Healthcare

Purpose: To evaluate the impact of age on healthcare costs and resource utilization in pts with CD. Methods: A retrospective analysis, using the PharMetrics database, of pts with a dx of CD (ICD-9 code 555.x) from Jan. 1, 2000 through June 30, 2005 was conducted. Pts had to be continuously enrolled for 6 months pre-and 12 months post-CD dx, and have 2 distinct claims for CD. Mean/pt healthcare resource utilization and costs were calculated for pts in the yr following their initial CD dx. Outcomes are presented for all pts with CD, and by the following age grps: pediatric <18 yrs, adults 18 to 64 yrs, and pts ≥ 65 yrs. Results: The cohort consisted of 13454 CD pts. Over half of the pts were females and the mean age was 42 yrs. Mean annual total healthcare costs for all pediatric CD pts were $16700. The mean healthcare costs were highest among pediatric and pts ≥ 65 with CD ($19347 and $19900). Inpt hospitalization costs had the largest component of the mean annual total cost for all pts followed by drug, and outpt costs. Resource utilization was highest for pts ≥ 65 yrs. Conclusions: There is limited data assessing the healthcare costs and resource utilization in pts with CD by age group. Healthcare costs among this pt population are high. Pediatric pts and pts ≥ 65 yrs had higher mean healthcare costs than adults 18 to 64 yrs, primarily driven by inpt hospitalizations. New therapies that can reduce hospitalizations have the potential to decrease overall cost of care for CD pts.Table: Mean Healthcare Costs and Resource Utilization.

Heart Failure Related Costs and Health Care Resource Utilization Following An Emergency Department (ED) Visit For Worsening Heart Failure: A Claims Data Analysis

Chronic rhinosinusitis (CRS) is a common and costly health problem in the United States. A better understanding of healthcare resource utilization (HCRU) and healthcare expenditure (HCE) pertaining to CRS is required. The objective of this study is to investigate geographic variations in HCRU and HCE for CRS. Retrospective study of administrative database. Patients meeting pre-defined diagnostic criteria for CRS with continuous 1-year pre-index and 2-year post-index data were identified on IBM® Marketscan Research Databases over a 5-year period (2013-2017). Data pertaining to demographics, HCRU, and HCE were analyzed according to geographic region. Multivariable generalized linear models accounted for age, sex, baseline medication utilization, and co-morbidities. About 237,969 patients were included. Antibiotics were the most commonly prescribed medication (95%). Surgery rate (11%), immunotherapy (9.2%), oral steroid use (66%), and antibiotic utilization (mean 6.3 prescriptions) were highest in the South. However, visits with an otolaryngologist were considerably higher in the Northeast (62%). The Northeast region had the highest mean HCE ($2,449), which was 13% greater than HCE for the North Central region ($2,172). HCRU and HCE were higher in urban areas across all metrics, with 2-year HCE being 18% greater in urban areas ($2,374 vs. $2,019). Significant geographic variation in HCE was observed even after adjusting for covariates. Significant geographic variations in HCRU and HCE exist for CRS even after adjusting for covariates. Future studies are needed to help direct quality improvement and cost-saving efforts as well as efficient resource allocation in an era of value-based care. 4 Laryngoscope, 131:2641-2648, 2021.

P226 Background/objective: Data on healthcare resource utilization (RU) in acute stroke will assist in evaluation of cost-efficacy and cost-effectiveness of new treatments. We present results of a substudy of resource utilization within GAIN Americas, a multi-center, randomized, placebo-controlled, phase 3 clinical trial of the glycine antagonist GV150526 in acute stroke, conducted in the US and Canada. Previously reported clinical results showed no difference in clinical outcome by treatment at 3 months. Methods: RU data included pre-stroke and Month 3 residence and employment status, hospital length of stay (LOS) by ward type, discharge destination, and outpatient rehabilitation services. There were no treatment differences on RU endpoints, so data were combined across treatment groups. Results: The study population comprised 1604 acute stroke patients (85% ischemic; median age: 72; female: 48%; median NIHSS score: 12). Case fatality was 13% in hospital, 21% by Month 3. Median hospital LOS was 9 days (mean=15), including 3 days (mean = 4.5) in intensive care and 4.5 days (mean=6.8) in step-down. Discharge destinations included rehabilitation facility (49%), home (27%) and nursing home (11%). Pre-stroke, 87% lived in own home, but at 3 months only 62% lived at home. Outpatient rehabilitation services included occupational therapy (31%), physical therapy (39%), speech therapy (20%) and psychotherapy (2%). Pre-stroke, 21% were employed full- or part-time; at Month 3, 6% were employed. Of those employed pre-stroke, 60% reported being unable to work for health reasons at Month 3. Conclusion: These data describe the social and economic burden of stroke in a well-defined cohort. Such information should be valuable to care providers at many levels of the healthcare system and to health outcomes researchers. Prospective collection of detailed RU data from a large clinical trial is feasible and worthwhile.

