US Consumer Price Index Research Articles

Understanding Investor Sentiment: Analyzing Its Influence on Stock and Cryptocurrency Markets During the Russia–Ukraine War

ABSTRACTThis paper examines the shifts in investor sentiment during the Russia–Ukraine war and its consequent impact on market volatility. By employing a comprehensive dataset that includes the S&P 500 index, historical Bitcoin prices, the Investor Sentiment Index, the Industrial Production Index, and the US Consumer Price Index, this study applies several econometric models such as generalized autoregressive conditional heteroskedasticity (GARCH) models, regression analyses, vector error correction models (VECM), and the Granger causality model. The analysis spans from January 2021 to March 2023. The findings indicate that investor sentiment significantly influences returns in both stock and cryptocurrency markets, having a positive effect. These results underscore the importance for investors and policymakers to monitor investor sentiment during periods of conflict to understand its potential impact on financial markets. This research offers valuable insights that can guide investment decisions and inform policy interventions.

Trend and burden of cancer related hospitalizations in the US: Insights from a National Inpatient Sample Database analysis.

1543 Background: Cancer-related hospitalizations constitute one of the primary drivers of cancer-related healthcare expenses. Understanding the burden and characteristics of these hospitalizations is essential to appropriately direct resources, improve outcomes, and avoid unnecessary hospitalizations. Our study sought to evaluate the national trends, reasons, disposition status, length of stay, and associated costs for cancer-related hospitalizations. Methods: We conducted a retrospective analysis of cancer hospitalizations using the 2008-2019 National Inpatient Sample. Cancer-related hospitalizations were identified using validated Clinical Classification Software (CCS) codes 11 to 45. Trends in hospitalization volume, mortality, length of stay, disposition status, and costs were analyzed overall and by cancer type, adjusted according to the US Consumer Price Index. Results: There were 371 million weighted hospitalizations from 2008 to 2019, of which 15.1% (56 million) were cancer related. The most reported cancer types were breast cancer (11.9%), secondary malignancies (11.2%), and prostate cancer (10.3%). The most common reasons for cancer-related hospitalizations were septicemia (4.8%), pneumonia (4.7%), and complications of surgical procedures or medical care (3.1%). Trend analysis showed that the total number of cancer-related hospitalizationsincreased from 12,963 to 16,500 per 100,000 hospitalizations during the study period (relative increase, 27.3%). Mortality rates decreased from 5.1% to 4.0% (relative decrease, 21.6%), while the length of stay decreased from 3.5 to 3.2 days (relative decrease, 8.6%) during the study period. Disposition to home or short-term facilities decreased (relative decrease, 3.1%), while to long-term facilities increased (relative increase, 20.6%) during the same period. Total hospitalization cost increased from $55.5 billion in 2008 to $76.4 billion in 2019 (a relative increase of 37.7%). Conclusions: Our analysis shows that while cancer-related hospitalizations and associated costs increased substantially, mortality rates, and length of stay decreased. These trends reflect rising cancer burden but improvements in hospital cancer care quality and efficiency. Ongoing efforts to optimize cancer treatment, minimize unnecessary hospitalizations, reduce length of stay, and facilitate safe discharges are needed to improve patient outcomes and control costs further. Continued surveillance and health policies should address the rising demand for high-value cancer care.[Table: see text]

The Impact of COVID-19 on the US Consumer Price Index (CPI)

This research investigates the profound impact of irregular commodity price changes during unusual circumstances, particularly focusing on the COVID-19 pandemic. The research stems from the recognition that global events have the potential to trigger irregular and drastic changes in commodity prices. This research holds significant implications for both consumers and policymakers in navigating the complexities of global crises. The research employs the Consumer Price Index (CPI) as a crucial indicator to chart drastic changes in consumer product prices from January 2019 to September 2023. To establish a baseline, CPI data from January 2010 to December 2018 is utilized, and an Autoregressive Integrated Moving Average (ARIMA) model is employed to forecast hypothetical CPI for the target period. The comparison between forecasted and observed CPI data reveals the vast influence of the COVID-19 pandemic on consumer prices. This research explores various subcategories of CPI, emphasizing sectors such as Food and Beverage, Transportation, Housing, and Medical Care. The research found that COVID-19 leads to delays and lagging effects in certain sectors reflecting the overall increase in consumer product prices. The Medical Care CPI also exhibited the most complexity, reflecting the immediate and direct impact of the pandemic on healthcare costs.

