KNG Health Consulting (United States)

Millions of older Americans ages 50 to 64 rely on the nongroup (or individual) health insurance market for coverage. However, high premium and out-of-pocket costs can pose a major burden for those with coverage and prevent uninsured older adults from gaining coverage. Health care affordability challenges can negatively impact access to care. The American Rescue Plan Act of 2021 addressed a critical need for older adults by improving health care affordability in the nongroup health insurance market for two years. This paper analyzes 2019 affordability data, providing important context for the new law while illuminating the need for permanent measures.

Nasogastric tubes (NGTs) are used for decompression in patients with acute small bowel obstruction (SBO); however, their role remains controversial. There is evidence that NGT use is still associated with high incidence of aspiration pneumonia. The aims of this study were to define the prevalence of aspiration pneumonia in patients with SBO managed with an NGT and estimate the association of aspiration pneumonia with 30-day mortality rates, length of stay (LOS), and hospital costs. A retrospective cohort study was done using Medicare Inpatient Standard Analytic Files from 2016 to 2018. Patients hospitalized with SBO and managed with NGT were identified using an algorithm of ICD-10-CM codes. The key exposure was aspiration pneumonia. Outcome measures included 30-day mortality rates, LOS, and hospital costs. 53715 patients hospitalized with SBO and managed with an NGT were identified and included in the analysis. We observed a prevalence of aspiration pneumonia of 7.3%. The 30-day mortality rate was 31% for those who developed aspiration pneumonia vs. 10% for those without pneumonia (P < .001). Those with aspiration pneumonia, on average, were hospitalized 7.0days longer (P < .001) and accrued $20,543 greater hospitalization costs (P < .001) than those without pneumonia. Controlling for hospital size and hospital teaching status, we noted a significant association between aspiration pneumonia and increased mortality (P < .001), longer length of stay (P < .001), and higher hospital costs (P < .001). Among patients hospitalized for SBO who required an NGT, aspiration pneumonia was associated with a higher mortality rate, longer hospital LOS, and higher total hospital costs. vv.

Background: The diagnosis and treatment of femoroacetabular impingement (FAI) have increased steadily within the past decade, and research indicates clinically significant improvements after treatment of FAI with hip arthroscopy. Purpose: This study examined the societal and economic impact of hip arthroscopy by high-volume surgeons for patients with FAI syndrome aged <50 years with noncontroversial diagnosis and indications for surgery. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: The cost-effectiveness of hip arthroscopy versus nonoperative treatment was evaluated by calculating direct and indirect treatment costs. Direct cost was calculated with Current Procedural Terminology medical codes associated with FAI treatment. Indirect cost was measured with the patient-reported data of 102 patients who underwent arthroscopy and from the reimbursement records of 32,143 individuals between the ages of 16 and 79 years who had information in a private insurance claims data set contained within the PearlDiver Patient Records Database. The indirect economic benefits of hip arthroscopy were inferred through regression analysis to estimate the statistical relationship between functional status and productivity. A simulation-based approach was then used to estimate the change in productivity associated with the change in functional status observed in the treatment cohort between baseline and follow-up. To analyze cost-effectiveness, 1-, 2-, and 3-way sensitivity analyses were performed on all variables in the model, and Monte Carlo analysis evaluated the impact of uncertainty in the model assumptions. Results: Analysis of indirect costs identified a statistically significant increase of mean aggregate productivity of $8968 after surgery. Cost-effectiveness analysis showed a mean cumulative total 10-year societal savings of $67,418 per patient from hip arthroscopy versus nonoperative treatment. Hip arthroscopy also conferred a gain of 2.03 quality-adjusted life years over this period. The mean cost for hip arthroscopy was estimated at $23,120 ± $10,279, and the mean cost of nonoperative treatment was estimated at $91,602 ± $14,675. In 99% of trials, hip arthroscopy was recognized as the preferred cost-effective strategy. Conclusion: FAI syndrome produces a substantial economic burden on society that may be reduced through the indirect cost savings and economic benefits from hip arthroscopy.

Cost-effectiveness of sunitinib as second-line treatment for gastrointestinal stromal tumor in the People’s Republic of China Jian Li,1 Hong Ye Ren,2 Juanjuan Zhang,2 Peng Dong,2 Yan Wang,3 Andrea L Stevens,3 Yi Han,3 Min Huang4 1Laboratory of Carcinogenesis and Translational Research for the Ministry of National Education, Department of GI Oncology, Peking University School of Oncology, Beijing Cancer Hospital & Institute, 2Pfizer Inc., Beijing, People’s Republic of China; 3WG Consulting, New York, NY, USA; 4School of Pharmacy, Sun Yat-sen University, Guangzhou, Guangdong, People’s Republic of China Objective: To evaluate the cost-effectiveness of sunitinib as a second-line treatment in patients with advanced gastrointestinal stromal tumors that no longer respond to imatinib 400 mg/d, compared with imatinib 600 mg/d, 800 mg/d, or best supportive care (BSC) in the People’s Republic of China. Methods: This study was conducted from the government payer’s perspective with a time horizon of 5 years. Three health states were considered: progression-free survival, disease progression survival, and death, with a cycle length of 6 weeks. Probabilities of disease progression and death were estimated based on survival functions using exponential distribution and progression survival data in the clinical trials. Drug costs were based on drug retail prices and the patient assistance program in the People’s Republic of China, and adverse event management costs were based on published data and/or expert opinion. Uncertainties for parameters in the study were addressed through one-way deterministic and probabilistic sensitivity analysis. Results: When sunitinib was compared with imatinib 600 mg/d and BSC, the incremental cost-effectiveness ratio was RMB75,715 with RMB121,080 per quality-adjusted life-year (QALY) gained. Sunitinib demonstrated lower costs and higher QALYs than imatinib 800 mg/d. In the probabilistic sensitivity analysis, the willingness-to-pay per QALY gained was set to be three times the per capita gross domestic product of the People’s Republic of China, that is, RMB46,510 in 2014. Sunitinib was demonstrated to be cost-effective compared with imatinib 600 mg/d, imatinib 800 mg/d, and BSC, with probabilities of 82.3%, 95.6%, and 78.2%, respectively. Limitations: Clinical data for imatinib 800 mg/d and BSC in the analysis were based upon studies in non-Chinese populations. Because of the unavailability of utility data from Chinese gastrointestinal stromal tumor patients, the analysis used the utility estimates from studies performed in other countries. Conclusion: Sunitinib provides greater clinical benefit than high-dose imatinib or BSC as a second-line treatment. In the Chinese setting, sunitinib is estimated to be cost-effective compared with imatinib 800 mg/d, imatinib 600 mg/d, or BSC. Keywords: cost-effectiveness analysis, gastrointestinal stromal tumor, imatinib, sunitinib, best supportive care, second-line