Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis

AbstractBackground:ADHD is a highly prevalent disease in childhood which often persists into adulthood, then co-occurring with common adult conditions. Especially for adult ADHD, little is known about the costs of ADHD and the additional costs of comorbid conditions.Aims:To determine medical costs of ADHD and costs of comorbidities (mood, anxiety and substance use disorders, obesity), including their co-occurrence rates, stratified by age and gender.Method:Claims data from a German Statutory Health Insurance database with approximately four million member-records per year were analysed. A total of 25,300 prevalent ADHD patients were identified by means of an ICD-10 GM diagnosis of ADHD. A 1:1 age and gender adjusted reference group without ADHD diagnosis was randomly selected. Total health claims and health care costs related to ADHD were analysed, in addition to more targeted analyses of the occurrence and costs of pre-defined common comorbidities of, in particular, adult ADHD (SUD, mood and anxiety disorders, obesity). Outcomes were mean costs per patient and occurrence rates of comorbid conditions. Surplus costs of a comorbid condition in persons with ADHD relative to costs of this condition in persons without ADHD were calculated. Subgroup analyses were conducted based on age (0–12 years, 13–17 years, 18–30years, 30+ years) and gender.Results:Patients with ADHD were €1500 more expensive annually than individuals without ADHD (p < 0.001). Main cost drivers were inpatient care, psychiatrists and psychotherapists. Mood, anxiety, substance use disorders and obesity were significantly more frequent in ADHD patients and additional costs resulting from the comorbid conditions amounted up to €2800. Costs were slightly higher in women than men and increased with age for both genders. In young adults (18–30 years) health care costs dropped notably, especially costs for the medical treatment of ADHD with stimulants and costs for psychiatrists, before rising again in the group of patients over 30 years who had higher comorbidity rates.Conclusions:Medical costs for ADHD are substantial, in part through frequently occurring comorbid conditions, and particularly in adulthood, and are likely to further accelerate in the coming years. A gap of care was found, starting with the transition age group of patients over 17 years, as indicated by reduced costs per person during young adulthood, as well as an overall strong drop in administrative prevalence. In the future, approaches to improve the situation of care and reduce costs at the same time, i.e. through managed care programmes, should be implemented and benefit from detailed knowledge on age and gender-specific cost-drivers.

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Social determinants of depression: association with age, gender and primary health care model

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1011 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J China

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Social Determinants ◽

Care Physician ◽

Health Policies ◽

Age And Gender ◽

Primary Health ◽

And Gender ◽

Primary Health Care Physician

Abstract Background Depression is one of the most common mental disorders worldwide and is a major contributor to the overall global burden of disease. The social determinants of age, gender and access to a primary health care physician have been identified as significant determinants of variability in the prevalence of depression. This research evaluates the association between depression and these social determinants in the city of Almada, in Portugal. Methods This cross-sectional study reports the one-month prevalence (December, 2015) of depression and its association with age, gender and access to a primary health care doctor in Almada's primary health care population. Data was collected from the 'Information System of the Regional Health Administration' (SIARS) database. The diagnostic tools used for the identification of cases were the ICPC-2 codes 'P76: Depressive Disorder' and 'P03: Feeling Depressed'. An odds ratio was applied as an association measure. Results Regarding gender and age: women are more likely to develop depression than men (OR 3.21) and the age group of 40-64 years is more likely to develop depression compared with other age groups (OR 2.21). The odds of being affected by depression for patients with a permanent primary health care physician, compared with users without a permanent primary health care physician, are higher (OR 2.24). Conclusions The patterns of association of age and gender, uncovered in this dataset, are consistent with previously reported findings for other Western countries. The association between depression and the assignment of a permanent primary health care doctor is highly significant. This finding suggests the existence of a higher detection rate of depression in patients with a permanent doctor and adds weight to the need to implement health policies that guarantee a primary health care physician for each patient. Key messages The age and gender gap in depression calls for stronger public health and intersectoral strategies to promote and protect mental health, in community-based settings. Reducing barriers and enhancing access to high-quality primary medical care must be a cornerstone of mental health policies.

