Out-of-Pocket Costs and Importance of Nonmedical and Indirect Costs of Inpatients

Introduction Outpatient autologous stem cell transplantation (ASCT) has become standard of care in many centres due to limited inpatient resources and rising financial constraints. Outpatient ASCT involves family members/friends assuming some patient care responsibilities during the acute transplant period. Although this may be associated with reduced direct medical costs, little work has been done to ascertain the "out of pocket costs" and "lost opportunity costs" to patients and their caregivers. Outpatient transplantation is perceived to provide superior quality of life (QOL) for patients, but there is little evidence to support this. In addition to patients' QOL, there is limited data on the impact of these treatments on caregivers' QOL. Thus, our objectives were to compare the QOL of patients and their caregivers undergoing outpatient and inpatient ASCT, and to quantify indirect costs to them. Methods This is a single centre cohort study of consecutive patients with lymphoma and plasma cell disorders undergoing ASCT at Princess Margaret Cancer Centre from April 2016 - July 2019. Patients without a primary caregiver were still eligible to complete the QOL portion of the study. All patients completed four questionnaires: Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT); FACT-Fatigue (FACT-F); EQ-5D-3L; and a distress impact thermometer. Clinically meaningful differences between the groups and serially were defined as ≥ 4 points on the FACT-BMT and FACT-F, and ≥0.08 on the EQ-5D-3L. Caregivers completed three questionnaires: Caregiver Quality of Life Index-Care (C-QOLC), a distress impact thermometer, and a caregiver self-administered financial expenditure survey (C-SAFE). Indirect costs were defined as lost opportunity costs (i.e., wages) and out-of-pocket costs (e.g., parking, accommodations). Questionnaires were completed at 5 time points: D0 (prior to ASCT), D+7, D+14 (discharge from daily visits), D+28 (discharge from ASCT) and D+100 (follow-up). Results In total, 68 patients have been enrolled to date (41 outpatients and 27 inpatients), and 54 caregivers (38 outpatients and 16 inpatients). Median patient age was 57 yrs (range: 18-71), and 66% were male. Of the 68 patients, 69% had a diagnosis of multiple myeloma and 31% lymphoma. Majority of caregivers were spouses (74%). In the overall sample, FACT-F scores (fatigue) increased significantly at D+7, D+14, and D+28, with improvement at D+100 (all p<0.05 and clinically meaningful). Compared to inpatients, outpatients had higher fatigue levels at D+7 and D+14 that were statistically significant (Figure 1), with D+14 being clinically significant as well. For all patients, QOL scores by FACT-BMT declined at D+7, but then improved to above baseline values at D+100 (p<0.05) (Table 1). On the EQ-5D-3L, patients' self-reported overall best imaginable health status decreased at D+7 and D+14 relative to baseline (p<0.05); no significant difference was observed at D+28 and D+100 (Figure 1). Health utility scores were also calculated from the EQ-5D-3L. There were no significant trends in the overall sample, but when comparing the two groups, outpatients had lower measures at D+14 that were statistically and clinically relevant. With respect to caregiver QOL, in the entire sample, QOL was higher at D+100 relative to baseline (p<0.05) (Figure 2). There were no differences between the two groups. In addition, there was no statistically significant difference in lost opportunity costs (wages) between the two groups, however there was a trend towards higher lost opportunity costs in outpatient caregivers in the early ASCT process (D0, D+7, D+14). The mean overall costs (burden) for the primary caregiver in the acute first 100d phase of ASCT was C$4475. The indirect out-of-pocket costs by caregivers varied greatly, with an average of $58 at baseline (range $0-455) and $121 at D+28 (range $0-710). Conclusions There was significant deterioration of various QOL measures in all patients, irrespective of outpatient or inpatient status. Outpatients, however, reported significantly higher fatigue levels at D+7 and D+14. Caregiver QOL appears comparable between the two modalities, and appears to improve significantly by the follow-up period. The financial burden on caregivers, mostly driven by lost opportunity costs (wages), is high, with a trend towards higher burden in outpatient caregivers in the early parts of ASCT. Disclosures Chen: Celgene: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Amgen: Honoraria. Kridel:Gilead Sciences: Research Funding. Kukreti:Celgene: Honoraria; Amgen: Honoraria; Takeda: Honoraria. Kuruvilla:Celgene: Honoraria; Astra Zeneca: Honoraria; Seattle Genetics: Consultancy; Amgen: Honoraria; Roche: Consultancy; Karyopharm: Consultancy; Gilead: Consultancy; Abbvie: Consultancy; BMS: Consultancy; Roche: Research Funding; Janssen: Research Funding; Merck: Consultancy; Gilead: Honoraria; BMS: Honoraria; Karyopharm: Honoraria; Janssen: Honoraria; Roche: Honoraria; Seattle Genetics: Honoraria; Novartis: Honoraria; Merck: Honoraria. Reece:Otsuka: Research Funding; Karyopharm: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Research Funding; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; BMS: Research Funding. Tiedemann:Amgen: Honoraria; Novartis: Honoraria; Takeda: Honoraria; Celgene: Honoraria; BMS: Honoraria; Janssen: Honoraria. Trudel:Pfizer: Honoraria; Celgene: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; GlaxoSmithKline: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Honoraria; Janssen: Honoraria, Research Funding; Astellas: Research Funding; Genentech: Research Funding; Sanofi: Honoraria. Prica:Janssen: Honoraria; Celgene: Honoraria.