Development and application of machine learning models in US consumer price index forecasting: Analysis of a hybrid approach

<p>This study aims to apply advanced machine-learning models and hybrid approaches to improve the forecasting accuracy of the US Consumer Price Index (CPI). The study examined the performance of LSTM, MARS, XGBoost, LSTM-MARS, and LSTM-XGBoost models using a large time-series data from January 1974 to October 2023. The data were combined with key economic indicators of the US, and the hyperparameters of the forecasting models were optimized using genetic algorithm and Bayesian optimization methods. According to the VAR model results, variables such as past values of CPI, oil prices (OP), and gross domestic product (GDP) have strong and significant effects on CPI. In particular, the LSTM-XGBoost model provided superior accuracy in CPI forecasts compared with other models and was found to perform the best by establishing strong relationships with variables such as the federal funds rate (FFER) and GDP. These results suggest that hybrid approaches can significantly improve economic forecasts and provide valuable insights for policymakers, investors, and market analysts.</p>

Development and application of machine learning models in US consumer price index forecasting: Analysis of a hybrid approach

Development and application of machine learning models in US consumer price index forecasting: Analysis of a hybrid approach

Time Series Modeling and Forecasting of US Consumer Price Index Using WTI Crude Oil Price

This study aims to forecast U.S. inflation by using crude oil prices as a key variable. WTI crude oil price and Consumer Price Index Year-over-Year (CPI YoY) data from 2000 to 2022 are extracted to construct a time series model. The empirical analysis relies on Autoregressive Integrated Moving Average (ARIMA) model and regression to formulate forecasts based on historical patterns and error dynamics. The study finds out that compared to the automatically generated ARIMA model, using fitted values of the WTI time series model to predict CPI YoY through a multi-variable model is better. According to the prediction, the CPI YoY forecast for 2023 reveals a decreasing tendency in 2023, implying a slower rate of increase in U.S. inflation. The result provides insights into economic conditions, helps decision-making, and mitigates the potential risks associated with price fluctuations. Overall, the research contributes to a deeper understanding of the dynamics between energy markets and inflationary pressures in the United States.

Abstract 19065: Resource Utilization After Cardiac Surgery in Adults With Congenital Heart Diseases: A Nationwide Analysis

Objective: This study examined resource utilization following cardiac surgery among ACHD patients.Methods: We used the NIS (2012-2018) to identify >18yo admissions with TOF, Pulmonary valve anomalies/Congenital Pulmonary Stenosis, cTGA, DORV, TGA, HLHS, and Ebstein's anomaly and Open-heart valve or Great Vessels\Conduit replacement procedures. Hospitalization costs were adjusted for inflation to 2022 US dollars using the medical care component of the US Consumer Price Index. A mixed-effect linear regression model was used to identify factors associated with increased costs.Results: Out of 91,565 admissions, 4,578 involved one of the procedures of interest. The median age was 32 (IQR 34 - 46), and 46.6% were females. The median hospitalization cost was $54,400 (IQR 40,990 - 74,520). Valve procedures were the most common (79%). Overall, 19% of admissions had multiple HRU codes, with Blood transfusions (12.5% ) and ICD/pacemakers (7.2% being the most common. The high and low tercile group had a median hospitalization cost of $92,370 (IQR 74,850 - 120,900) and $36,300, IQR 31,180 - 40,930). Hospital-level factors, complications, and the need for HRU services significantly increased hospitalization costs. Notably, in-hospital mortality was associated with a 58% cost increase. Conclusion: Although the proportion of ACHD admissions requiring cardiac surgery is relatively low, the economic burden is significantly high, particularly those with in-hospital mortality. On average, higher hospitalization costs are associated with complications, the utilization of HRU procedures, the type of hospital providing care, and the US region.