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Aging, health expenditure, proximity to death, and income in Finland

Health Economics Policy and Law ◽

10.1017/s174413310800443x ◽

2008 ◽

Vol 3 (2) ◽

pp. 165-195 ◽

Cited By ~ 42

Author(s):

UNTO HÄKKINEN ◽

PEKKA MARTIKAINEN ◽

ANJA NORO ◽

ELINA NIHTILÄ ◽

MIKKO PELTOLA

Keyword(s):

Health Care ◽

Health Expenditure ◽

Long Term Care ◽

Health Care Expenditure ◽

Term Care ◽

Age And Gender ◽

And Gender ◽

Proximity To Death ◽

Naive Model

AbstractThis study revisits the debate on the ‘red herring’, i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity to death with the predictions of a naïve model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a naïve model is used in health expenditure projections. Among individuals not in long-term care, we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasize that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone, as often claimed in public discussion. We do not find any strong positive associations between income and expenditure for most non-LTC categories of health care utilization. Income was positively related to expenditure on prescribed medicines, in which cost-sharing between the state and the individual is relatively high. Overall, our results indicate that the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.

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Profiling Primary Care Physicians for a New Managed Care Network

Health Services Management Research ◽

10.1177/095148489701000304 ◽

1997 ◽

Vol 10 (3) ◽

pp. 173-186 ◽

Cited By ~ 2

Author(s):

R. J. Ozminkowski ◽

M. Noether ◽

P. Nathanson ◽

K. M. Smith ◽

B. E. Raney ◽

...

Keyword(s):

Health Care ◽

Primary Care Physicians ◽

Claims Data ◽

Severity Of Illness ◽

Policy Implications ◽

Case Mix ◽

Reform Strategies ◽

Insurance Program ◽

Insurance Claims Data ◽

Care Costs

We developed methods for comparing physicians who would be selected to participate in a major employer's self-insurance program. These methods used insurance claims data to identify and profile physicians according to deviations from prevailing practice and outcome patterns, after considering differences in case-mix and severity of illness among the patients treated by those providers. The discussion notes the usefulness and limitations of claims data for this and other purposes. We also comment on policy implications and the relationships between our methods and health care reform strategies designed to influence overall health care costs.

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Abstract 19672: Comparison of Major-bleeding Risk and Health Care Costs Among Treatment-naïve Non-valvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivaroxaban or Warfarin

Circulation ◽

10.1161/circ.132.suppl_3.19672 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Alpesh Amin ◽

Allison Keshishian ◽

Lin Xie ◽

Onur Baser ◽

Kwanza Price ◽

...

Keyword(s):

Health Care ◽

Health Care Costs ◽

Major Bleeding ◽

Bleeding Event ◽

Bleeding Risk ◽

Medical Costs ◽

Medicare Advantage ◽

Major Bleeding Event ◽

Treatment Naïve ◽

Care Costs

Objective: The study aim was to compare major bleeding risk and health care costs after initiating oral anticoagulants (OACs) for treatment-naïve non-valvular atrial fibrillation (NVAF) patients. Methods: Patients in the Medicare advantage population prescribed apixaban, rivaroxaban, dabigatran or warfarin were selected from the Optum Research Database 01JAN2013-31DEC2014. The first OAC prescription date was designated as the index date. Patients were required to have a NVAF diagnosis, continuous health plan enrollment for 6 months and no OAC claims before the index date. Patients were classified into four cohorts based on their index OAC prescription. Major bleeding events, identified by the Cunningham algorithm plus additional bleeding sites, were compared using a Cox proportional hazards model. Health care costs were calculated per patient per month and compared using generalized linear models. Results: The study included 36,260 patients: 3,762 apixaban, 2,677 dabigatran, 8,740 rivaroxaban, and 21,081 warfarin patients. CHA2DS2-VASc score was higher in apixaban patients (4.2) compared to dabigatran and rivaroxaban (both 4.0; p<0.001), but lower than in warfarin patients (4.3; p<0.001). After adjusting for baseline characteristics, apixaban patients were significantly less likely to have a major-bleeding event within one year of treatment initiation compared to rivaroxaban (HR=0.69; 95% CI=0.59-0.81) and warfarin (HR=0.71; 95% CI=0.61-0.82) patients and trended towards numerically lower major bleeding compared to dabigatran patients (HR=0.87; 95% CI=0.72-1.06). Major bleeding-related medical costs were lower in apixaban patients ($53) compared to rivaroxaban ($111) and warfarin ($138) patients (p<0.001) and similar to dabigatran patients ($44, p=0.370). Furthermore, apixaban patients incurred lower all-cause medical costs ($1,646) compared to dabigatran ($1,974, p=0.02), rivaroxaban ($1,909, p=0.002) and warfarin ($2,162, p<0.001) patients. Conclusion: In a large national Medicare advantage population, treatment-naïve NVAF patients treated with apixaban were significantly less likely to have a major-bleeding event compared to those prescribed rivaroxaban or warfarin and had significantly lower medical costs.