Download Full-text

Quality of Life and Caregiver Burden in Patients and Their Caregivers Undergoing Outpatient Autologous Stem Cell Transplantation Compared to Inpatient Transplantation

Blood ◽

10.1182/blood-2021-153120 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3055-3055

Author(s):

Anca Prica ◽

Vinita Dhir ◽

Rachel Aitken ◽

Harminder K Paul ◽

Osvaldo Espin-Garcia ◽

...

Keyword(s):

Quality Of Life ◽

Board Of Directors ◽

Research Funding ◽

Indirect Costs ◽

Well Being ◽

Advisory Committees ◽

Caregiver Quality ◽

Lost Opportunity ◽

Out Of Pocket Costs

Abstract Introduction Outpatient autologous stem cell transplantation (ASCT) has become standard of care in many centres due to limited inpatient resources and rising financial constraints. Outpatient ASCT involves family members/friends assuming patient care responsibilities during the acute transplant period. Although this may be associated with reduced direct medical costs, less is known about the "out of pocket costs" and "lost opportunity costs" to patients and their caregivers, as well as impact on caregiver quality of life (QOL). Outpatient transplantation is perceived to provide superior QOL for patients, but there is little evidence to support this. Thus, our objectives were to compare the QOL of patients and their caregivers undergoing outpatient and inpatient ASCT, and to quantify indirect costs to them. Methods This is a single centre cohort study of patients with lymphoma and multiple myeloma undergoing ASCT at Princess Margaret Cancer Centre from April 2016 - February 2021. Patients without a primary caregiver were still eligible to complete the QOL portion of the study. Patients completed several questionnaires including FACT-BMT, FACT-F, and EQ-5D. Caregiver questionnaires included: Caregiver Quality of Life Index-Care (C-QOLC), and a caregiver self-administered financial expenditure survey (C-SAFE). Total indirect costs were defined as lost opportunity costs (i.e., wages) plus out-of-pocket costs (e.g., parking, accommodations). Questionnaires were completed at 5 time points: D0 (prior to ASCT), D+7, D+14 (discharge from daily visits), D+28 (discharge from ASCT) and D+100 (follow-up). Demographic and clinical characteristics were assessed using descriptive statistics. Pairwise changes in QOL from baseline were assessed using linear mixed models to account for repeated measures with group, age and sex included as fixed effects. Alpha was defined as p<0.05. Results A total of 97 patients (49 outpatients and 45 inpatients) and 66 caregivers (43 outpatients and 22 inpatients) were enrolled. Patients had a median age of 59 years (range 18-71) and were predominantly male (60%) with 66% diagnosed with multiple myeloma and 34% with lymphoma. Majority of caregivers were spouses (76%). Inpatients were more likely to be employed and have lymphoma. The overall cohort demonstrated a clinically meaningful decrease (≥4 points) from baseline in mean FACT-F scores (fatigue) at D+7, D+14, and D+28 with slight improvements at D+100 (Table 1). Compared to inpatients, outpatients overall exhibited significantly (p=0.011) greater changes in fatigue from baseline at D+7 and D+14, with comparable change scores at D+28 and D+100 between groups (Figure 1a). Moreover, for all patients, there was a clinically meaningful decrease from baseline in mean QOL scores by FACT-BMT (≥4 points) at D+7 and D+14, and a meaningful improvement at D+100, with no differences between groups (Table 1). On the FACT-BMT subscales, outpatients had overall worsening scores compared to inpatients on the Physical (p=0.029), and Functional Well-Being Subscales (p=0.043) (Figure 1c), while no differences were detected on the Emotional and Social Well-being scales. Health utility scores were also calculated from the EQ-5D-3L, with a significant downward trend in the overall sample at D+7; however, no clinically relevant changes (≥ 0.08) were noted, and results were comparable between groups (Figure 1d). With respect to caregiver QOL, there were no differences in mean change scores between the two groups; however overall, caregivers had a significant improvement at D+100 compared to baseline (p<.05; Figure 1e). Outpatient caregivers experienced higher mean out-of-pocket costs ($1360 vs. $789, p=0.03) with the primary caregiver facing significantly greater total indirect costs ($1960 vs. $1068, p=0.025) (Table 