Dating common commodity price and inflation shocks with alternative approaches

This paper investigates the occurrence of common price shocks (co-exceedance) across different commodities. IMF monthly price series of 11 commodities are considered over the 1980-2021 period. The analysis considers two alternative stochastic processes. The first looks for common volatility clusters using individual GARCH models to detect whether and when respective clusters overlap. Through an appropriate battery of tests, the second alternative looks for a common Bubble Generating Process (BGP) by searching for individual explosive roots and then dating them to identify the possible overlaps and first movers. Evidence emerging about these shock generating processes is linked to the analogous behaviour of the US Consumer Price Index (CPI) to assess to what extent inflation shocks can be associated to the observed commodity price spikes. Results show that the detection of temporary bubbles and volatility clusters only partially agrees on the episodes of exuberance, on the first-moving commodities and on the involvement of the CPI. This provides helpful suggestions on the development of a real-time surveillance tool supporting policy intervention in periods of commodity price turbulence.

Transformation of investor attitude towards financial markets: A perspective on the Russia–Ukraine conflict

AbstractThe ongoing conflict between Russia and Ukraine has significantly affected global financial markets, requiring investors to adapt their attitudes accordingly. This study aims to explore the transformation of investor attitudes towards financial markets within the context of the Russia–Ukraine conflict. By analysing monthly data spanning from January 2021 to March 2023, including Standard and Poor 500 index, Bitcoin historical price, gross national income, US consumer price index and investor attitude index, various models such as regression, the vector error correction model, generalized autoregressive conditional heteroskedasticity and the granger causality model are utilized. The findings reveal a noteworthy and positive impact of investor attitude on returns in both markets. Positive investor sentiment is linked to higher returns and enhanced market confidence. Particularly, investor attitude's influence is particularly pronounced during wartime, as global net income exerts a significant negative effect on both markets. These findings emphasize the necessity of evaluating the financial health of industrial companies prior to making investment decisions amidst periods of conflict. Furthermore, the results provide remarkable guidelines for policymakers and investors, underscoring the necessity of tracking the investor attitudes during wartime and acknowledging their potential impact on investment decision‐making in financial markets.

The consumer price index prediction using machine learning approaches: Evidence from the United States

The consumer price index (CPI) is one of the most important macroeconomic indicators for determining inflation, and accurate predictions of CPI changes are important for a country's economic development. This study uses multivariate linear regression (MLR), support vector regression (SVR), autoregressive distributed lag (ARDL), and multivariate adaptive regression splines (MARS) to predict the CPI of the United States. Data from January 2017 to February 2022 were randomly selected and divided into two stages: 80 % for training and 20% for testing. The US CPI was modeled for the observed period and relied on a mix of elements, including crude oil price, world gold price, and federal fund effective rate. Evaluation metrics—mean absolute percentage value, mean absolute error, root mean square error, R-squared, and correlation of determination—were employed to estimate forecasted values. The MLR, SVR, ARDL, and MARS models attained high accuracy parameters, while the MARS algorithm generated higher accuracy in US CPI forecasts than the others in the testing phase. These outputs could support the US government in overseeing economic policies, sectors, and social security, thereby boosting national economic development.

The Russia–Ukraine conflict and investor psychology in financial markets

AbstractThis study examines the effect of the Russia–Ukraine conflict on global financial markets and the resulting changes in investor psychology. We have analysed weekly data from January 2021 to March 2023, including indicators such as gross national income, Bitcoin historical price, Standard and Poor 500 index, US consumer price index, US dollar index, and investor psychology index, using a variety of econometric techniques. Our findings reveal a positive and significant correlation between investor psychology and market returns. These results highlight the importance of monitoring investor psychology during times of conflict as it can greatly impact investment decisions in financial markets, providing valuable insights for investors and policymakers.

Economic benefits of substance use disorder treatment: A systematic literature review of economic evaluation studies from 2003 to 2021