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Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

BMC Health Services Research ◽

10.1186/s12913-020-05811-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Andreas Niedermaier ◽

Anna Freiberg ◽

Daniel Tiller ◽

Andreas Wienke ◽

Amand Führer

Keyword(s):

Health Care ◽

Health Care Costs ◽

Asylum Seekers ◽

Health Care Services ◽

Claims Data ◽

Care Utilization ◽

Care Services ◽

Outpatient Sector ◽

Analysis Of Claims Data ◽

Care Costs

Abstract Background Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations. Methods Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision. Results The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector. Conclusion The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.

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Treatment Persistence with Azacitdine (Vidaza) Is Associated with Lower Inpatient Hospitalization Costs Over Time

Blood ◽

10.1182/blood.v120.21.4231.4231 ◽

2012 ◽

Vol 120 (21) ◽

pp. 4231-4231

Author(s):

B. Douglas Smith ◽

Dalia Mahmoud ◽

Stacey Dacosta Byfield ◽

Henry J Henk

Keyword(s):

Health Care ◽

Health Care Costs ◽

Medical Costs ◽

Sensitivity Analyses ◽

Bleeding Complications ◽

Inpatient Hospitalization ◽

Treatment Persistence ◽

Hospitalization Costs ◽

The Relationship ◽

Care Costs

Abstract Abstract 4231 Background: In the US, understanding the costs associated with Myelodysplastic Syndromes (MDS) is challenging given that multiple channels including pharmacy, ambulatory, and inpatient hospitalization (IPH) settings make up the total expenses to manage patients. Recent studies suggest that MDS patients under active medical management experience fewer cytopenia-related medical problems compared to untreated, transfusion dependent (TD) patients who require more medical treatments, often for recurrent infections and bleeding complications. It is clear that persistence of drug therapy is essential to achieve optimal clinical responses for MDS patients and we sought to determine if continued therapy also optimized costs related to the disease. Aim: To evaluate the relationship between treatment persistence with AZA and health care costs encountered for patients with MDS. Methods: Commercial and Medicare Advantage enrollees with a diagnosis of high grade MDS (ICD-9, 238.73) who initiated AZA with pharmacy and medical benefits in the prior 6 months and who had a variable follow up period from initiation of AZA to disenrollment or end of study were identified in a US health plan claims database (1/1/2007-6/30/2010). The number of AZA “cycles” was calculated by dividing the total number of AZA administrations by 7 days, with a sensitivity analysis for 5 day administration, - commonly utilized in the “real-world”. Persistence was defined as the number of cycles of AZA. Eligible patientshad to have at least 2 AZA cycles. An independent analysis identified health care costs for the same patients during periods of transfusion-dependence (TD) - defined as periods in which they received 2 transfusions in an 8 week period and did not receive erythropoietin-stimulating agents (ESAs) or AZA. Average Per Patient Per Month (PPPM) costs were examined among patients with various lengths of TD periods, up to 1 year. Linear models were used to examine the relationship between persistence on AZA and PPPM health care costs. Healthcare costs included both payer and patient paid amounts under the medical and pharmacy benefit. Medical costs were further broken out into IPHs, ambulatory, and other costs captured. Several sensitivity analyses were performed to confirm the robustness of the results such as excluding patients with IPH prior to AZA initiation, and including patients with <2 cycles of AZA. Results: The baseline cost breakdown for MDS patients (n=225) who were transfusion dependent and not receiving treatment are outlined in Figure 1. Interestingly, the largest proportion of the medical costs for TD patients comes from IPHs. In fact, the PPPM IPH costs among TD periods account for approximately 65–75% of total health care costs - even at one year of their diagnosis. A similar analysis was done for patients completing at least 2 cycles of AZA (n = 100) which suggested that the proportion of cost related to IPHs was closer to 40%. This cohort averaged 6.3 cycles (median = 5) with 24% of patients completing at least 8 cycles. Importantly, completion of every additional AZA cycle (baseline 7day analysis) was found to be associated with, on average, a 6% decrease in medical care costs (p=0.005) driven largely by an 18% decrease in IPH costs (p<0.001; Figure 2) due to fewer medical events. Even a single additional AZA cycle was found to be associated with 5% lower total health care cost (p=0.006). These results also hold in the sensitivity analyses. As expected, an examination of medical needs of both TD and AZA treated patients led infections as a frequent driver of IPHs. Conclusions: Patients who persist with AZA therapy have lower PPPM medical costs, driven by decreased expenditures on IPHs. This is consistent with results identified in the AZA-001 clinical trial in which patients receiving AZA experienced reduced IPHs driven by less transfusions and need for IV antibiotics, antifungals, and antivirals. These lower overall costs offset the expected increase in continuing therapy based on the cost of drug alone. Improving duration of therapy of AZA may not only optimize clinical outcomes but may decrease cumulative costs of care among high risk MDS patients. Disclosures: Smith: Celgene: Consultancy. Mahmoud:celgene: Employment. Dacosta Byfield:Celgene: Consultancy. Henk:Celgene: Consultancy.

