Shifting Cost-drivers of Health Care Expenditures in Inflammatory Bowel Disease

Abstract Background Inflammatory bowel diseases (IBD) are costly, chronic illnesses. Key cost-drivers of IBD health care expenditures include pharmaceuticals and unplanned care, but evolving treatment approaches have shifted these factors. We aimed to assess changes in cost of care, determine shifts in IBD cost-drivers, and examine differences by socioeconomic and insurance status over time. Methods The Medical Expenditure Panel Survey (MEPS), a nationally representative database that collects data on health care utilization and expenditures from a nationally representative sample since 1998, was utilized. Adult subjects with IBD were identified by ICD-9 codes. To determine changes in per-patient costs or cost-drivers unique to IBD, a control population of rheumatoid arthritis (RA) subjects was generated and matched in 1:1 case to control. Total annual health care expenditures were obtained and categorized as outpatient, inpatient, emergency, or pharmacy related. Temporal cohorts from 1998 to 2015 were created to assess change over time. Per-patient expenditures were compared by disease state and temporal cohort using weighted generalized linear models. Results A total of 641 IBD subjects were identified and matched to 641 RA individuals. From 1998 to 2015, median total annual health care expenditures nearly doubled (adjusted estimate 2.20; 95% CI, 1.6–3.0) and were 36% higher in IBD compared with RA. In IBD, pharmacy expenses increased 7% to become the largest cost-driver (44% total expenditures). Concurrently, inpatient spending in IBD decreased by 40%. There were no significant differences in the rate of change of cost-drivers in IBD compared with RA. Conclusions Per-patient health care costs for chronic inflammatory conditions have nearly doubled over the last 20 years. Increases in pharmaceutical spending in IBD may be accompanied by reduction in inpatient care. Additional studies are needed to explore patient-, disease-, system-, and industry-level cost mitigation strategies.

Download Full-text

P022 SHIFTING COST-DRIVERS OF HEALTH CARE EXPENDITURES IN INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.141 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S55-S56

Author(s):

Benjamin Click ◽

Rocio Lopez ◽

Susana Arrigain ◽

Jesse Schold ◽

Miguel Regueiro ◽

...

Keyword(s):

Health Care Expenditures ◽

Cost Of Care ◽

Rate Of Change ◽

Cost Driver ◽

Medical Expenditure ◽

Healthcare Expenditures ◽

Cost Drivers ◽

Inflammatory Bowel ◽

Nationally Representative ◽

Over Time

Abstract Background Inflammatory bowel diseases (IBD) are costly, chronic illnesses. Key cost-drivers of IBD healthcare expenditures include pharmaceuticals and unplanned care, but evolving treatment approaches have shifted these factors. We aimed to assess changes in cost of care, determine shifts in IBD cost-drivers, and examine differences by socioeconomic and insurance status over time. Methods The Medical Expenditure Panel Survey (MEPS), a nationally representative database that collects data on healthcare utilization and expenditures from a nationally representative sample since 1998 was utilized. Adult subjects with IBD were identified by ICD-9 codes. In order to determine changes in per-patient costs or cost-drivers unique to IBD, a control population of rheumatoid arthritis (RA) subjects was generated and matched in 1:1 case to control. Total annual healthcare expenditures were obtained and categorized as outpatient, inpatient, emergency, or pharmacy related. Temporal cohorts from 1998 to 2015 were created to assess change over time. Per-patient expenditures were compared by disease state and temporal cohort using weighted generalized linear models. Results Total of 641 IBD subjects were identified and matched to 641 RA individuals. From 1998 to 2015, median total annual healthcare expenditures nearly doubled (adjusted estimate 2.20; 95% CI 1.6–3.0) and were 36% higher in IBD compared to RA. In IBD, pharmacy expenses increased 7% to become the largest cost driver (44% total expenditures). Concurrently, inpatient spending in IBD decreased by 40%. There were no significant differences in the rate of change of cost-drivers in IBD compared to RA. Conclusions Per-patient healthcare costs for chronic inflammatory conditions have nearly doubled over the last 20 years. Increases in pharmaceutical spending in IBD may be accompanied by reduction in inpatient care. Additional studies are need to explore patient, disease, system, and industry level cost mitigation strategies.