IntroductionThe economic burden of substance use disorder (SUD) is significant, comprising costs of health care and social services, criminal justice resources, loss of productivity, and premature mortality. This study assembles and synthesizes two decades of evidence describing the benefits of SUD treatment across five main outcome domains; 1) health care utilization; 2) self-reported criminal activity by offense type; 3) criminal justice involvement collected from administrative records or self-reported; 4) productivity assessed through working hours or wages earned; and 5) social services (e.g., a day spent in transitional housing). MethodsThis review included studies if they reported the monetary value of the intervention outcomes, most commonly through a cost-benefit or cost-effectiveness framework. The search included studies from 2003 to the present day as of this writing (up to October 15, 2021). Summary cost estimates were adjusted using the US Consumer Price Index (CPI) to reflect the 12-month benefits per client in USD 2021. We followed the PRISMA methodology for study selection and assessed quality using the Checklist for Health Economic Evaluation Reporting Standards (CHEERS). ResultsThe databases yielded 729 studies after removing duplicates, and we ultimately selected 12 for review. Studies varied widely regarding analytical approaches, time horizons, outcome domains, and other methodological factors. Among the ten studies that found positive economic benefits, reductions in criminal activity or criminal justice costs represented the largest or second largest component of these benefits (range $621 to $193,440 per client). ConclusionsConsistent with previous findings, a reduction in criminal activity costs is driven by the relatively high societal cost per criminal offense, notably for violent crimes, such as aggravated assault and rape/sexual assault. Accepting the economic rationale for increased investment in SUD interventions will require recognizing that more benefits accrue to individuals by avoiding being victims of a crime than to governments through budget offsets resulting from savings in non-SUD program expenses. Future studies should explore individually tailored interventions to optimize care management, which may yield unexpected economic benefits to services utilization, and criminal activity data to estimate economic benefits across a broad range of interventions.

Charting Trends in Medicare Reimbursement for Lower Extremity Imaging.

Medicare reimbursement is rapidly declining in many specialties. An in-depth analysis of Medicare reimbursement for routinely performed diagnostic imaging procedures in the United States is warranted. The purpose of this study was to evaluate Medicare reimbursement trends for the 20 most common lower extremity imaging procedures performed between 2005 and 2020, including radiographs, computed tomography (CT), and magnetic resonance imaging (MRI). We hypothesized that Medicare reimbursement for imaging procedures would decline substantially over the studied period. Cohort study. The Physician Fee Schedule Look-up Tool from the Centers for Medicare and Medicaid Services was analyzed for reimbursement rates and relative value units associated with the top 20 most utilized Current Procedural Terminology (CPT) codes in lower extremity imaging from 2005 to 2020. Reimbursement rates were adjusted for inflation and listed in 2020 US dollars using the US Consumer Price Index. To compare year-to-year changes, the percentage change per year and compound annual growth rate were calculated. A 2-tailed t test was used to compare the unadjusted and adjusted percentage change over the 15-year period. After adjusting for inflation, mean reimbursement for all procedures decreased by 32.41% (P = .013). The mean adjusted percentage change per year was -2.82%, and the mean compound annual growth rate was -1.03%. Compensation for the professional and technical components for all CPT codes decreased by 33.02% and 85.78%, respectively. Mean compensation for the professional component decreased by 36.46% for radiography, 37.02% for CT, and 24.73% for MRI. Mean compensation for the technical component decreased by 7.76% for radiography, 127.66% for CT, and 207.88% for MRI. Mean total relative value units decreased by 38.7%. The commonly billed imaging procedure CPT 73720 (MRI lower extremity, other than joint, with and without contrast) had the greatest adjusted decrease of 69.89%. Medicare reimbursement for the most billed lower extremity imaging studies decreased by 32.41% between 2005 and 2020. The greatest decreases were noted in the technical component. Of the modalities, MRI had the largest decrease, followed by CT and then radiography.

Abstract 11038: Clinical Characteristics and Outcomes of High-Cost Pediatric Heart Transplant Hospitalizations in the United States