2). For fully employed primary caregivers, the mean lost wages were $1231 for inpatients vs. $2150 for outpatients over the 3 month acute ASCT period. Conclusions There was significant deterioration of various measures of QOL in all patients, irrespective of outpatient or inpatient status. Outpatients, however, reported significantly greater changes in fatigue from baseline at D+7, D+14 and D+28. Caregiver QOL appears comparable between the two modalities. The financial burden on caregivers is high, with significantly higher total indirect costs in outpatient caregivers in the acute post-ASCT period. Figure 1 Figure 1. Disclosures Prica: Kite Gilead: Honoraria; Astra-Zeneca: Honoraria. Chen: Astrazeneca: Membership on an entity's Board of Directors or advisory committees; Beigene: Membership on an entity's Board of Directors or advisory committees; BMS: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Gilead: Consultancy, Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy. Crump: Novartis: Membership on an entity's Board of Directors or advisory committees; Kyte/Gilead: Membership on an entity's Board of Directors or advisory committees; Epizyme: Research Funding; Roche: Research Funding. Kridel: Gilead Sciences: Research Funding. Kuruvilla: AbbVie: Honoraria; Incyte: Honoraria; Medison Ventures: Honoraria; Merck: Honoraria; Novartis: Honoraria; Gilead: Honoraria; Seattle Genetics: Honoraria; Karyopharm: Honoraria, Other: Data and Safety Monitoring Board; Roche: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; AstraZeneca: Honoraria, Research Funding; TG Therapeutics: Honoraria; Amgen: Honoraria; Pfizer: Honoraria; BMS: Honoraria; Antengene: Honoraria. Reece: Celgene: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria, Research Funding; BMS: Honoraria, Research Funding; Janssen: Consultancy, Honoraria, Research Funding; Sanofi: Honoraria; Millennium: Research Funding; Karyopharm: Consultancy, Research Funding; Amgen: Consultancy, Honoraria; GSK: Honoraria.

Download Full-text

DEEP Study: Indirect and Out-of-pocket Costs of Persistent Orofacial Pain

Journal of Dental Research ◽

10.1177/0022034518773310 ◽

2018 ◽

Vol 97 (11) ◽

pp. 1200-1206 ◽

Cited By ~ 6

Author(s):

M. Breckons ◽

J. Shen ◽

J. Bunga ◽

L. Vale ◽

J. Durham

Keyword(s):

Health Care ◽

Orofacial Pain ◽

Care Pathway ◽

Indirect Costs ◽

Pain Scale ◽

Care Utilization ◽

North East ◽

Use Of Services ◽

Patients At Risk ◽

Out Of Pocket Costs

Persistent orofacial pain (POFP) is common and caused by a group of conditions affecting the face, head, or mouth. Recent research highlighted a problematic care pathway with high costs to the health care provider, but the financial impact on patients and employers is not understood. This study aimed to describe patient (out-of-pocket) and employer (indirect) costs of POFP and to identify whether the dichotomized Graded Chronic Pain Scale (GCPS) was predictive of costs. A cohort of 198 patients was recruited from primary and secondary care settings in North East England and followed over a 24-mo period. Patients completed the GCPS and Use of Services and Productivity Questionnaire every 6 mo and a Time and Travel Questionnaire at 14 mo. Questionnaires examined the implications of health care utilization on patients’ everyday lives and personal finances. Time and travel costs were calculated and applied to use-of-services data to estimate out-of-pocket costs, while the human capital method and QQ method (quantity and quality of work completed) were used to estimate absenteeism and presenteeism costs, respectively. Per person per 6-mo period (in 2017 pounds sterling), mean out-of-pocket costs were £333 (95% CI, £289 to £377), and indirect costs were £1,242 (95% CI, £1,014 to £1,470). Regression analyses indicated that over 6 mo, the GCPS was predictive of the following: out-of-pocket costs—a difference of £311 between low and high GCPS per person per 6-mo period (95% CI, £280 to £342; P < 0.01, n = 705 observations over 24 mo); indirect costs—a difference of £2,312 between low and high GCPS per person per 6-mo period (95% CI, £1,886 to £2,737; P < 0.01; n = 352 observations over 24 mo). This analysis highlights “hidden” costs of POFP and supports the use of the dichotomized GCPS to identify patients at risk of higher impact and associated costs and thereby stratify care pathways and occupational health support appropriately.

