall, 2,012 patients (534 PIDs; 1,478 SIDs) were analyzed. Compared to fSCIg-subgroups, monthly mean rates of NV and PPV were respectively 2.5 and 3.1 times higher in PID cSCIg-treated patients, and 1.6 and 3.1 times higher in SID cSCIg-treated patients, leading to costs 2.6 and 2.3 times higher, both in PIDs and SIDs. Monthly mean costs related to SCIg-administration for all hospitalizations (with and without stayover) were 1.6 times and 1.8 times higher for cSCIg versus fSCIg -treated patients, in PIDs and SIDs respectively. Such differences are related to the observed hospitalizations types, fSCIg-treated patients had more frequent but less costly hospitalizations (without stayover) versus cSCIg-treated patients. SCIg drug costs were 1.4 and 1.2 times lower for cSCIg versus fSCIg, in PIDs and SIDs respectively. The total HCRU costs related to SCIg-administration was estimated to be 575€ and 1851€ lower with fSCIg versus cSCIg, in PIDs and SIDs respectively. Regardless of the SCIg indication, fSCIg-treated patients had lower HCRU costs for SCIg-administration versus cSCIg-treated patients. The higher hospitalizations rates without stayover in fSCIg subgroup can be explained by the dose adjustment necessary during treatment initiation.

Health care resource utilization and costs associated with advanced or metastatic nonsmall cell lung cancer in the United States.

BACKGROUND: The treatment landscape for advanced nonsmall cell lung cancer (NSCLC) has evolved from 2015 onward, since the introduction of immune checkpoint inhibitors (ICIs). Considering this shift, there have been limited prior analyses that assess the economic burden of NSCLC within the current treatment landscape. OBJECTIVE: To present an analysis of health care resource utilization (HCRU) and costs associated with the treatment of patients with advanced or metastatic NSCLC in the United States between 2010 and 2019. METHODS: Patients with locally advanced or metastatic NSCLC who initiated first-line (1L) systemic treatment between January 1, 2010, and June 30, 2019, were included from the HealthCore Integrated Research Database using a previously developed claims-based predictive model algorithm. Mean total HCRU and costs and mean per-person-per-year (PPPY) HCRU and costs were estimated for 2 follow-up periods: the time during the entire follow-up period and the time during the 1L treatment period. Distribution of treatment classes (defined as chemotherapy, ICIs, targeted therapies, and others) were also analyzed by index year. RESULTS: 27,257 patients met the eligibility criteria and were included in the analysis. The mean duration of follow-up for all patients was 16.6 months (median 10.6 months), and the median time to discontinuation of 1L treatment was 2.8 months. The number of outpatient visits accounted for the majority of HCRU across the entire study follow-up (mean 97.7 in total and 147.1 PPPY) and for the 1L treatment period (mean 46.3 in total and 167.5 PPPY). The total mean cost across the entire study follow-up was $158,908 ($250,942 PPPY). For the 1L treatment period, the total mean cost was $72,760 ($271,590 PPPY). Total mean outpatient costs for systemic anticancer treatment were $61,797 for the entire study follow-up ($85,609 PPPY) and $27,138 during the 1L treatment period ($92,412 PPPY). Total costs increased over the study duration, which were mainly due to increasing outpatient costs for systemic therapy. In both follow-up periods, inpatient costs, other outpatient costs (nonsystemic therapy-related costs), and pharmacy costs remained relatively stable but still accounted for more than 60% of the total costs. Analysis of treatment classes over time showed that chemotherapy was the most frequently used treatment, regardless of line of therapy. A trend was observed for increased ICI use from 2015 onward. CONCLUSIONS: Despite the improvement in treatment options, a high economic burden associated with the treatment of NSCLC still exists. The total costs have been increasing, mainly driven by outpatient costs for systemic therapy, which might reflect the greater use of ICIs for advanced NSCLC. Costs for inpatient services, other outpatient services, and pharmacy services remained stable but still accounted for the majority of the economic burden. Further studies are required to assess the impact of innovative treatments on the disease management costs of advanced NSCLC. DISCLOSURES: This study was funded by the healthcare business of Merck KGaA, Darmstadt, Germany (CrossRef Funder ID: 10.13039/100009945) as part of an alliance between the healthcare business of Merck KGaA, Darmstadt, Germany, and Pfizer. Zhang, Liu, and Yang are employees of EMD Serono. Beachler, Dinh, and Jamal-Allial are employees of HealthCore Inc., which received funding from the healthcare business of Merck KGaA, Darmstadt, Germany, and Pfizer for the implementation of this study. Masters and Kolitsopoulos are employees of Pfizer. Lamy was an employee of the healthcare business of Merck KGaA, Darmstadt, Germany, at the time this study was conducted.