Introduction: Pediatric heart transplantation (HT) is resource-intensive, with the HT hospitalization being a major driver of costs. We sought to determine the characteristics and outcomes of patients whose HT hospital admissions incur high costs. Methods: The Pediatric Health Information System database was queried for pediatric (<18 y) hospital admissions between 1/1/2008 and 12/31/2021 in which HT was performed. High-cost HT admission was defined as ≥95 th percentile of cost for all HT admissions during the study period. Costs were standardized across centers using a cost-to-charge ratio; all cost values (in US dollars) were indexed to the 2020 US Consumer Price Index. The primary outcome was mortality during the index HT admission. Clinical characteristics and outcomes were compared between high-cost HT admissions and lower-cost HT admissions (<95 th cost percentile) using logistic regression. Results: A total of 4352 pediatric HTs were identified; for the entire cohort, median HT admission cost was $501,535 (IQR $270,291 - $902,302). Within the high-cost group (N = 217), HT admission costs ranged from $1,971,069 - $44,500,000; the majority (N = 195) had costs between $2 million and $5 million. High-cost admissions accounted for 23% of costs within the entire cohort. Median length of stay in the high-cost group was 247d (IQR 160d-342d) and 59d (IQR 24d-115d) in the lower-cost group (P<0.001). High-cost HT admissions increased over time (2.9% of admissions in 2008; 5.5% in 2021, P<0.001). Patients with high-cost HT admissions were younger (1y vs 6y, P<0.001), more likely to have single ventricle congenital heart disease (42.4% vs 28.9%, P<0.001), undergo ECMO (55.3% vs 19.3%) and/or VAD (37.3% vs 16.2%, P<0.001 for both), and receive dialysis (13.8% vs 3.6%, P<0.001). Hospital mortality was higher in high-cost HT patients (22.6% vs 4.2%, P<0.001); this relationship persisted after adjusting for clinical and center characteristics (OR 7.2, 95% CI 4.97 - 10.57, P<0.001). Conclusions: High-cost admissions for pediatric HT contribute disproportionately to overall hospital mortality and cost after HT, and are associated with high resource utilization. These findings highlight opportunities to improve outcomes in this growing and high-risk population.

A VECM analysis of Bitcoin price using time-varying cointegration approach

This study proposed an optimal model to examine the relationship between the Bitcoin price and six macroeconomic variables – the Bitcoin price, Standard and Poor's 500 volatility index, US treasury 10-year yield, US consumer price index, gold price and dollar index. It also examined the effectiveness of the vector error correction model (VECM) in analyzing the interrelationship among these variables. The authors employed the following approach: first, the authors sampled the period August 2010–February 2022. This is because Bitcoin achieved a market capitalization of more than US$1 tn over this period, gaining market attention and acceptance from retail, corporate and institutional investors. Second, the authors employed a VECM with the six macroeconomic variables. Finally, the authors expanded the long-run equilibrium relationship (time-invariant cointegration)-based VECM to develop a time-varying cointegration (TVC) VECM. The authors estimated the TVC VECM using the Chebyshev polynomial specification based on various information criteria. The results showed that the Bitcoin price can be modeled with the VECM (p = 1, r = 1). The TVC approach generated more explanatory power for Bitcoin pricing, indicating the effectiveness of the approach for modeling the long-run relationship between Bitcoin price and macroeconomic variables.

Procedural Trends in Medicare Reimbursement and Utilization for Breast Reconstruction: 2000-2019.

Development of appropriate reimbursement models for breast reconstruction in the United States requires an understanding of relevant economic trends. The purpose of this study is to evaluate longitudinal patterns in Medicare reimbursement for frequently performed breast reconstruction procedures between 2000 and 2019. Reimbursement data for 15 commonly performed breast reconstruction procedures were analyzed using the Centers for Medicare & Medicaid Services Physician Fee Schedule Look-Up Tool for each Current Procedural Terminology code. By utilizing changes to the US consumer price index, monetary data were adjusted for inflation to 2019 US dollars. Inflation-adjusted trends were used to calculate average annual and total percentage changes in reimbursement over time. From 2000 to 2019, average adjusted reimbursement for all procedures fell by 13.32%. All procedures demonstrated a negative adjusted reimbursement rate other than immediate insertion of breast prosthesis, which increased by 55.37%. The largest mean decrease was observed in breast reconstruction with other technique (-28.63%), followed by single pedicle transverse rectus abdominis myocutaneous flap (-26.02%), single pedicle transverse rectus abdominis myocutaneous flap with microvascular anastomosis (-23.33%), latissimus dorsi flap (-19.65%), and free flap reconstruction (-19.36%). There has been a steady yet substantial decline in Medicare reimbursement for the majority of breast reconstruction procedures over the last 20 years. Given increasing medical costs and the financial uncertainty of the US health care system, an understanding of Medicare reimbursement trends is vital for policymakers, administrators, and physicians to develop agreeable reimbursement models that facilitate growth and economic vitality of breast reconstruction in the United States.

