PMU41 Clinical Pharmacy Provider Dashboards May Prevent Avoidable Adverse Events and Reduce Total Cost of Care

e18843 Background: The Department of Health and Human Services (HHS) designed the 340B drug pricing program to allow institutions that service specialty populations to acquire drugs at lower prices. Objective: To analyze the dispersion in total cost of care (TCOC) for Medicare FFS patients (pts) with metastatic pancreatic cancer (m-PANC) treated at 340B or non-340B institutions, by NCCN Category 1 regimen. Methods: We identified pts with m-PANC using ICD-10 diagnosis codes in the 2016-18 Medicare Parts A/B/D 100% Research Identifiable Files. Study pts had 2+ claims with a pancreatic cancer diagnosis and Medicare FFS coverage for 6 months pre- and 3 months post-metastasis diagnosis. Study pts were treated with NCCN Category 1 regimens: 1L gemcitabine monotherapy (gem-mono), 1L gemcitabine/nab-paclitaxel (gem-nab), 1L FOLFIRINOX (FFX), and 2L liposomal irinotecan-based regimen (nal-IRI). Pts were attributed to 340B or non-340B institutions based on plurality of chemotherapy claims. TCOC reflects insurer-paid services per line of therapy (LOT) for 3 categories: chemotherapy/supportive drugs (chemo/Rx), inpatient care (IP), and other outpatient care (OP). We grouped pts by quartile (qrt) and evaluated drivers of TCOC and mean rates of admissions (admits/pt). Results: We identified 2,697 (340B) and 3,839 (non-340B) pts taking NCCN Category 1 regimens. Gem-mono represented 1% and 4% of all pts in 340B and non-340B institutions, respectively. Gem-nab accounted for 72% of pts in both cohorts. For gem-nab, FFX, and nal-IRI pts, median TCOC was similar in both cohorts, although mean TCOC by qrt was lower at 340B institutions than non-340B institutions, except for gem-nab in the 1st qrt. The components of TCOC were similar between 340B and non-340B institutions in all qrts. In both cohorts, % IP costs increased between the 1st and 4th qrt (340B:15% to 23%, non-340B:14% to 25%). From the 1st to the 4th qrt, admits/pt increased in both cohorts. In the 340B cohort, nal-IRI pts had the lowest admits/pt while gem-nab pts had the highest in all qrts. In the non-340B cohort, nal-IRI pts had the lowest admits/pt except for in the 1st qrt. Conclusions: Median TCOC was lower at 340B institutions than non-340B institutions for all regimens, and the range of TCOC dispersion was also smaller at 340B institutions. Across qrts, chemotherapy accounted for approximately half the TCOC; however, IP costs were proportionally higher in the 4th qrt. Comparing regimens, despite 2L nal-IRI pts being more heavily pretreated, median costs in each cohort were similar to 1L gem-nab and 1L FFX, while admits/pt were generally lower than 1L gem-nab and 1L FFX across qrts and cohorts.

Download Full-text

Cost-Consequence Analysis of Single-Dose Dalbavancin Versus Standard of Care for the Treatment of Acute Bacterial Skin and Skin Structure Infections in a Multisite Healthcare System

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1732 ◽

2020 ◽

Cited By ~ 1

Author(s):

Julia Gonzalez ◽

Diana Carolina Andrade ◽

JianLi Niu

Keyword(s):

Healthcare System ◽

Treatment Success ◽

Standard Of Care ◽

Cost Of Care ◽

Secondary Outcome ◽

Total Cost ◽

Skin Structure ◽

Cost Consequence ◽

The Difference ◽

The Cost

Abstract Background Acute bacterial skin and skin structure infections (ABSSSIs) are common infectious diseases that cause a significant economic burden on the healthcare system. This study aimed to compare the cost-effectiveness of dalbavancin vs standard of care (SoC) in the treatment of ABSSSI in a community-based healthcare system. Methods This was a retrospective study of adult patients with ABSSSI treated with dalbavancin or SoC during a 27-month period. Patients were matched based on age and body mass index. The primary outcome was average net cost of care to the healthcare system per patient, calculated as the difference between reimbursement payments and the total cost to provide care to the patient. The secondary outcome was proportion of cases successfully treated, defined as no ABSSSI-related readmission within 30 days after the initiation of treatment. Results Of the 418 matched patients, 209 received SoC and 209 received dalbavancin. The average total cost of care per patient was greater with dalbavancin vs SoC ($4770 vs $2709, P < .0001). The average reimbursement per patient was $3084 with dalbavancin vs $2633 SoC (P = .527). The net cost, calculated as revenue minus total cost, was $1685 with dalbavancin vs $75 with SoC (P = .013). The overall treatment success rate was 74% with dalbavancin vs 85% with SoC (P = .004). Conclusions Dalbavancin was more costly than SoC for the treatment of ABSSSI, with a higher 30-day readmission rate. Dalbavancin does not offer an economic or efficacy advantage.