PRS7 Characteristics, Cost and Health Care Resource Use in a Population of Medicare Fee-for-Service (FFS) Patients with Chronic Obstructive Pulmonary Disease (COPD) Who Also Experience Pneumonia

Patients with COPD are at increased risk for lung infections, such as pneumonia. However, few studies have characterized the impact of pneumonias on health care resource utilization (HRU) and cost in Medicare Fee-for-Service (FFS) patients. The objective of this study was to characterize and estimate outcomes among patients with pneumonia, compared to those without pneumonia. A retrospective analysis of COPD patients between 1/1/2016 and 12/31/2017 using FFS claims was conducted. To evaluate HCRU and costs, propensity scoring and exact matching were used to create a one-to-one matched cohort of incident pneumonia patients to those without pneumonia. Patient demographics, comorbidities (Charleston Comorbidity Index [CCI]), and treatments were evaluated before and after matching. HCRU and associated healthcare costs were assessed during the 12-months post-index. Regression models were utilized to compare adjusted outcomes between groups after matching. In the baseline cohort of 2.46M patients, incident pneumonia patients (15.5%) were older (mean age: 73.7 vs. 71.9 years), with more comorbidities (CCI: 4.5 vs. 3.1). 35.7% of pneumonia patients experienced ≥1 baseline exacerbation vs. 13.2% without pneumonia (unadjusted OR: 3.65; p<0.05). After matching, demographic and clinical differences between groups were balanced with N=330,435 in each cohort. In the matched cohort, post-index HCRU after pneumonia event were significantly higher (all p<0.05) for hospitalizations (65.8% vs. 35.9%), ER visits (58.3% vs. 53.1%), and outpatient office visits (94.1% vs. 92.2%) versus the control cohort. Matched unadjusted post-index mean all-cause costs were 58.9% higher in the pneumonia cohort ($53,268; 95% CI: $52,812-$53,734, p<0.0001) compared to those without pneumonia ($33,523; 95% CI: $33.402-$33,644, p<0.0001). After adjustment total costs remained 51.9% higher for the pneumonia cohort. Patients with COPD who experience pneumonia also experience more exacerbations and have significantly higher total HRU and costs when compared to non-pneumonia patients, primarily driven by the difference in hospitalizations.

PCV35 Costs of Septal Reduction Therapy for Obstructive Hypertrophic Cardiomyopathy: A US Claims Analysis

To quantify total healthcare resource utilization (HCRU) costs for patients with obstructive hypertrophic cardiomyopathy (oHCM) receiving septal myectomy (SM) or alcohol septal ablation (ASA). Retrospective study utilizing medical and pharmacy claims data representing >50 million US commercially insured and Medicare Advantage members from the HealthCore Integrated Research Database during 2013-2019. Direct medical costs included inpatient, outpatient, emergency department, and pharmacy (2019 $ US) and were the sum of plan paid, patient paid, and any coordination of benefit. HCRU costs were captured for ≥1 SM or ASA procedure for oHCM patients (≥18 years) and reported 12-months pre- and post-procedure. Of 119 identified patients, 95 (80%) received SM. Mean length of inpatient hospitalization stay was longer for SM (8.3 days) than ASA (6 days). Post-surgery HCM-related medication usage was greater for SM (98%) than ASA (88%). Mean number of outpatient visits increased from pre- to post-surgery (SM=12.2 vs 15.9; ASA=7.2 vs 9.5), with 86% of SM and 83% of ASA patients having ≥1 cardiology visit. Compared to the pre-surgery, total HCM-related costs increased during post-surgery period, index surgery inclusive (SM=$27,045 vs $119,772; ASA=$11,278 vs $54,351), driven by increased inpatient hospitalization (SM=$10,325 vs $112,923; ASA=$5,509 vs $47,450) and surgical cost (SM=$6,665 vs $92,031; ASA=$52 vs $44,815). For pre-SM vs post-SM, HCM-related medication costs decreased ($974 vs $744) along with outpatient visit costs ($14,202 vs $5,782); for ASA, HCM-related medication ($827 vs $1,201) and outpatient visit costs increased ($4,645 vs $5,431). Our results indicate a trend towards increasing costs after septal reduction therapy, driven mostly by inpatient hospitalization and surgical costs. All outpatient costs decreased after myectomy, while only diagnostic cost decreased in the ablation group. HCRU increased after surgery for both groups, with length of stay and HCM-related medication use being higher in SM.