Adverse Events, Resource Use, and Economic Burden in Patients with Mantle Cell Lymphoma in the United States

Introduction : In patients with mantle cell lymphoma (MCL), adverse events (AEs) can impair patient adherence to planned therapeutic regimens. In addition, moderate to severe AEs generally require medical attention and therefore are often associated with increased health care resource use (HRU) and costs. Real-world data on HRU and costs associated with MCL and its treatments are sparse in current literature. The goals of this study were: (1) assess HRU and direct costs of MCL; (2) examine variation in costs across treatment types; and (3) document the economic burden associated with MCL treatment-related AEs.Methods :A retrospective cohort analysis was performed using MarketScan databases that contain employer- and health-plan-sourced administrative claims data, including information on diagnoses, procedures, and associated utilization of health care services for over 60 million privately insured individuals across the US. Cost information in the data include patient copay, coinsurance, charges, and the actual amounts paid by the payers. Patients were included if they were aged ≥18 years, had at least two medical claims on separate dates with a diagnosis code for MCL (ICD-9-CM code 200.4x or ICD-10-CM code C83.1x) during July 2010-June 2015, and were continuously enrolled in medical and drug plans for ≥12 months before the date of first MCL diagnosis (ie, study index date). Patients with evidence of MCL diagnosis or MCL treatment in the 12 months before the study index date were excluded. Mean per-patient monthly HRU and costs were assessed overall and by care setting (eg, inpatient, outpatient, pharmacy). Both all-cause and MCL-related costs were calculated; all cost data, adjusted to 2016 US dollars using the Medical Care component of the US Consumer Price Index, were assessed from the payer's perspective. The incremental HRU and costs associated with AEs were assessed by stratifying these measures according to patients' AE status (AE or no AE) and the number of AEs experienced (0, 1-2, 3-5, ≥6) during follow-up. Additionally, subgroup analyses were conducted to assess the association of AEs with mean HRU and costs among patients receiving specific regimens. All analyses were descriptive in nature.Results :In total, 783 patients with MCL (median age, 65 years [range, 19-99 years]) met the study selection criteria. Mean (standard deviation [SD]) all-cause and MCL-related monthly costs were $8393 ($16,276) and $6730 ($14,779), respectively. Inpatient admission costs ($4817 [$14,267]) and office visit costs ($1493 [$3250]) were the largest drivers of total all-cause costs. Among patients receiving systemic therapies, mean all-cause monthly costs were highest for rituximab/cyclophosphamide/doxorubicin/vincristine (R-CHOP), followed by ibrutinib monotherapy, bendamustine/rituximab (B-R), and rituximab alone (including rituximab maintenance therapy) (Figure 1); prescription drug costs were highest in patients receiving ibrutinib ($14,038 [$21,936]). The median length of stay per all-cause inpatient admission was 3.0 days (range, 2-4) among patients with no AE, which increased to 5.2 days (range, 1-50) among those with six or more AEs, as observed during all available follow-up (Figure 2). A corresponding increase in the length of stay per admission was also observed, with increasing numbers of AEs. The mean (SD) all-cause monthly costs were $4298 ($10,082) among those with no AEs and more than twofold higher ($10,335 [$16,868]) among those with at least six AEs during follow-up (Figure 3).Conclusions :This is the largest series of patients with MCL in which real-world economic burden data have been reported. Our results demonstrate that the economic burden of MCL is substantial, with mean monthly costs varying considerably by treatment regimen and care setting. We found that inpatient admissions and office visits were the largest drivers of total costs for patients treated with R-CHOP, B-R, and rituximab, while prescription drug costs were the largest component of total costs for patients receiving ibrutinib. Patients experiencing more AEs were observed to have higher monthly costs than those experiencing few AEs. [Display omitted] DisclosuresKarve:AstraZeneca: Employment, Other: Stocks. Nagar:RTI Health Solutions: Research Funding. Goyal:RTI Health Solutions: Research Funding. Kaye:RTI Health Solutions: Research Funding. Mato:Regeneron: Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Portola: Research Funding; Janssen: Consultancy; Pharmacyclics: Research Funding; DTRM: Research Funding; Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead Sciences, Inc.: Membership on an entity's Board of Directors or advisory committees; AbbVie: Consultancy, Research Funding; Acerta: Research Funding; AstraZeneca: Consultancy; Kite: Consultancy.