Download Full-text

Abstract WP406: Out of Pocket Costs for Pediatric Stroke Care

Stroke ◽

10.1161/str.44.suppl_1.awp406 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Patricia Plumb ◽

Eric Seiber ◽

Michael M Dowling ◽

JoEllen Lee ◽

Timothy J Bernard ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Costs ◽

Indirect Costs ◽

Stroke Care ◽

Annual Income ◽

Childhood Stroke ◽

Medical Visits ◽

Out Of Pocket Expenses ◽

Wage Earners ◽

Out Of Pocket Costs

Objective: Direct hospital costs have been reported for children who have had stroke, and are similar to direct costs for adults. There has been no information regarding the indirect costs families encounter that are not covered by insurance (i.e. out-of-pocket) costs. Knowing the magnitude of these costs will give a more complete understanding of the economic impact of childhood stroke. This study describes out-of-pocket costs families paid in the first year after a child’s ischemic stroke. Methods: 22 of 70 possible subjects were prospectively recruited at 4 centers in the US and Canada in 2008 and 2009 for the “Validation of the Pediatric NIH Stroke Scale” study, and their out-of-pocket costs were tracked for 1 year. Parents reported expenses every three months, including wages lost for hours they did not work, non-reimbursed costs for medical visits or other health care, and mileage. They provided estimates of annual income. We calculated total out-of-pocket costs in US dollars. We also reported costs as a proportion of annual income to account for regional differences in income. Results: Total median out-of-pocket cost for one year was $4354 (range 0-$28,666). Wage earners in two families lost their jobs. Out-of-pocket costs were greatest in the first three months after the incident stroke, with the largest proportion due to lost wages, followed by non-reimbursed healthcare, lodging, and transportation. Lost wages remained high in the second quarter, but fell by the third and fourth quarters. Healthcare costs remained stable for the 4 quarters. For the entire year median out-of-pocket costs represented 6.8% (range 0-81.9%) of annual income. Conclusions: Out-of-pocket expenses are significant for families following a child’s ischemic stroke. These median out-of-pocket expenses of $4300 are of particular concern given that the median American household has cash savings of only $3,860. These results can be combined with previous reports of childhood stroke costs to model the overall costs of childhood stroke. Childhood stroke creates an under-recognized cost to society because of decreased parental productivity due to lost hours from work.

Download Full-text

Estimating the pre- and post-diagnosis costs of tuberculosis care for adults in Karachi, Pakistan: Household economic impact and strategies for meeting the costs

10.21203/rs.3.rs-615524/v1 ◽

2021 ◽

Author(s):

Shama Razzaq ◽

Aysha Zahidie ◽

Zafar Fatmi

Keyword(s):

Public Service ◽

Point Of Care ◽

Indirect Costs ◽

Support Network ◽

Private Provider ◽

Patient Treatment ◽

And Coping ◽

Tuberculosis Care ◽

Out Of Pocket Costs ◽

Critical Investigation

Abstract Background Despite of free TB care in Pakistan, patients still have to bear high costs which push them more into poverty. This study estimated the types of costs households bear for TB care, and coping mechanisms used for bearing TB expenditures among adults ≥ 18 years in Karachi, Pakistan. Methods A total of 516 TB patients with completion of at least one month intensive treatment were recruited from four public sector hospitals in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. Direct medical and non-medical costs incurred as out-of-pocket and indirect costs (loss of income) during pre-diagnostic, diagnostic, treatment and hospitalization phase were estimated. Results Out of 516 participants, 52.1% were female with a mean age of 32.4 (± 13.7) years. The median costs per patient borne during the pre-diagnostic, diagnostic, treatment and hospitalization was estimated at USD63.8/ PKR7377, USD24/ PKR2755, USD10.5/ PKR1217 and USD349.0/ PKR40300, respectively. The total household median costs was estimated at USD129.2/ PKR14919 per patient. The median indirect costs were estimated at USD52.0/ PKR5950 per patient. First point of care was a private provider by 54.1% of patients, 36% attended public service, 5% and 4.1% went to dispensary and pharmacy, respectively. Conclusion TB patients bear substantial out-of-pocket costs before they are enrolled in publically funded TB program. There should be provision of transport and food vouchers, also health insurance for in-patient treatment. This advocates a critical investigation into an existing financial support network for TB patients in Pakistan with an eye towards easing the burden.