Economic and clinical outcomes of pegfilgrastim via prefilled syringe vs on-body injector: a real-world data analysis.

BACKGROUND: Pegfilgrastim is available as a prefilled syringe (PFS) and an on-body injector (OBI). Whether the administration method of pegfilgrastim affects the effectiveness and health care resources has not been evaluated in the setting of routine care. OBJECTIVE: To compare real-world clinical and economic outcomes between PFS and OBI methods of administration. METHODS: This was a retrospective observational study in patients diagnosed with breast cancer or non-Hodgkin lymphoma who received myelosuppressive chemotherapy and prophylactic use of pegfilgrastim via PFS or OBI between January 1, 2017, and May 31, 2018, according to MarketScan research databases. A propensity score was used to match the PFS cohort 1:1 to the OBI cohort. Outcomes were compared among the matched cohorts using a generalized linear model and generalized estimating equations with log-link function. RESULTS: 3,152 patients were identified. After matching, the final sample included 2,170 patients, representing 1,085 in each cohort. The incidence of febrile neutropenia (FN) in the first chemotherapy cycle was 1.01% for OBI (95% CI = 0.56-1.82) vs 1.48% for PFS (95% CI = 0.91-2.39; P = 0.336). In all chemotherapy cycles (total cycles = 7,467), the FN incidence was 0.91% for OBI (95% CI = 0.64-1.30) vs 1.22% for PFS (95% CI = 0.90-1.64; P = 0.214). There was no statistically significant difference in adjusted per-member per-month all-cause total cost health care resource utilization (HCRU) for hospitalizations, emergency department visits, and pharmacy claims. CONCLUSIONS: In a matched cohort of patients representing real-world utilization, there was no statistically or clinically meaningful difference in FN incidence between OBI and PFS methods of pegfilgrastim administration. There was no difference in total HCRU or total costs. OBI and PFS methods of administration are both indicated for patients requiring prophylactic pegfilgrastim, which is important considering that biosimilar PFS options are now available. DISCLOSURES: This study was funded by Sandoz, Inc. Wang, Li, and K. Campbell are employees of Sandoz, Inc. Schroader and D. Campbell are employees of Xcenda, which was contracted by Sandoz, Inc., to provide study and manuscript development. McBride reports receiving payment from Sandoz, Inc., as a consultant, unrelated to this study; Coherus for advisory board and speaker engagements; and Pfizer for advisory board participation during the time of this study.

Factors associated with clinical and economic outcomes following total knee replacement for patients with osteoarthritis

Purpose: Total knee replacement (TKR) is considered a definitive treatment for osteoarthritis (OA) after other interventions have failed. This study evaluated clinical characteristics and total healthcare resource utilization (HCRU) relative to the timing of surgery and examined factors associated with surgical outcomes and healthcare costs following TKR.