Download Full-text

Abstract WP382: The Cost of Ischemic Stroke: The Superiority of Marginal over Total Cost Estimation and Its Impact on National Cost Estimates

Stroke ◽

10.1161/str.44.suppl_1.awp382 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Annie N Simpson ◽

Charles Ellis ◽

Abby S Kazley ◽

Heather S Bonilha ◽

James S Zoller

Keyword(s):

South Carolina ◽

Ischemic Stroke ◽

Cost Of Illness ◽

Cost Of Care ◽

Control Group ◽

Medicare Beneficiaries ◽

Comorbid Conditions ◽

Total Cost ◽

Economic Decision Making ◽

The Cost

Introduction Cost of illness for ischemic stroke has historically been reported as mean cost per case over a time period. Such cost include expenditures made for comorbid conditions, and may result in an over-estimation of the economic burden of stroke on the nation. Without accurate estimates, policymakers cannot plan appropriately for the ageing US population. Hypothesis The 1-year marginal cost of stroke is less than the 1-year total cost of stroke for South Carolina (SC) Medicare beneficiaries. Methods A cost of illness analysis was performed from the Medicare perspective. SC Medicare billing files for 2004 and 2005 were used to estimate the mean 12 month cost of stroke for 2,976 Medicare beneficiaries hospitalized for ischemic Stroke in 2004. Using nearest neighbor propensity score matching, a control group of 5,952 non-stroke beneficiaries were matched on age, race, gender and comorbid conditions. Results The total cost estimated for stroke patients for 1 year was $81.3 million. The cost for the matched comparison group without stroke, but with similar age, gender, race and comorbid conditions was significantly less at $54.4 million (p<0.0001). Thus, the 2004 marginal costs to Medicare due to ischemic stroke in SC are estimated to be $26.9 million. If this difference is inflated to 2012 dollars and projected to estimate the 2012 one year burden of ischemic stroke nationally, total annual stroke costs would be overestimated by $4.89 billion. Conclusions Accurate estimates of cost of care for conditions, such as stroke, that are common in older patients with a high rate of comorbid conditions require the use of a marginal costing approach. Overestimation of cost of care for stroke may lead to erroneous funding allocation and prediction of larger savings than realizable from stroke treatment and prevention programs. Given the trend of policies based on cost savings, overestimation poses a danger of limiting services that patients may receive. Thus, it is important to use marginal costing for stroke program estimates, especially with the increasing public focus on evidence-based economic decision making to be expected with health reform.

Download Full-text

Association Between Outpatient Rehabilitation Therapy and Total Cost of Care for a Frail Elderly Population in a Medicare Accountable Care Organization

Population Health Management ◽

10.1089/pop.2019.0223 ◽

2020 ◽

Author(s):

Mark Angelo ◽

Ryan Vass ◽

Imelda Flores Vazquez ◽

Daniella Pierre ◽

Timothy Del Vecchio ◽

...

Keyword(s):

Frail Elderly ◽

Elderly Population ◽

Accountable Care Organization ◽

Cost Of Care ◽

Outpatient Rehabilitation ◽

Care Organization ◽

Accountable Care ◽

Total Cost ◽

Rehabilitation Therapy

Download Full-text

Complications Associated with Triple Arthrodesis Versus Non-Fusion Flatfoot Reconstruction: A Matched Cohort Study

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00393 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0039

Author(s):

William V. Probasco ◽

Benjamin E. Stein ◽

Cyrus Fassihi ◽

Lea McDaniel

Keyword(s):

Postoperative Complication ◽

Multivariate Regression ◽

Financial Burden ◽

Cost Of Care ◽

Wound Complications ◽

Complication Rates ◽

Triple Arthrodesis ◽

Total Cost ◽

Significant Difference ◽

Reconstruction Group

Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Pes planovalgus is a very common deformity of the foot, often resulting from adult acquired flatfoot disorder (AAFD). This deformity in its early stages is treated conservatively with non-operatively modalities such as bracing, however in its later stages often requires surgical correction of the deformity in order to improve the pain and function of the extremity. Two commonly performed procedures in the correction of this type of deformity are a triple arthrodesis or joint sparing flatfoot reconstruction. The objective of this study was to identify whether differences existed in the financial burden or complication rates of non-fusion flatfoot reconstruction versus triple arthrodesis. Methods: The PearlDiver Database was queried from 2006-2013 to identify all Medicare patients who were admitted for a triple arthrodesis or non-fusion flatfoot reconstruction. 2308 patients were identified in each cohort and statistically matched in a 1:1 manner to control for influence of demographics and/or comorbidities. Postoperative complication rates (within 30 days) were evaluated and broken down into major (PE/DVT, MI, CVA, sepsis, mortality, nerve injury) and minor (UTI, PNA, hardware failure, transfusion, wound complications) categories. Additionally, total cost of care including cost of readmissions, and readmission within 30 days were evaluated. Results: No significant differences were noted in the postoperative complication rates between the two procedures within the first 30 days post-operatively in the initial univariate regression. There was a significant difference in the rate of 30 day readmission with 2.3% of triple arthrodeses being readmitted vs. 1.08% in the non-fusion joint reconstruction group (p=.002). Adjusted multivariate regression yielded similar results, with no significant differences in postoperative complication rates. The difference in readmission rate remained significant in the multivariate regression (OR 2.13, 95% CI 1.33-3.51, p=.002). Significant differences were also noted for mean total cost of care, with a higher mean total cost identified for the fusion group (x=7,868.0) compared to the reconstruction group (x=4,064.49, p<.001, Adjusted 𝛽𝛽 3,836.71, 95% CI 3,525.23 to 4,148.19, p<.001). Conclusion: This study compared triple arthrodesis versus joint-sparing flatfoot reconstruction. Within this study group there was no difference in complications between the two procedures. There was a significantly higher incidence of 30-day readmission in the triple arthrodesis group by about 2-fold. When comparing the total cost of care, there was a significantly higher cost associated with the triple arthrodesis, which cost on average about $3800 more than joint sparing flatfoot reconstruction. While revealing with regard to the aforementioned variables within the first 30 days post-operatively, further research needs to be conducted on the long term outcomes of these procedures. [Table: see text][Table: see text][Table: see text]

Download Full-text