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Retrospective claims analysis of palliative care costs and survival in a U.S. metastatic renal cell (mRCC) population.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.433 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 433-433

Author(s):

Henry J. Henk ◽

Connie Chen ◽

Agnes Benedict ◽

Jane Sullivan ◽

April Teitelbaum

Keyword(s):

Health Care ◽

Health Care Costs ◽

Health Plan ◽

Index Date ◽

Claims Data ◽

Cohort Analysis ◽

Hospital Costs ◽

Best Supportive Care ◽

Study Cohort ◽

Care Costs

433 Background: Survival and costs outcomes for patients with mRCC receiving palliative or best supportive care (BSC) after stopping active therapy have been poorly characterized. This information is important to understand how resources are utilized at the end of life and to put current treatment costs into perspective. The objective of this retrospective database analysis was to examine survival and costs associated with BSC after receiving 1 or 2 lines of mRCC treatment. Methods: A retrospective cohort analysis using claims data from commercially insured or Medicare Advantage (MCR) enrollees of a large US health plan, with medical and pharmacy benefits. The study cohort consisted of patients with an index diagnosis for RCC [ICD-9-CM 189.0] from 1/1/07 to 6/30/10 initiating any of the following treatments from 30 days prior to index date through disenrollment: sunitinib, temsirolimus, sorafenib, bevacizumab, everolimus, pazopanib, cytokines. Patients were required to have a 6 mos. continuous enrollment ± index date (patients disenrolling due to death within the 6 mos. were retained). Lines of therapy (LOT) were identified based on prescription fill and administration dates, began following the last LOT and continued until disenrollment. Health care costs reported represent the health plan + patient paid amount. Results: The overall study cohort (n=274) was 73% male; mean (±SD) age 63.3 ± 11.1 yr. with the majority of patients commercially insured (80% vs 20% MCR). The majority started BSC following 1st LOT (68% vs 32%). Median survival from start of BSC was similar following 1st and 2nd LOT (126 and 118 days). The mean (median) duration of BSC after 1 LOT was 223 (114) days and 176 (109) days for 2 LOT. Total health care costs incurred during BSC averaged $50,187 ± 96,984 and $37,294 ± 51,101 and monthly costs were similar ($10,284 ± 17979) after 1 and 2 LOT, respectively. In both cases, inpatient hospital costs represented the largest proportion of these costs (47%) while outpatient costs represented 36%. Conclusions: Our study estimating BSC survival and costs in patients with mRCC based on US claims data found monthly cost of $10, 284. These estimates suggest that BSC costs are not insignificant.

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Effect of Chronic Kidney Disease and Comorbid Conditions on Health Care Costs: A 10-Year Observational Study in a General Population

American Journal of Nephrology ◽

10.1159/000272937 ◽

2010 ◽

Vol 31 (3) ◽

pp. 222-229 ◽

Cited By ~ 43

Author(s):

Sebastian E. Baumeister ◽

Carsten A. Böger ◽

Bernhard K. Krämer ◽

Angela Döring ◽

Dirk Eheberg ◽

...

Keyword(s):

Health Care ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

General Population ◽

Observational Study ◽

Health Care Costs ◽

Comorbid Conditions ◽

Care Costs

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Development of the Canadian Substance Use Exposure Database (CanSUED): Modeling the prevalence of substance use in Canadian Jurisdictions, 2006 to 2017

10.21203/rs.3.rs-15494/v1 ◽

2020 ◽

Author(s):

Jinhui Zhao ◽

Tim Stockwell ◽

Justin Sorge ◽

Adam Sherk ◽

John Dorocicz ◽

...