Changes in Medicare Physician Reimbursement for Stroke Procedures from 2000 to 2019

ABSTRACT BACKGROUND There is limited data regarding financial trends for procedural reimbursement in stroke care. A comprehensive understanding of such trends is important as continued progress is made to advance agreeable reimbursement models in the care of stroke patients. OBJECTIVE To evaluate monetary trends in Medicare reimbursement rates for commonly utilized procedures in stroke care from 2000 to 2019. METHODS The Centers for Medicare & Medicaid Services was queried for the included Current Procedural Terminology (CPT) codes and reimbursement data were extracted. The CPT codes compiled were the most commonly performed procedures for stroke-related International Classification of Diseases (ICD)-10 codes at our institution (I60-I63). Additionally, data were collected for alteplase and telestroke codes. The rate of change between procedures was compared utilizing an unpaired Student's t-test. All monetary data were adjusted for inflation to 2019 US dollars utilizing the US Consumer Price Index. RESULTS After adjusting for inflation, the average reimbursement for stroke (ICD I60-I63) procedures decreased by 11.2% from 2000 to 2019 (average of −0.43% per year). The adjusted reimbursement rate for included telestroke codes decreased by 12.1% from 2010 to 2019 (average of −1.4% per year). From 2005 to 2019, the reimbursement for alteplase rose by 163.98% (average of +7.3% per year). CONCLUSION When adjusted for inflation, Medicare reimbursement for common stroke procedures has decreased from 2000 to 2019. In contrast, reimbursement for alteplase has increased markedly. It is important to be aware of these trends in order to contextualize healthcare economic analyses and inform discussions.

Economic and Clinical Burden of Virus-Associated Hemorrhagic Cystitis in Patients Following Allogeneic Hematopoietic Stem Cell Transplantation