Download Full-text

How Do Out-of-Pocket Expenditures Affect Healthcare: A Qualitative Insight of Acute Exacerbation among Asthma Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i430427 ◽

2020 ◽

pp. 67-73

Author(s):

Muhammad Shahid Iqbal ◽

Fahad I. Al-Saikhan ◽

Nehad J. Ahmed ◽

Muhammad Zahid Iqbal

Keyword(s):

Acute Exacerbation ◽

Public Hospital ◽

Indirect Costs ◽

Sampling Technique ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Asthma Patients ◽

Convenience Sampling ◽

Out Of Pocket Costs

Introduction: This study was designed to determine the out of pocket costs (OOPCs) of acute exacerbation of asthma (AEA) in asthma patients attending a public hospital. Methodology: A cross-sectional study was done by interviewing the patients using the convenience sampling technique. Data were obtained based on per episode of AEA. OOPCs were calculated based on direct and indirect costs. A total of 128 patients participated in the study. The data were analyzed with SPSS ver 23. Results: The study group comprised of 88 males (68.8%), 57 (44.5%) singles and 67 (52.3%) less than 40 years of age. There were considerable differences found between the severity levels and lengths of hospital stay towards the OOPCs. Conclusion: The severity of the AEA and length of stay in the hospital increase the per episode OOPCs of AEA among asthma patients.

Download Full-text

Interpreting out-of-pocket expenditures for cancer patients: The importance of considering baseline household income information

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6541 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6541-6541

Author(s):

W. S. Oatis ◽

N. Nonzee ◽

T. Markossian ◽

V. Shankaran ◽

J. McKoy ◽

...

Keyword(s):

Breast Cancer ◽

Hodgkin Lymphoma ◽

Household Income ◽

Financial Burden ◽

Indirect Costs ◽

Medical Costs ◽

Cost Ratio ◽

Monthly Household Income ◽

Non Hodgkin Lymphoma ◽

Out Of Pocket Costs

6541 Background: Few studies have examined cancer-related out-of-pocket costs (expenses resulting from cancer morbidity and treatment that are not covered by insurance) as a function of baseline household income. We report income-adjusted out-of-pocket cost ratios for 50 patients with lymphoma and 156 patients with breast cancer. Methods: Patients with lymphoma or breast cancer provided 3-month retrospective documentation of cancer-related out-of-pocket costs. Costs were adjusted for income by dividing monthly costs by monthly household income. Direct medical costs include costs related to medications, doctor visits, and hospital stays. Direct non-medical costs are cancer-related peripheral costs, such as transportation and meals. Indirect costs are costs due to lost income. Results: Of our study patients, 83% were Caucasian, 65% were married, 53% were employed, and 65% had at least a bachelor's degree. All patients were undergoing active treatment and had insurance. Mean monthly out-of-pocket costs for patients with lymphoma were slightly greater than for those with breast cancer ($1,888 vs $1,455, respectively). Among patients with an annual income of $30,000 or less, the total monthly out-of-pocket costs were more than 3 times the monthly household income for patients with lymphoma and equal to the monthly household income for patients with breast cancer. The total mean income-adjusted cost ratio was 1.75 for patients with aggressive non-Hodgkin lymphoma versus 0.42 and 0.61 for those with indolent non-Hodgkin lymphoma or Hodgkin disease, respectively. Conclusions: Cancer-related out-of-pocket expenses disproportionately affect lower-income individuals with lymphoma or breast cancer and are primarily driven by the financial burden of co-payments for medical care. Future studies should evaluate out-of-pocket costs in relation to household income to determine more accurately the economic burden of cancer. [Table: see text] No significant financial relationships to disclose.

Download Full-text

Is There a Difference in The “Out-Of-Pocket” Costs of Cancer Treatment When Comparing Patients From The Brazilian National Health System With Patients Enrolled in Clinical Research Protocols?