ObjectivesRespiratory syncytial virus (RSV) is a frequent cause of acute lower respiratory infection in children, imposing a substantial economic burden on healthcare systems. This systematic review aimed to assess the economic burden and healthcare utilisation of RSV in children aged 0–59 months in Italy. Study designSystematic review. MethodsA systematic search of PubMed, Embase, Scopus, and the International HTA Database, including studies published in English or Italian, was conducted between January 2000 and July 2022. Inclusion criteria required studies to be conducted in Italy and provide data on the economic costs and healthcare resource utilisation related to RSV infections. ResultsOut of 20,845 records screened, 18 articles met the inclusion criteria. Only one study provided comprehensive data on RSV disease costs, including hospitalisation, diagnostic tests, and medical procedures for infants with RSV-bronchiolitis. The mean cost per inpatient was higher for RSV-positive children (€5753.43 ± €2041.62) than that for RSV-negative children. Additionally, five studies reported a median length of hospital stay of 5 days for RSV-infected children, and four studies indicated a higher frequency of intensive care unit admissions for RSV-infected children than for those with other viral infections. ConclusionsThis is the first systematic review to examine the economic burden and healthcare utilisation of RSV in children aged 0–59 months in Italy. While limited data were available, the findings underscore the urgency to conduct further research and gather additional evidence on the costs and healthcare resource utilisation associated with RSV infections. Such efforts are essential for informing the development of effective prevention strategies for paediatric RSV infections in Italy.

The American Heart Association's 2020 Strategic Goals emphasize the value of optimizing risk factor status to reduce the burden of morbidity and mortality. In this study, we aimed to quantify the overall and marginal impact of favorable cardiovascular risk factor (CRF) profile on healthcare expenditure and resource utilization in the United States among those with and without cardiovascular disease (CVD). The study population was derived from the 2012 Medical Expenditure Panel Survey (MEPS). Direct and indirect costs were calculated for all-cause healthcare resource utilization. Variables of interest included CVD diagnoses (coronary artery disease, stroke, peripheral artery disease, dysrhythmias, or heart failure), ascertained by International Classification of Diseases, Ninth Edition, Clinical Modification codes, and CRF profile (hypertension, diabetes mellitus, hypercholesterolemia, smoking, physical activity, and obesity). Two-part econometric models were used to study expenditure data. The final study sample consisted of 15 651 MEPS participants (58.5±12 years, 54% female). Overall, 5921 (37.8%) had optimal, 7002 (44.7%) had average, and 2728 (17.4%) had poor CRF profile, translating to 54.2, 64.1, and 24.9 million adults in United States, respectively. Significantly lower health expenditures were noted with favorable CRF profile across CVD status. Among study participants with established CVD, overall healthcare expenditures with optimal and average CRF profile were $5946 and $3731 less compared with those with poor CRF profile. The respective differences were $4031 and $2560 in those without CVD. Favorable CRF profile is associated with significantly lower medical expenditure and healthcare utilization among individuals with and without established CVD.

Background: Previous real-world studies suggest multiple-inhaler triple therapy (MITT; ICS/LAMA/LABA) is overused and incorrectly positioned within the COPD treatment pathway. Addressing the timing of MITT initiation in COPD care to optimise patient outcomes and reduce burdens on healthcare systems is warranted. Objectives: To assess if early MITT initiation in exacerbating patients reduces subsequent healthcare resource utilisation (HCRU), direct medical costs and acute exacerbations of COPD (AECOPDs). Methods: A retrospective, longitudinal cohort study (206974, funded by GlaxoSmithKline plc) using linked electronic medical records and hospital administrative data in the UK. COPD patients were indexed on an AECOPD (Jul 2012–May 2016), followed by MITT initiation within 180 days of indexing. Patients with an AECOPD 6 months prior to indexing were excluded. HCRU, direct medical costs and AECOPDs during 2-year follow-up were compared between early (≤30 days) and delayed (31–180 days) MITT initiators using parametric statistical tests. Results: 11025 COPD patients initiated MITT within 180 days of an AECOPD; 934 met all other selection criteria (367 [39%] early, 567 [61%] delayed). The table shows HCRU, direct medical costs and AECOPDs. Conclusions: Number of inpatient stays and total costs were higher in patients with delayed MITT initiation, suggesting early MITT initiation reduces economic burden on the healthcare system.