POS-327 THE COST OF END OF LIFE INPATIENT ENCOUNTERS IN PATIENTS WITH CHRONIC KIDNEY DISEASE IN THE UNITED STATES

Real-world data reporting healthcare resource utilization (HCRU) and costs associated with end of life inpatient encounters in patients with CKD are limited. Within the DISCOVER CKD observational study of patients with CKD, the PREMIER dataset (Premier Applied Sciences®, Premier Inc) of hospital admissions in the US was analysed, covering the period from 2016 until end of March 2020. Patients were aged ≥18 years at first recorded CKD diagnosis code (ICD-10 code indicating CKD stages 3-5; or kidney failure). Inpatient hospital deaths were identified as inpatient encounters where the discharge status was death. Precise information on cause of death was unavailable, therefore as a proxy these encounters were classified as cardiovascular (CV), kidney failure, or infection-related if a corresponding diagnosis code was recorded as the primary or admitting reason for the encounter, with the remaining unclassified encounters grouped as “other”. The cost (USD) of an inpatient encounter ending in mortality was calculated as the total HCRU incurred during the encounter. The payor for the encounter was identified as either Commercial, Medicaid, Medicare or Other (remaining unclassified or unknown payor types). A total of 237,734 inpatient encounters which ended in mortality were observed with mean (SD) age at death of 74.2 (12.4) years, with the regional distribution of these encounters matching the regional distribution of CKD patients in the dataset (Table 1). Of these encounters, 10.6% were attributed to CV, 1.8% to kidney failure and 32.1% to infection. Given the advanced age of the population, the majority of encounters had Medicare payor coverage. The average (SD) cost of CV related encounters (n=20,779) was $30,874.89 ($73,841.18); kidney failure encounters (n=3,573) $37,588.15 ($274,523.52), and infection-related encounters (n=63,541) was $27,194.42 ($40,980.16). The cost of end of life inpatient encounters was high overall with kidney failure incurring the highest average cost. Despite all patients having CKD, relatively few end of life encounters were attributed to kidney failure, demonstrating the health economic burden of patients with CKD and associated comorbidities.

Healthcare resource utilization and costs among patients with relapsed and/or refractory multiple myeloma treated with proteasome inhibitors in real-world clinical practice in Germany

Aims To assess the real-world healthcare resource utilization (HRU) and costs associated with different proteasome inhibitors (PIs) for the treatment of patients with relapsed and/or refractory multiple myeloma (RRMM) in Germany. Methods We conducted a retrospective medical chart review of treatment patterns, outcomes, and HRU for patients with RRMM treated with bortezomib, carfilzomib, or ixazomib in second- or third-line (2L or 3L) therapy in Germany. Data were collected between 1 January 2017 and 30 June 2017. Costs were calculated based on drug prices and unit costs in Germany. Results Physicians provided data on 302 patients. Mean monthly total direct costs per patient receiving PI-based therapy were €7,925 and €10,693 for 2L and 3L, respectively, of which approximately 90% was anti-myeloma drug costs. Overall, the highest costs were associated with patients receiving 3L therapy. Regardless of treatment line, costs were higher for patients who had received a stem cell transplant (SCT) in a previous treatment line than for those who had not; the data suggest that this reflects the use of triplet regimens following a SCT. Patients with a complete response (CR) experienced no unplanned hospitalizations during the study period, whereas patients with progressive disease experienced the highest number of unplanned and planned hospitalizations. In 2L therapy, the highest proportion of patients with a CR was observed in those receiving carfilzomib (12% carfilzomib; 4% bortezomib; 0% ixazomib). Limitations Patients with missing or incomplete follow-up data were included in the study and were accounted for using monthly cost estimates. Conclusions Anti-myeloma drugs were the main contributor to total HRU costs associated with RRMM in Germany. Improved treatment response was associated with lower costs and reduced hospitalizations.