10.21203/rs.3.rs-807102/v1 ◽

2021 ◽

Author(s):

Thiago Artioli ◽

Karine Corcione Turke ◽

Aline Hernandez Marquez Sarafyan ◽

Beatriz Boos Ortolani ◽

Ingrid Victoria Maria Biondo Edle von Schmadel ◽

...

Keyword(s):

Health System ◽

Cancer Treatment ◽

National Health ◽

National Health System ◽

Indirect Costs ◽

Tertiary Hospital ◽

Cross Sectional ◽

Oral Medications ◽

Research Protocols ◽

Out Of Pocket Costs

Abstract Introduction: Economic burden of cancer treatment does not fall only on the Brazilian National Health System (“SUS”) but also on patients. Nonreimbursed indirect costs include noncovered oral medications, food, transportation, and others. Our study compares out-of-pocket costs of cancer treatment between patients from the SUS and patients enrolled in research protocols. Methods Observational, cross-sectional and analytical study conducted in 2021. Patients undergoing chemotherapy were divided into 2 groups: patients from a tertiary hospital affiliated with the SUS and patients enrolled in research protocols at a research center. The primary outcome was the evaluation of out-of-pocket costs using a socioeconomic questionnaire to identify the cost and time spent by patients during treatment. This study was approved by the Research Ethics Committee. Results 195 patients were included, of whom 165 (84.6%) were treated by the SUS and 30 (15.4%) by research protocols. Of the total, 61% were female, and the mean age of the patients was 57 years. The median total out-of-pocket costs of SUS patients was Brazilian reais (R$) 453.80 (US$ 78.92), and that of patients who were enrolled in research protocols was R$ 448.00 (US$ 77.91) (P = 0.317). A comparison of the groups by multivariate analysis showed that only the time spent by patients on chemotherapy and radiotherapy was significantly different, being higher in the SUS group (OR 2.58, 95% CI 1.03–6.50). Conclusion Total out-of-pocket spending by SUS patients is similar in magnitude to that by patients in research protocols, although the reasons for the spending are different.

Download Full-text

Nonsevere Hypoglycemia Episode Clinical and Economic Outcomes: A Comparison between Sulfonylurea and Sodium-Glucose Cotransporter 2 Inhibitor as Add-On to Metformin from a Canadian Perspective

International Journal of Endocrinology ◽

10.1155/2018/3718958 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Pendar Farahani

Keyword(s):

Sensitivity Analysis ◽

Work Productivity ◽

Indirect Costs ◽

Risk Difference ◽

Economic Outcomes ◽

Economic Evaluations ◽

Clinical Settings ◽

Sodium Glucose Cotransporter ◽

Number Of Patients ◽

Out Of Pocket Costs

Background. Nonsevere hypoglycemia episodes (NSHEs) are associated with clinically adverse outcomes, lower health-related quality of life, increased burden of disease, and reduced work productivity. Objective. To estimate prevalence of NSHEs and associated economic outcomes attributable to sulfonylurea (SU) versus sodium-glucose cotransporter 2 inhibitor (SGLT2i) initiation after metformin over one year for Canadian patients with type 2 diabetes (T2DM). Methods. Risk difference for NSHEs was calculated for SU and SGLT2i from RCT data. Estimation of NSHEs attributable to SU utilization in Canada was calculated from published data. Both direct and indirect costs associated with NSHEs were obtained from previous published studies in literature. Results. The number of patients with T2DM and exposure to SU in Canada in 2016 was estimated to be 1,246,438. The average underreported NSHEs in clinical settings were estimated at 67.7%. Risk difference for NSHEs for SU versus SGLT2i was estimated at 26.7%. Estimation of excess NSHEs attributable to SU utilization versus SGLT2i in Canada was estimated at 130,434 events per year (sensitivity analysis: minimum 80,680 and maximum 624,465). Total indirect costs including loss-of-work productivity and out-of-pocket costs secondary to excess NSHEs due to SU utilization versus SGLT2i after metformin were estimated at CDN$8.6M (M = millions) for 2016 (sensitivity analysis: minimum CDN$5.3M and maximum CDN$81.2M). Conclusion. NSHE, which is a forgotten variable in economic evaluations for healthcare reimbursement models, occurs frequently in real-world clinical settings but is infrequently reported. NSHEs can lead to a significant loss-of-work productivity and out-of-pocket costs.

Download Full-text