PMC13 VALUE OF ADDING MEDICAL CLAIMS DATA TO THE PHARMACY-BASED MODELS PREDICTING FUTURE HEALTH CARE COSTS AND JUMPS IN 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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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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Recurrent Acute Rhinosinusitis

Otolaryngology ◽

10.1177/0194599811426089 ◽

2011 ◽

Vol 146 (2) ◽

pp. 307-312 ◽

Cited By ~ 42

Author(s):

Neil Bhattacharyya ◽

Jeff Grebner ◽

Noel G. Martinson

Keyword(s):

Computed Tomography ◽

Health Care ◽

Health Care Costs ◽

Medical Center ◽

Academic Medical Center ◽

Nasal Endoscopy ◽

Oral Antibiotic ◽

Medical Claims ◽

Acute Rhinosinusitis ◽

Care Costs

Objectives. To determine the epidemiology of recurrent acute rhinosinusitis (RARS) and to understand direct health care costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis. Study Design. Retrospective longitudinal analysis of a medical claims database. Setting. Academic medical center. Methods. Medical claims data (2003–2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis claims each with a filled oral antibiotic prescription in a 12-month period) were extracted. Sinonasal diagnostic procedures, provider visits, and medical costs were determined. Results. A total of 4588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. RARS patients averaged 3.8 antibiotic prescriptions, 5.6 other sinus-related prescriptions, and 5.6 provider visits per year. Total direct health care costs related to RARS averaged $1091/patient-year, with oral antibiotic and nasal prescription costs averaging $210 and $452 per year, respectively. Conclusions. RARS may affect approximately 1 in 3000 adults per year. Despite significant direct health care costs of more than $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.

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