Excess Health Care Costs of Obesity in Adults with Diabetes Mellitus: a Claims Data Analysis

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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Direct health care costs in patients with type 2 diabetes mellitus six months after starting insulin treatment in Spain: The INSTIGATE Study

Endocrinología y Nutrición (English Edition) ◽

10.1016/s2173-5093(11)70060-5 ◽

2011 ◽

Vol 58 (6) ◽

pp. 274-282

Author(s):

María Costi ◽

Helen Smith ◽

Jesús Reviriego ◽

Conxa Castell ◽

Alberto Goday ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Health Care ◽

Type 2 Diabetes Mellitus ◽

Health Care Costs ◽

Insulin Treatment ◽

Care Costs

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Health Care Costs by Type of Expenditure across eGFR Stages among Patients with and without Diabetes, Cardiovascular Disease, and Heart Failure

Journal of the American Society of Nephrology ◽

10.1681/asn.2019121308 ◽

2020 ◽

Vol 31 (7) ◽

pp. 1594-1601 ◽

Cited By ~ 1

Author(s):

Gregory A. Nichols ◽

Anastasia Ustyugova ◽

Anouk Déruaz-Luyet ◽

Maureen O’Keeffe-Rosetti ◽

Kimberly G. Brodovicz

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Cardiovascular Disease ◽

Health Care ◽

Kidney Function ◽

Health Care Costs ◽

Large Contribution ◽

Integrated Delivery System ◽

Comorbidity Burden ◽

Care Costs

BackgroundCKD is associated with higher health care costs that increase with disease progression. However, research is lacking on the type of health care costs associated with CKD across all stages in a general population with a substantial comorbidity burden.MethodsUsing electronic medical records of an integrated delivery system, we evaluated health care costs by expenditure type in general and in patients with CKD by eGFR and presence of comorbidities. We categorized 146,132 patients with eGFR data in 2016 or 2017 and examined nonmutually exclusive groups according to presence of diabetes mellitus, cardiovascular disease, or heart failure. We used 1 year of follow-up data to calculate outpatient, inpatient, emergency, pharmaceutical, dialysis, and total health care costs by eGFR (Kidney Disease Improving Global Outcomes–defined eGFR categories), adjusted for age, sex, and nonwhite race.ResultsMean total health care costs among patients with CKD without comorbidities were 31% higher than among patients without CKD ($7374 versus $5631, respectively). Hospitalizations accounted for 35% of total costs among those with CKD and no comorbidities but up to 55% among patients with CKD and heart failure. The proportion of costs attributable to hospitalizations accelerated with declining kidney function, reaching as high as 66%.ConclusionsPoorer kidney function and the presence of diabetes mellitus, cardiovascular disease, or heart failure drive substantial health care costs and increase the proportion of costs attributable to inpatient care. The large contribution of inpatient costs begins in earlier stages of CKD and escalates as kidney function declines. Additional therapies to reduce CKD incidence, slow CKD progression, and lower hospitalization risk are needed to benefit patients and reduce CKD’s economic burden.

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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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