Healthcare Resource Utilization and Cost in Patients with Relapsed/Refractory Classical Hodgkin's Lymphoma Who Received Autologous Stem Cell Transplantation in the US

Introduction: Limited real-world studies exist on the management of relapsed/refractory (R/R) classical Hodgkin's lymphoma (cHL) patients (pts) who failed autologous stem transplant (auto-SCT) and their subsequent healthcare resource utilization (HRU) and cost. Current treatment options include chemotherapy, a second auto-SCT, allogenic (allo-) SCT, palliative care, or newer therapies like brentuximab vedotin (BV) or programmed death-1 (PD-1) blocking antibodies. Pts eligible for treatment post auto-SCT failure may consume significant resources and using real-world data may inform the place of therapy of newly approved agents. Therefore, the objectives of this study were to compare HRU and cost among R/R cHL pts who received auto-SCT by transplant success and failure. Methods: This retrospective cohort study used electronic medical record (EMR) data of US pts from a network of oncology practices, including practices affiliated with CancerLinQ, maintained in the Definitive Oncology Dataset. Eligible adult (≥18 years) pts who had a confirmed diagnosis of cHL and ≥1 R/R event that occurred between 2000 to 2019 were included. Treatment patterns included any systemic anti-cancer therapy received post auto-SCT failure. Descriptive analyses examined differences by auto-SCT success vs failure. Auto-SCT failure was defined as having a R/R event or disease progression after receipt of auto-SCT. HRU included hospitalization rates, emergency department (ED) visits, and infused supportive care drugs. Costs (inflated for 2020$) were based on matched Health Care Utilization Project coded events. HRU and costs were reported per patient per month (PPPM) from initial cHL diagnosis (first-line [1L] therapy) through the second R/R event (third-line [3L] therapy) and for 3L among a subset of pts who failed auto-SCT in second line (2L). PPPM was calculated by dividing the total HRU or cost during the observation period by the number of months of the observation period and then averaged across all pts (regardless of being flagged for a specific service). Results: A total of 157 pts (54.9%) received auto-SCT among the R/R cHL cohort (n=286). Most pts were Caucasian (77.7%) with a median age of 31 years (range: 19-73) at the first R/R event. Median length of follow-up was 11 months from the first R/R event. Nearly all pts (91.7%) received auto-SCT after the start of 2L (68.2%, n=107) and 3L (23.6%, n=37). Approximately 9.6% (n=15) also received allo-SCT in later lines. Among auto-SCT pts, 62.4% (n=98) had a transplant success vs 37.6% (n=59) with a transplant failure. Across these 59 pts, 46 (78.0%) received treatment post auto-SCT failure. Treatment post auto-SCT failure consisted of 21 different anti-cancer regimens (monotherapy or in combination) and included BV (alone or in combination) (37.3%, n=22), chemotherapy (30.5%, n=18), PD-1 therapy (alone or in combination) (6.8%, n=4), other (5.1%, n=3), and allo-SCT (1.7%, n=1). The 59 pts with auto-SCT failure primarily failed in 2L (66.1%, n=39) and 3L (27.1%, n=16). HRU and costs for the 39 pts who failed auto-SCT in 2L were substantial in 3L. Approximately 92.3% of pts had a hospitalization, 30.8% had an ED visit, and 51.3% received infused supportive care treatment in 3L. Monthly costs in 3L were high: hospitalization $3,903, ED visit $130, infused supportive care $279, anti-cancer therapy $64,572, and $69,186 total. From the start of 1L through the end of 3L, the proportion of pts with a hospitalization was significantly higher for pts who failed auto-SCT (Table). Subsequently, costs were also higher and average length of stay longer. While HRU did not differ, infused supportive care costs were higher for auto-SCT pts. No significant differences in HRU and cost were observed across the two groups for ED visits and oncology setting outpatient visits. Anti-cancer therapy costs were significantly higher for pts who failed auto-SCT. Total monthly costs were higher for pts who failed auto-SCT. Conclusion: In the real-world setting, almost 40% of R/R cHL pts failed auto-SCT. There appears to be no clear standard of care post auto-SCT failure and using real-world data may inform the place in therapy of newer therapies. The HRU and cost of managing post auto-SCT failure was substantial and highlights the significant unmet need in this population. These findings add to the scarce real-world data on treatment patterns, utilization, and cost among R/R cHL pts who receive auto-SCT. Disclosures Yang: Merck &amp; Co, Inc.: Current Employment. Desai:Merck &amp; Co., Inc: Current Employment, Current equity holder in publicly-traded company. Gilligan:ConcertAI: Current Employment; Merck &amp; Co., Inc.: Research Funding. Raut:Merck &amp; Co., Inc.: Current Employment. Nahar:Merck Sharp &amp; Dohme, Corp., a subsididary of Merck &amp; Co., Inc., Kenlworth, NJ, USA: Current Employment.