Download Full-text

Comparison of Health Care Expenditures Among U.S. Older Adults With Pain Who Reported Frequent Exercise Versus Nonfrequent Exercise

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0301 ◽

2021 ◽

pp. 1-9

Author(s):

David R. Axon ◽

Jonathan Chien ◽

Hanh Dinh

Keyword(s):

Health Care ◽

Medical Expenditure Panel Survey ◽

Survey Design ◽

Health Care Expenditure ◽

Prescription Medication ◽

Health Care Expenditures ◽

Cross Sectional Study ◽

Medical Expenditure ◽

Cross Sectional ◽

Nationally Representative

This cross-sectional study included a nationally representative sample of U.S. adults aged ≥50 years with self-reported pain in the past 4 weeks from the 2018 Medical Expenditure Panel Survey. Adjusted linear regression analyses accounted for the complex survey design and assessed differences in several types of annual health care expenditures between individuals who reported frequent exercise (≥30 min of moderate–vigorous intensity physical activity ≥5 times per week) and those who did not. Approximately 23,940,144 of 56,979,267 older U.S. adults with pain reported frequent exercise. In adjusted analyses, individuals who reported frequent exercise had 15% lower annual prescription medication expenditures compared with those who did not report frequent exercise (p = .007). There were no statistical differences between frequent exercise status for other health care expenditure types (p > .05). In conclusion, adjusted annual prescription medication expenditures were 15% lower among older U.S. adults with pain who reported frequent exercise versus those who did not.

Download Full-text

Nationally Representative Health Care Expenditures of Community-Based Older Adults with Pain in the United States Prescribed Opioids vs Those Not Prescribed Opioids

Pain Medicine ◽

10.1093/pm/pnaa114 ◽

2020 ◽

Author(s):

David R Axon ◽

Marion Slack ◽

Leila Barraza ◽

Jeannie K Lee ◽

Terri Warholak

Keyword(s):

Older Adults ◽

Health Care ◽

Emergency Room ◽

Health Care Expenditures ◽

Medical Expenditure ◽

Community Based ◽

Opioid Prescription ◽

The Past ◽

Nationally Representative ◽

Prescription Status

Abstract Objective To compare health care expenditures between older US adults (≥50 years) with pain who were prescribed opioid medications and those who were not. Design Cross-sectional. Setting Community-based adults in the 2015 Medical Expenditure Panel Survey (MEPS). Subjects Nationally representative sample of US adults alive for the calendar year, aged 50 years or older, who reported having pain in the past four weeks. Methods Older US adults (≥50 years) with pain in the 2015 MEPS data were identified. The key independent variable was opioid prescription status (prescribed opioid vs not prescribed opioid). Hierarchical linear regression models assessed health care expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total) in US dollars for opioid prescription status from a community-dwelling US population perspective, adjusting for covariates. Results The 2015 study cohort provided a national estimate of 50,898,592 noninstitutionalized US adults aged ≥50 years with pain in the past four weeks (prescribed opioid N = 16,757,516 [32.9%], not prescribed opioid N = 34,141,076 [67.1%]). After adjusting for covariates, individuals prescribed an opioid had 61% greater outpatient (β = 0.477, P < 0.0001), 69% greater office-based (β = 0.524, P < 0.0001), 14% greater emergency room (β = 0.131, P = 0.0045), 63% greater prescription medication (β = 0.486, P < 0.0001), 29% greater other (β = 0.251, P = 0.0002), and 105% greater total (β = 0.718, P < 0.0001) health care expenditures. There was no difference in opioid prescription status for inpatient expenditures (P > 0.05). Conclusions This study raises awareness of the economic impact associated with opioid use among US older adults with pain. Future research should investigate these variables in greater depth, over longer time periods, and in additional populations.

