The Impact of Population-Based Disease Management Services on Health Care Utilisation and Costs: Results of the CAPICHe Trial

ObjectivesTo investigate health care utilisation including both primary and secondary health care 6 months before the diagnosis of a relapse or a second malignant neoplasm (SMN) in survivors of childhood acute lymphoblastic leukaemia (ALL).Design and settingA Danish population-based matched cohort study linking multiple nationwide registries.ParticipantsParticipants were recruited from a total of 622 childhood ALL 2.5-year event-free survivors diagnosed between 1994 and 2015. Cases were survivors developing a relapse or an SMN and references were survivors still in first remission. Each case was matched with five references on age, sex, treatment protocol and risk group.Primary outcome measuresConsultations in general practice and hospital the last 6 months before relapse or SMN. Cases and references were compared with monthly incidence rate ratios (IRRs) from negative binomial regression models.ResultsOf the 622 childhood ALL survivors, 60 (9.6%) developed a relapse (49) or an SMN (11) and 295 matched references were identified. Health care utilisation in general practice increased among cases the last month before the event compared with references with an IRR of 2.71 (95% CI 1.71 to 4.28). Data showed a bimodal structure with a significantly increased number of visits 4, 5 and 6 months before the event. Hospital health care utilisation increased 2 months before the event in cases with an IRR of 5.01 (3.78 to 6.63) the last month before the event and an IRR of 1.94 (1.32 to 2.85) the second-last month comparing cases and references.ConclusionsSurvivors of childhood ALL developing a relapse or an SMN have a short period of increased health care utilisation before diagnosis. At hospital, this might be explained by pre-diagnostic examinations. In general practice, data suggest a bimodal structure with children later developing a relapse having more contacts also half a year before the relapse, suggesting that there could be early warnings.

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Health care utilisation and economic burden of difficult-to-treat rheumatoid arthritis: a cost-of-illness study

Rheumatology ◽

10.1093/rheumatology/keab078 ◽

2021 ◽

Cited By ~ 1

Author(s):

Nadia M T Roodenrijs ◽

Paco M J Welsing ◽

Marlies C van der Goes ◽

Janneke Tekstra ◽

Floris P J G Lafeber ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Health Care ◽

Resource Use ◽

Economic Burden ◽

Linear Regression Analysis ◽

Work Productivity ◽

Health Care Utilisation ◽

Care Utilisation ◽

Annual Total ◽

The Impact

Abstract Objectives To determine the impact of difficult-to-treat rheumatoid arthritis (D2T RA) on (costs related to) health care utilisation, other resource use and work productivity. Methods Data regarding health care utilisation, other resource use and work productivity of 52 D2T (according to the EULAR definition) and 100 non-D2T RA patients were collected via a questionnaire and an electronic patient record review during a study visit. Annual costs were calculated and compared between groups. Multivariable linear regression analysis was performed to assess whether having D2T RA was associated with higher costs. Results Mean (95% confidence interval) annual total costs were €37,605 (€27,689-50,378) for D2T and €19,217 (€15,647-22,945) for non-D2T RA patients (p < 0.001). D2T RA patients visited their rheumatologist more frequently, were more often admitted to day care facilities, underwent more laboratory tests and used more drugs (specifically tsDMARDs), compared with non-D2T RA patients (p < 0.01). In D2T RA patients, the main contributors to total costs were informal help of family and friends (28%), drugs (26%) and loss of work productivity (16%). After adjustment for physical functioning (health assessment questionnaire (HAQ)), having D2T RA was no longer statistically significantly associated with higher total costs. HAQ was the only independent determinant of higher costs in multivariable analysis. Conclusions The economic burden of D2T RA is significantly higher than that of non-D2T RA, indicated by higher health care utilisation and higher annual total costs. Functional disability is a key determinant of higher costs in RA.

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