Direct Medical Costs of Dementia With Lewy Bodies by Disease Complexity

ObjectivesThere is currently no accurate profile of the economic burden of dementia with Lewy bodies (DLB), particularly any examination of the direct medical costs of DLB by the number of affected clinical domains. Understanding how trends in the use of healthcare resources evolve as DLB progresses presents opportunities for the development of earlier and more appropriate interventions. DesignRetrospective study using claims data extracted from the IBM MarketScan Commercial and Medicare Supplemental database. Setting and ParticipantsIn total, 536 patients with DLB from the Commercial database and 5485 patients with DLB from the Medicare Supplemental database. MethodsPatients were grouped into disease complexity categories based on core clinical features (ie, fluctuating cognition, motor symptoms, visual hallucinations, and rapid eye movement sleep behavior disorder in addition to dementia) observed during the study period: dementia with no core features observed, dementia plus 1, 2, or ≥3 core features, respectively. Outcome measures included healthcare resource utilization and healthcare costs. ResultsIn both databases, total healthcare resource utilization and costs increased with number of core features. Compared with patients with no core features observed, patients in all other complexity categories had significantly higher mean medical visits and costs in both adjusted and unadjusted analyses. Fluctuating cognition was associated with the highest total costs, suggesting that this clinical feature in particular is associated with a considerable economic burden. Conclusions and ImplicationsAnalyzing direct medical costs of DLB by disease complexity using claims data showed that a higher cost impact was associated with increasing number of clinical domains affected and with specific clinical domains, suggesting the need for both targeted and comprehensive interventions to improve the overall economic burden of DLB.

Treatment patterns and healthcare resource utilization in palmoplantar pustulosis patients in Japan: A claims database study.

BackgroundPalmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory autoimmune condition, characterized by sterile pustules on the palms and soles. The treatment patterns of PPP and total health care resource utilization in Japan are not well described. Investigating these areas is needed to understand current PPP management in Japan.ObjectiveTo describe the characteristics, medication treatment and health care resource utilization patterns, and associated costs of PPP patients in Japan.MethodsA retrospective analysis of insurance claims data was conducted using the Japan Medical Data Center database. Adult Patients with at least two claims with a PPP diagnosis from January 1, 2011 to March 30, 2017 and six months of follow-up after the first diagnosis were included. Patient characteristics described include age, gender, and comorbid conditions. Treatment patterns assessed include the types of treatment, sequence of treatment, and rates of discontinuation, switching, persistence and use of concomitant medications.ResultsA total of 5,162 adult patients met all inclusion criteria. Mean (SD) patient age was 49.7 (11.6) years and 43.2% were male. A total of 2441 patients (47.8%) received systemic non-biologic drugs during the entire follow up period, 2,366 (46.4%) were prescribed topical therapy, 273 (5.4%) were prescribed phototherapy, while 18 (0.4%) of patients with other autoimmune comorbidities were eligible for prescribed biologics. For treatment-naïve patients with mild PPP, topical therapy was most commonly (77.1%) prescribed, whereas in moderate to severe cases of PPP, systemic non-biologic drugs (65%) were most often used. The frequency of switching was similar (64.3% to 75.3%) across various therapies and treatment lines.ConclusionThis study describes the treatment patterns and health care resource utilization for Japanese PPP patients using a large claims database, and highlights an unmet need to derive better treatment strategies for PPP and address disease burden in Japan.