Download Full-text

P022 SHIFTING COST-DRIVERS OF HEALTH CARE EXPENDITURES IN INFLAMMATORY BOWEL DISEASE

Gastroenterology ◽

10.1053/j.gastro.2019.11.222 ◽

2020 ◽

Vol 158 (3) ◽

pp. S89-S90

Author(s):

Benjamin Click ◽

Rocio Lopez ◽

Susana Arrigain ◽

Jesse Schold ◽

Miguel Regueiro ◽

...

Keyword(s):

Health Care ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Health Care Expenditures ◽

Cost Drivers ◽

Inflammatory Bowel

Download Full-text

Differences in Health Care Expenditures Among Non-Latino Whites and Asian Subgroups Vary Along the Distribution of the Expenditures

Medical Care Research and Review ◽

10.1177/1077558719874212 ◽

2019 ◽

pp. 107755871987421 ◽

Cited By ~ 2

Author(s):

Sungchul Park ◽

Jie Chen ◽

Dylan H. Roby ◽

Alexander N. Ortega

Keyword(s):

Health Care ◽

Limited English Proficiency ◽

Medical Expenditure Panel Survey ◽

Health Care Expenditures ◽

Medical Expenditure ◽

High Expenditure ◽

Low Levels ◽

Nationally Representative ◽

The Difference ◽

White Adults

Using a nationally representative sample from the 2013 to 2016 Medical Expenditure Panel Survey, we examined differences among non-Latino Whites and Asian subgroups (Asian Indians, Chinese, Filipinos, and other Asians) across distributions of total health care expenditures and out-of-pocket (OOP) expenditures. For total health care expenditures, differences between Asian and White adults persisted throughout the distribution, but the magnitude of the difference was larger at no or low levels of expenditures than at high expenditure levels. A similar pattern was observed in OOP expenditures, but the magnitude of the difference was substantially larger at low levels of expenditures. The extent of the difference varied by Asian subgroup, but this trend persisted across all the subgroups. Similar trends were observed by nativity and limited English proficiency. Our findings suggest that differences in health care expenditures between Whites and Asians are more pronounced at low expenditure levels.

Download Full-text

National Estimates of Out-of-Pocket Health Care Expenditure Burdens Among Nonelderly Adults With Cancer: 2001 to 2008

Journal of Clinical Oncology ◽

10.1200/jco.2010.33.0522 ◽

2011 ◽

Vol 29 (20) ◽

pp. 2821-2826 ◽

Cited By ~ 152

Author(s):

Didem S.M. Bernard ◽

Stacy L. Farr ◽

Zhengyi Fang

Keyword(s):

Health Care ◽

Chronic Conditions ◽

Medical Expenditure Panel Survey ◽

Health Care Expenditure ◽

Chronically Ill ◽

Medical Expenditure ◽

Never Married ◽

Patients With Cancer ◽

Nationally Representative ◽

Total Burden

Purpose To compare the prevalence of high out-of-pocket burdens among patients with cancer with other chronically ill and well patients, and to examine the sociodemographic characteristics associated with high burdens among patients with cancer. Methods The sample included persons 18 to 64 years of age who received treatment for cancer, taken from a nationally representative sample of the US population from the 2001 to 2008 Medical Expenditure Panel Survey. We examined the proportion of persons living in families with high out-of-pocket burdens associated with medical spending, including insurance premiums, relative to income, defining high health care (total) burden as spending more than 20% of income on health care (and premiums). Results The risk of high burdens is significantly greater for patients with cancer compared with other chronically ill and well patients. We find that 13.4% of patients with cancer had high total burdens, in contrast to 9.7% among those with other chronic conditions and 4.4% among those without chronic conditions. Among nonelderly persons with cancer, the following were associated with higher out-of-pocket burdens: private nongroup insurance, age 55 to 64 years, non-Hispanic black, never married or widowed, one child or no children, unemployed, lower income, lower education level, living in nonmetropolitan statistical areas, and having other chronic conditions. Conclusion High burdens may affect treatment choice and deter patients from getting care. Thus, although a detailed patient-physician discussion of costs of care may not be feasible, we believe that an awareness of out-of-pocket burdens among patients with cancer is useful for clinical oncologists.