BACKGROUND AND AIM: Healthcare systems need to substantially reduce greenhouse gas (GHG) emissions as societies decarbonize their economies. In respiratory medicine, contributions from healthcare resource utilization (HCRU) and short-acting β₂-agonist (SABA) relievers, which provide rapid relief from asthma symptoms, are significant. SABA relievers contribute to the majority of inhaler usage and total carbon footprint of inhaler devices across Europe. In asthma, high SABA use is common and associated with poor disease control and increased exacerbation risk.¹ In chronic obstructive pulmonary disease (COPD), exacerbation history is linked with increased rate of future exacerbations;² both SABA use and exacerbations increase HCRU requirements. Here, we provide an overview of the healthCARe-Based carbON cost of treatment (CARBON) sustainability program, which evaluates the carbon footprint associated with poorly and well-managed care of common respiratory diseases. METHODS: CARBON is the first program to quantify the carbon footprint of HCRU and medications in respiratory healthcare by using a combination of certified published studies and methodologies. RESULTS:Patients with well-managed asthma and COPD are likely to have a lower carbon impact through reduced requirements for SABA medication use and HCRU. This CARBON group of studies is evaluating the overall carbon footprint associated with SABA use, exacerbations, and HCRU in over 1.5 million patients with asthma or COPD in over 30 European and North American countries. CONCLUSIONS:Understanding what comprises the carbon footprint of respiratory healthcare and how it is impacted by poor disease control or disease progression is the first step in understanding how innovative treatments and guideline implementation can drive carbon reduction without risking improvements in patient outcomes. The principle of evidence-led care improvement as a means to achieve greater sustainability will have multiple benefits for patients and society.

IntroductionIrritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are common functional intestinal disorders which impact all age groups, yet there is limited comparative evidence on the economic benefits of treatment of these conditions on the elderly. We assessed differences in healthcare resource utilization (HCRU) and total costs of care among Medicare-insured patients initiating linaclotide, lubiprostone, or plecanatide after 1 year.MethodsRetrospective analysis from the Merative™ MarketScan® Medicare Database (January 2017–September 2023), including adult patients who initiated a qualifying IBS-C/CIC medication (linaclotide, lubiprostone, plecanatide) (index date defined as date of initiation) and had at least 6 months of pre-index and 12 months of post-index continuous benefit coverage under fee-for-service Medicare plans. For HCRU and all-cause total cost (medical + pharmacy) outcomes, 12-month comparisons were characterized via count (for HCRU) or cost ratios between linaclotide and lubiprostone, and linaclotide and plecanatide. Generalized linear regression models adjusting for key baseline patient characteristics and 6-month pre-index HCRU and cost were used to estimate differences in outcomes at 12 months between treatment groups.ResultsA total of 7916 Medicare patients were included in the analysis, of whom 5773 initiated linaclotide, 1856 initiated lubiprostone, and 287 initiated plecanatide. After adjusting for key patient characteristics and pre-index HCRU, count ratios > 1 demonstrated that patients who received lubiprostone versus linaclotide had significantly greater HCRU (P < 0.05) at 12 months. After 12 months follow-up, adjusted all-cause total costs of care were significantly lower among patients who received linaclotide versus lubiprostone or plecanatide, largely driven by lower all-cause medical costs observed in patients who received linaclotide (P < 0.05).ConclusionThese findings suggest that linaclotide treatment may be associated with lower total healthcare costs compared to lubiprostone and plecanatide for patients initiating IBS-C/CIC-related drugs in Medicare populations.

Living liver donation is generally considered safe, but donors may experience short- or long-term complications. The purpose of this study was to assess healthcare resource utilization after liver donation in living liver donors in comparison with the general population. Outpatient or emergency department visits and hospital admissions were compared between living liver donors who underwent hepatic resection for living liver donation between 2004 and 2018 and the matched general population. Healthcare resource utilization data for 5 y after liver donation were collected from the National Health Insurance Service database. For every living liver donor, 4 individually matched nondonors were selected from the National Health Insurance Service database using age, sex, preexisting comorbidities, and previous healthcare utilization history. A total of 1886 living liver donors and 7309 nondonors were included. In the first year after donation, living liver donors required more outpatient department visits (7 [4-13] versus 3 [1-7], P < 0.001) and more emergency department visits (13.33% versus 0.15%, P < 0.001) compared with matched nondonors. A similar trend persisted for 5 y after donation. The number of hospital admissions of living liver donors was higher for up to 2 y after donation with longer hospital length of stay (13.0 [10.5-16.0] d versus 5.0 [3.0-9.0] d, P < 0.0001). Healthcare resource utilization in living liver donors for 5 y after donation was higher compared with matched nondonors. The higher healthcare resource demand may be related to postoperative complications or lowered threshold for healthcare resource utilization after donation.

Costs and healthcare utilization associated with alcohol use disorder: A cohort study.

Healthcare resource utilization for chronic low back pain among high-utilizers

The Clinical outcomes, healthcare resource utilization, and related costs (COHERENT) model. Application in heart failure patients

Assessing Outcomes, Healthcare Resource Utilisation and Costs across Europe in Newly Diagnosed Multiple Myeloma (NDMM) Patients Post Autologous Stem Cell Transplant (ASCT)

Factors associated with high healthcare resource utilisation among COPD patients