Greater Red Blood Cell Transfusion Burden Is Associated with More Healthcare Resource Utilization in Patients with Beta-Thalassemia

Introduction: Previous studies have examined the total healthcare resource utilization (HCRU) of patients with beta-thalassemia in relation to the general population. However, limited studies have examined the impact of red blood cell transfusion (RBCT) burden on broad aspects of HCRU beyond transfusion costs among patients with beta-thalassemia. Methods: Patients with beta-thalassemia in Taiwan's National Health Insurance Research Database (NHIRD) in 2016 were identified (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] of D56.1). The index date was the first medical claim in the database after 2001. Identified patients were followed from the index date until the end of the study period (December 31, 2016). During the follow-up period, RBCT units and HCRU (all-cause and thalassemia-related) were measured. Thalassemia-related HCRU was defined as any HCRU claim accompanied by a thalassemia or beta-thalassemia diagnosis code. To control for the different lengths of follow-up between patients, both RBCT units and HCRU were reported as the average per 12 weeks over the entire follow-up period. Patients were categorized into 4 cohorts based on the average number of RBCT units received per 12 weeks during follow-up: 0 RBCT units; &gt; 0 to &lt; 6 RBCT units; ≥ 6 to &lt; 12 RBCT units; or ≥ 12 RBCT units. HCRU outcomes of interest were hospital admissions, hospitalized days, outpatient visits, and emergency room (ER) visits. Descriptive statistics were computed to describe HCRU observed in each cohort. Results: A total of 2,984 patients with beta-thalassemia were included in the analysis, with a mean follow-up of 6.87 years. Mean age at index was 37.8 (standard deviation 23.7) years, and 1,903 (63.8%) patients were female. A total of 1,616 (54.2%) patients did not receive RBCT units during the follow-up period. Of the remaining 1,368 patients, 1,112 (81.3%) received &gt; 0 to &lt; 6 RBCT units, 112 (8.2%) received ≥ 6 to &lt; 12 RBCT units, and 144 (10.5%) received ≥ 12 RBCT units per 12 weeks during follow-up. Mean all-cause and thalassemia-related HCRU was higher for transfused patients than for non-transfused patients across all HCRU categories. Thalassemia-related hospital admissions, hospitalized days, and outpatient days all increased as the transfusion burden increased. Patients in the cohort with the highest average transfusion burden (≥ 12 RBCT units per 12 weeks) had numerically greater mean thalassemia-related hospital admissions (0.5; standard error [SE] = 0.04), hospitalized days (2.5; SE = 0.21), and outpatient visits (4.9; SE = 0.41) than the other cohorts (Figure). Conclusions: Patients with beta-thalassemia and higher average transfusion burden during the follow-up period had additional HCRU compared with patients who required fewer RBCT units. These data may support physician and payer understanding of the downstream economic impact of RBCT burden in beta-thalassemia. Disclosures Tang: GSK: Consultancy; Roche: Research Funding; Pfizer: Research Funding; Janssen: Research Funding; Amgen: Research Funding. Furnback:Sanofi: Consultancy; Regeneron: Consultancy; Celgene Corporation: Consultancy; Abbott: Consultancy; Astellas: Consultancy; Pfizer: Consultancy; Eli Lilly: Consultancy; Janssen: Consultancy; Johnson &amp; Johnson: Consultancy; Gilead: Consultancy; Novocure: Consultancy; Progentec Diagnostics: Consultancy; Becton Dickinson: Consultancy; AstraZeneca: Consultancy; Bristol-Myers Squibb: Consultancy. Wang:Gilead Sciences: Consultancy, Equity Ownership; Celgene Corporation: Consultancy, Equity Ownership; Regeneron Pharmaceuticals: Consultancy, Equity Ownership; Novocure: Consultancy; Pfizer: Consultancy; Eli Lilly: Consultancy; Johnson &amp; Johnson: Consultancy; Astellas: Consultancy; Amgen, Vertex Pharma, Illumina, Biogen, Alexion Pharma, Incyte, Biomarin Pharma, Seattle Genetics, Sarepta Therapeutics, Array Biopharma, Ionis Pharma, Sage Therapeutics, Mylan NV, Neurocrine Biosciences, Bio Techne Corp, Jazz Pharma, Alnylam Pharma, Blue: Equity Ownership. Tang:Asclepius Analytics: Employment. Huang:Celgene Corporation: Employment. Tang:Celgene Corporation: Employment, Equity Ownership. Musallam:Celgene Corporation: Consultancy.

A Retrospective Claims Analysis of Advanced Prostate Cancer Costs and Resource Use.