Keyword(s):

Substance Use ◽

Mixed Model ◽

Multilevel Models ◽

Demographic Data ◽

Canadian Community Health Survey ◽

Small Sample ◽

Similar Data ◽

Age And Gender ◽

National Surveys ◽

And Gender

Abstract Background Small area and regional estimates of substance use (SU) exposures are increasingly needed to support estimation of the burden of SU-attributable morbidity and mortality. There is also a need to assess SU prevalence for subgroups by place, time and sociodemographic characteristics to plan the efficient delivery of treatment and harm reduction services. However, the data available from national surveys are often insufficient to produce reliable estimates for subgroups because of small sample sizes. There are also often missing estimates for some jurisdictions and some years when no surveys were conducted. We describe new methods which utilize Canadian national survey data of SU, sales, SU attributable hospitalisations and demographic data to develop the Canadian Substance Use Exposure Database (CanSUED). Estimates from this database have been used in the study of Canadian Substance Use Costs and Harm (CSUCH). Methods Exposures were estimated for eight substance categories: alcohol, tobacco, opioids, cannabis, cocaine, other central nervous system (CNS) stimulants, other CNS depressants and other psychoactive substances. The design-based direct estimates of SU were based on the Canadian Alcohol and Drug Monitoring Survey (CADUMS) in 2008-2012, the Canadian Tobacco, Alcohol and Drug Survey (CTADS) in 2013, 2015 and 2017, per capita alcohol and tobacco sales, and rates of wholly SU-attributable hospitalisations for all Canadian jurisdictions by age and gender. Multilevel models were used to model the design-based estimates of SU to produce reliable estimates for subgroups when the coefficient of variation (CV) of the estimates were > 33.3% and to predict SU exposure in ten provinces in 2006, 2007, 2014 and 2016 and in the three territories for 2006-2017 by using empirical best linear unbiased prediction (EBLUP). Results Direct design-based estimates were based on the surveys from a total of 107,750 Canadians aged 15+. The analyses produced reliable estimates of SU prevalence by year-province-gender-age using mixed models with the EBLUP method. Correlational analyses show that the model-based estimates were significantly related to the design-based estimates produced from both the CADUMS/CTADS and Canadian Community Health Survey. The new model estimates indicate increases in binge drinking, cannabis use, other CNS depressant substance use and cocaine use between 2006 and 2017. Rates of use of opioids and tobacco showed declines. Rates of use of other substances were relatively stable or did not show overall change across the whole time period. Conclusion The mixed model-adjusted approaches produced reliable estimates for small areas and age-gender groups and help fill gaps caused by data suppression in local and national surveys. We suggest that these methods provide the most comprehensive and reliable estimates available of Canadian substance use by substance category, year, jurisdiction, age and gender. The methods could also be applied in other countries where similar data are available.

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The moderating role of age and gender differences in the relation between subjective well-being, psychopathology and substance use in Uruguayan adolescents

Revista Latinoamericana de Psicopatologia Fundamental ◽

10.1590/1415-4714.2018v21n3p486.5 ◽

2018 ◽

Vol 21 (3) ◽

pp. 486-510 ◽

Cited By ~ 1

Author(s):

Maria Eugenia Fernandez ◽

Lore Van Damme ◽

Sarah De Pauw ◽

Daniel Costa-Ball ◽

Lilian Daset ◽

...

Keyword(s):

Substance Use ◽

Linear Regression ◽

Linear Regression Analysis ◽

Positive Association ◽

Well Being ◽

Multivariate Linear Regression ◽

Multivariate Linear Regression Analysis ◽

Subjective Well Being ◽

Age And Gender ◽

And Gender

The aim of this study is to explore the Subjective well-being (SWB) of school-going adolescents in Uruguay (N= 325; Mage= 14.67; SD= 1.62). We investigate age- and gender-specific relationships between psychopathology and substance use on the one hand, and subjective well-being on the other hand. Multivariate linear regression analyses, indicated five significant predictors of SWB: three psychopathology factors (depression-anxiety, social anxiety and dissocial behaviour), and age displayed a negative association, while one psychopathology factor (resilience) showed a positive association. When extending the multivariate linear regression analysis with interaction effects, significant interactions appeared regarding gender and resilience and age and substance use. Our study focuses on the necessity to have evidence-based results in order to plan appropriate preventive interventions with adolescents.

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