Download Full-text

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.002 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Victor Okunrintemi ◽

Erica Spatz ◽

Joseph Salami ◽

Haider Warraich ◽

Salim Virani ◽

...

Keyword(s):

Health Care ◽

Health Care Providers ◽

Medical Expenditure Panel Survey ◽

Medical Expenditure ◽

Atherosclerotic Cardiovascular Disease ◽

Care Providers ◽

Patient Centered ◽

Patient Reported ◽

Centered Care ◽

Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

Download Full-text

Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE)

Lupus ◽

10.1177/0961203318762604 ◽

2018 ◽

Vol 27 (7) ◽

pp. 1107-1115 ◽

Cited By ~ 4

Author(s):

M E Ogunsanya ◽

S O Nduaguba ◽

C M Brown

Keyword(s):

Health Care ◽

Prescription Drugs ◽

Lupus Erythematosus ◽

Medical Expenditure Panel Survey ◽

Cutaneous Lupus Erythematosus ◽

Health Care Expenditures ◽

Medical Expenditure ◽

Care Utilization ◽

Medication Costs ◽

Cutaneous Lupus

Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization—inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures—total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00–1.28)), ER visits (UR = 1.17, 95% CI (1.09–1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51–3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

Download Full-text

Racial and ethnic patterns and differences in health care expenditures among Medicare beneficiaries with and without cognitive deficits or Alzheimer’s disease and related dementias

BMC Geriatrics ◽

10.1186/s12877-020-01888-y ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sungchul Park ◽

Jie Chen

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Health Care ◽

Ethnic Groups ◽

Ethnic Differences ◽

Cognitive Deficits ◽

Health Care Expenditures ◽

Medical Expenditure ◽

Medicare Beneficiaries ◽

Racial And Ethnic Differences

Abstract Background Numerous studies have documented racial and ethnic differences in the prevalence and incidence of Alzheimer’s disease and related dementias (ADRD). Less is known, however, about racial and ethnic differences in health care expenditures among older adults at risk for ADRD (cognitive deficits without ADRD) or with ADRD. In particular, there is limited evidence that racial and ethnic differences in health care expenditures change over the trajectory of ADRD or differ by types of service. Methods We examined racial and ethnic patterns and differences in health care expenditures (total health care expenditures, out-of-pocket expenditures, and six service-specific expenditures) among Medicare beneficiaries without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Using the 1996–2017 Medical Expenditure Panel Survey, we performed multivariable regression models to estimate expenditure differences among racial and ethnic groups without cognitive deficits, those with cognitive deficits without ADRD, and those with ADRD. Models accounted for survey weights and adjusted for various demographic, socioeconomic, and health characteristics. Results Black, Asians, and Latinos without cognitive deficits had lower total health care expenditures than whites without cognitive deficits ($10,236, $9497, $9597, and $11,541, respectively). There were no racial and ethnic differences in total health care expenditures among those with cognitive deficits without ADRD and those with ADRD. Across all three groups, however, Blacks, Asians, and Latinos consistently had lower out-of-pocket expenditures than whites (except for Asians with cognitive deficits without ADRD). Furthermore, service-specific health care expenditures varied by racial and ethnic groups. Conclusions Our study did not find significant racial and ethnic differences in total health care expenditures among Medicare beneficiaries with cognitive deficits and/or ADRD. However, we documented significant differences in out-of-pocket expenditures and service-specific expenditures. We speculated that the differences may be attributable to racial and ethnic differences in access to care and/or preferences based on family structure and cultural/economic factors. Particularly, heterogeneous patterns of service-specific expenditures by racial and ethnic groups underscore the importance of future research in identifying determinants leading to variations in service-specific expenditures among racial and ethnic groups.

Download Full-text