BackgroundCastration-resistant prostate cancer (CRPC) is associated with high costs and healthcare resource utilization (HCRU).ObjectiveThis study followed patients with CRPC through their continuum of care and analyzed claims data regarding treatments, total HCRU, and costs, both before and after metastasis diagnosis.MethodsA retrospective cohort of patients with newly diagnosed metastatic CRPC (mCRPC) in the USA was identified from the Truven Health MarketScan database from January 2009 to March 2015. The mCRPC algorithm employed International Classification of Diseases, Ninth Revision codes for prostate cancer (pre-index) and secondary metastatic disease (index date) and a subsequent claim for a US FDA-approved treatment for mCRPC. Patient inclusion required evidence of surgical or pharmacological castration and no evidence of bone-targeted treatments during the baseline period while evaluating continuous enrollment 25 months pre-index and 6 months post-index. Treatment patterns were assessed during pre- and post-index periods; HCRU and costs were annualized for comparison purposes regarding both pre- and post-index timeframes.ResultsAmong 261 patients with mCRPC (mean age 72 years), the most common treatments during the pre-index period were bicalutamide (90.04%), leuprolide (81.99%), abiraterone (22.22%), docetaxel (20.69%), and ketoconazole (18.01%). Mean per-patient-per-year (PPPY) all-cause annualized healthcare costs significantly increased from $US35,102.55 in the pre-index nonmetastatic CRPC (nmCRPC) period to $US156,499.89 after metastasis diagnosis (mCRPC). Mean PPPY inpatient admissions and emergency department visits increased from 0.20 to 1.36 and from 0.63 to 1.56, respectively.ConclusionsAverage yearly costs and HCRU were four times higher following mCRPC diagnosis, indicating a need for appropriate management strategies to optimize the potential delay of disease progression among patients with nmCRPC.

The association of pain interference and opioid use with healthcare utilization and costs, and wage loss among adults with osteoarthritis in the United States

Aim: To examine associations of opioid use and pain interference with activities (PIA), healthcare resource utilization (HRU) and costs, and wage loss in noninstitutionalized adults with osteoarthritis in the United States (US).Methods: Adults with osteoarthritis identified from the Medical Expenditure Panel Survey for 2011/2013/2015 were stratified by no-opioid use with no/mild PIA, no-opioid use with moderate/severe PIA, opioid use with no/mild PIA, and opioid use with moderate/severe PIA. Outcomes included annualized total HRU, direct healthcare costs, and wage loss. Multivariable regression analyses were used for comparisons versus no-opioid use with no/mild PIA (referent). The counterfactual recycled prediction method estimated incremental costs. Results reflect weighted nationally representative data.Results: Of 4,921 participants (weighted n = 20,785,007), 46.5% had no-opioid use with no/mild PIA; 23.2% had no-opioid use with moderate/severe PIA; 9.6% had opioid use with no/mild PIA; and 20.7% had opioid use with moderate/severe PIA. Moderate/severe PIA and/or opioid use were associated with significantly higher HRU and associated costs, and wage loss. Relative to adults with no/mild PIA, opioid users with moderate/severe PIA were more likely to have hospitalizations, specialist visits, and emergency room visits (all p < .001). Relative to the referent, opioid use with no/mild PIA had higher per-patient incremental annual total healthcare costs ($11,672, 95% confidence interval [CI] = $11,435–$11,909) and wage loss ($1,395, 95% CI = $1,376–$1,414) as did opioid use with moderate/severe PIA ($13,595, 95% CI = $13,319–$13,871; and $2,331, 95% CI = $2,298–$2,363) (all p < .001). Compared with the referent, estimated excess national total healthcare costs/lost wages were $23.3 billion/$1.3 billion for opioid use with no/mild PIA, and $58.5 billion/$2.2 billion for opioid use with moderate/severe PIA.Limitations: Unobservable/unmeasured factors that could not be accounted for.Conclusions: Opioid use with moderate/severe PIA had significantly higher HRU, costs, and wage loss; opioid use was more relevant than PIA to the economic burden. These results suggest unmet needs for alternative pain management strategies.