Introduction: Hemorrhagic cystitis (HC) due to viral infections, such as BK virus, cytomegalovirus and/or adenovirus, after Allogeneic Hematopoietic Cell Transplantation (allo-HCT) causes morbidity and mortality, impacts quality of life, and poses a substantial burden to the health care system. Virus-associated HC (V-HC) occurs in up to 25% and 54% of pediatric and adult allo-HCT recipients respectively. V-HC is associated with incapacitating pain, life-disturbing urinary symptoms, and in severe forms, severe hematuria requiring transfusion support, bladder obstruction, renal impairment and increased mortality. At present, management is purely supportive as there are no approved or recommended anti-virals for V-HC. The impact of V-HC on health resource utilization (HRU) and HCT outcomes has not been studied at a national level. The objective of this study was to compare the economic burden, HRU and clinical outcomes among allo-HCT recipients with V-HC to those without V-HC using a large US claims database. Methods: A US claims database obtained from the Decision Resources Group Real World Evidence Data Repository was used to identify patients with first (index) allo-HCT procedure from 1/1/2012-12/31/2017. The 1-year period prior to the index allo-HCT was considered as the baseline period. Although, there are diagnosis codes in the International Classification of Diseases (ICD-9 or ICD-10) coding system for HC, there are no specific diagnosis codes to identify V-HC. Hence, an algorithm was developed through clinical guidance to identify these patients among those with HC diagnosis codes (Figure 1). Outcomes were examined in the 1-year post allo-HCT and included total healthcare reimbursements, HRU and clinical outcomes for allo-HCT patients with vs. without V-HC. Total reimbursements were estimated from submitted charges using a reimbursement-to-charge ratio of 0.425 and were reported in 2019 US dollars, adjusted using the medical care component of the US Consumer Price Index. Further, a generalized linear model was used to determine adjusted reimbursements stratified by the presence or absence of any acute or chronic graft-versus-host diseases (GVHD) after adjusting for age, health plan, underlying disease, stem cell source, number of comorbidities, baseline costs, and follow-up time. Results: Of 13,363 allo-HCT recipients, 759 (5.7%) patients met the criteria for V-HC. Total unadjusted mean reimbursement was $632,870 (SD=$640,815) for patients with V-HC and $340,469 (SD=$377,591) for patients without V-HC (Table 1). In multivariable model after adjusting for confounders, the adjusted reimbursements were significantly higher for V-HC patients with and without GVHD compared to patients without V-HC (p<.0001) (Figure 2). V-HC was associated with increased hospital length of stay (LOS) and readmission rates. Patients with V-HC had 7.9 additional days in the hospital (35.5 vs 27.6 days; p<.0001) and 6.1 additional days (34.3 vs. 28.2 days; p=0.0009) in the intensive care unit (ICU) for the index hospitalization, as compared to patients without V-HC (Table 1). The hospital readmission rate was higher for allo-HCT patients with V-HC compared to those without V-HC (3.5 vs. 1.9 per person yr; p<.0001), resulting in 12.9 more days in the hospital (50.0 days vs. 37.1 days; p<.0001) and 7.3 more days in the ICU (25.8 days vs. 18.5 days; p<.0001) after the index hospitalization (Table 1). V-HC was associated with increased mortality in patients with GVHD and increased risk of renal impairment in all allo-HCT patients. Among patients with GVHD, those with V-HC had significantly higher all-cause mortality as compared to those without V-HC (23.2% vs. 18.4%; p=0.0035) (Table 2). When stratified by GVHD, there were no significant differences in the baseline risk for renal impairment; while V-HC was associated with increased risk for renal impairment in the follow-up period in patients with or without GVHD (p<.0001 for both) (Table 2). Conclusions: Allo-HCT patients with V-HC have significantly higher healthcare reimbursements, health resource utilization, and worse clinical outcomes including renal impairment, irrespective of the presence of GVHD; with significantly higher all-cause mortality in the presence of GVHD. Our results highlight the unmet clinical need for effective strategies to prevent and treat V-HC in HCT recipients that may also reduce costs among these patients. Disclosures McGuirk: Pluristem Ltd: Research Funding; Juno Therapeutics: Consultancy, Honoraria, Research Funding; Astellas: Research Funding; Kite Pharmaceuticals: Consultancy, Honoraria, Research Funding, Speakers Bureau; Fresenius Biotech: Research Funding; Novartis: Research Funding; Gamida Cell: Research Funding; Bellicum Pharmaceutical: Research Funding; Allo Vir: Consultancy, Honoraria, Research Funding. Moon:AlloVir, Inc.: Current Employment, Current equity holder in publicly-traded company. Chandak:AlloVir, Inc.: Other: Independent contractor. Zhang:AlloVir, Inc.: Other: Independent contractor. Papanicolaou:Chimerix: Other: Consulting and other fees, Research Funding; Astellas Pharma: Other: Consulting and other fees, Research Funding; Merck & Co.: Other: Consulting and other fees, Research Funding; Octapharma: Other: Consulting and other fees; Partner Therapeutics: Other: Consulting and other fees; ADMA Biologics: Other: Consulting and other fees; Shionogi: Other: Consulting and other fees; Cidara: Other: Consulting and other fees; Amplyx: Other: Consulting and other fees; Siemens: Other; Takeda: Research Funding.

Declining Medicare Reimbursement in Orthopaedic Trauma Surgery: 2000-2020.

To evaluate monetary trends in government (Medicare) reimbursement rates for 20 commonly used orthopedic trauma surgical procedures over a 20-year period. The Physician Fee Schedule Look-Up Tool from the Centers for Medicare & Medicaid Services was queried for the 20 common Current Procedural Terminology (CPT) codes in orthopaedic trauma, and reimbursement data were extracted. All monetary data were adjusted for inflation to 2020 US dollars (USD) using changes to the US Consumer Price Index. Both the average annual and the total percentage change in reimbursement and in Relative Value Units were calculated for all included procedures. After adjusting for inflation, the average reimbursement for all procedures decreased by 30.0% from 2000 to 2020. Total Relative Value Units during this time increased by 4.4% on average. Procedures about the foot and ankle demonstrated the greatest decrease in the mean adjusted reimbursement at -42.6%, whereas procedures about the shoulder and upper extremity demonstrated the smallest mean decrease at 23.7% during the study period. From 2000 to 2020, the adjusted reimbursement rate for all included procedures decreased by an average of 1.5% each year. To the best of our knowledge, this is the first study to comprehensively evaluate trends in procedural Medicare reimbursement for orthopaedic trauma. When adjusted for inflation, Medicare reimbursement for included procedures has steadily decreased from 2000 to 2020. Increased awareness and consideration of these trends will be important for policy makers, hospitals, and surgeons to assure continued access to meaningful surgical orthopaedic trauma care in the United States.