1434. Treatment Patterns, Healthcare Resource Use, and Associated Costs in Females with Uncomplicated Urinary Tract Infection in the United States

Abstract Background Urinary tract infections (UTIs) disproportionately affect women and are a substantial burden on healthcare systems. We assessed the effect of antibiotic (AB) switching on UTI recurrence, healthcare resource use (HRU), and related costs among adolescent and adult females in the US with uncomplicated UTIs (uUTIs). Methods This retrospective cohort study used US Optum claims data (United Healthcare, January 1, 2013–December 31, 2018). Eligible patients were females ≥ 12 years of age with an acute uUTI diagnosis at outpatient or emergency department (ED) visit (index date) and an oral AB prescription within ± 5 days of index. Patients with recurrent UTIs (rUTIs), defined as 2 UTI diagnoses (including index) in 6 months or ≥ 3 UTI diagnoses (including index) in 12 months, were included; those with complicated UTI were excluded. Patients were assigned to two groups: AB switch (≥ 2 filled prescriptions of different AB within 28 days post index [uUTI episode]) and no AB switch. Results In 5870 eligible patients (mean age 44.5 years; 76.6% White), ciprofloxacin (CIP; 38.6%), nitrofurantoin (NFT; 31.4%), and trimethoprim-sulfamethoxazole (TMP-SMX; 25.6%) were the most commonly prescribed first-line ABs at index, and 567 (9.7%) patients switched AB. CIP was switched to NFT and TMP-SMX in 2.0% and 1.7% of patients, respectively. NFT was switched to CIP and TMP-SMX in 2.6% and 1.5% of patients, respectively. TMP-SMX was switched to CIP and NFT in 3.0% and 2.4% of patients, respectively. During index visit, the AB switch group had higher mean ambulatory care and pharmacy claims (both p < 0.001), and higher total mean HRU costs (&2186.4) per patient compared with the no switch group (&1508.8; p = 0.011). More patients had rUTI in the AB switch group (18.9%) versus the no switch group (14.2%; p < 0.001), and more had ED visits in the AB switch group than the no switch group (p < 0.0001) (Table 1). During follow-up, the AB switch group had a higher mean number of uUTI episodes per patient (p < 0.001; Table 1), and more patients had UTI-related ED visits (10.8%) compared with the no switch group (7.7%; p = 0.010; Table 2). Table 1. Primary outcomes of uncomplicated UTI outpatients during January 1, 2013–December 31, 2018, stratified by any switch in AB use during index episode Table 2. Primary outcomes of uncomplicated UTI outpatients during January 1, 2013–December 31, 2018, stratified by any switch in AB use during 12-month follow-up Conclusion US females with uUTI who switched AB had more rUTI cases and increased overall costs and HRU compared with those who did not switch AB, suggesting an unmet need for improved prescribing practices. Disclosures Rena Moon, MD, Premier Applied Sciences, Premier Inc. (Employee) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Alex Kartashov, PhD, Premier Applied Sciences, Premier Inc. (Employee) Ning Rosenthal, MD, Premier Applied Sciences, Premier Inc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

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2374. Healthcare Resource Use, Costs, and Recurrences in Patients with Clostridioides difficile Infection: A Real-world Data Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2052 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S819-S819

Author(s):

Winnie Nelson ◽

Laura Stong ◽

Naomi Sacks ◽

Alexandria Portelli ◽

Bridget Healey ◽

...

Keyword(s):

Resource Utilization ◽

Resource Use ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Healthcare Resource Use ◽

Diagnosis Code ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Ed Visits

Abstract Background Clostridioides difficile infection (CDI), especially recurrent CDI (rCDI), is associated with high morbidity and resource use and imposes a significant burden on the US healthcare system. The objective of this study was to evaluate the burden of rCDI on healthcare resource utilization. Methods A retrospective study analyzed commercial claims data from patients aged 18–64 years old in the IQVIA PharMetrics Plus™ database. CDI episodes required an inpatient stay with CDI diagnosis code (ICD-9-CM 008.45; ICD-10-CM A04.7, A04.71, A04.72), or an outpatient medical claim with CDI diagnosis code plus a CDI treatment, and index episodes occurred from January 1, 2010 to June 30, 2017. Only patients who were observable 6 months before and 12 months after the index CDI episode were included. Each CDI episode was followed by a 14-day claim-free period after the end of treatment. rCDI was defined as another CDI episode within an 8-week window immediately after the claim-free period. Number of CDI and rCDI episodes, healthcare resource use, and costs were calculated over 12-month follow-up and stratified by number of rCDI episodes. Costs were adjusted to 2018 dollars. Results 46,571 patients with an index CDI episode were included, with 3,129 (6.7%) who had 1 rCDI, 472 (1.0%) who had 2 rCDI, and 134 (0.3%) who had 3+ rCDI episodes. Mean age was 47.4 years, and 62.4% were female. In the 12-month follow-up, the mean (SD) numbers of inpatient visits were 1.4 (2.1) for those with no rCDI, 2.7 (3.4) for those with 1 rCDI, 3.7 (3.9) for those with 2 rCDI, and 5.8 (6.0) for those with 3+ rCDI episodes. Emergency department (ED) visits had a similar trend, with mean (SD) number of visits of 1.5 (3.5), 2.5 (6.0), 3.7 (7.0), and 4.6 (13), respectively for the four study groups. All-cause costs after the index CDI were $71,980 for those with no rCDI, $131,953 for those with 1 rCDI, $180,574 for those with 2 rCDI, and $207,733 for those with 3+ rCDI. Conclusion CDI and rCDI are associated with substantial healthcare resource utilization and direct medical costs. During the 12 months after an index CDI episode, the number of inpatient admissions and ED visits increased substantially for patients with an rCDI episode. Direct medical costs for patients with rCDI also increased with number of recurrences. Disclosures All authors: No reported disclosures.

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1414. Real-World Study of Healthcare Resource Use and Costs Associated with Inappropriate and Suboptimal Antibiotic Use Among Females with Uncomplicated Urinary Tract Infection in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1606 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S792-S792

Author(s):

Madison T Preib ◽

Fanny S Mitrani-Gold ◽

Xiaoxi Sun ◽

Christopher Adams ◽

Ashish V Joshi

Keyword(s):

Urinary Tract ◽

Resource Use ◽

Real World ◽

Index Date ◽

Healthcare Resource ◽

Healthcare Resource Use ◽

Population Total ◽

The Us ◽

Commercial Population

Abstract Background Urinary tract infections (UTIs) are the most common outpatient infection requiring medical care in the US; but, despite Infectious Diseases Society of America 2011 guidelines for treating uncomplicated UTI (uUTI), variation in prescribing practices still exists. Few studies have used real-world data (RWD) to evaluate uUTI-associated healthcare resource use (HRU) and costs. We examined HRU and direct costs associated with appropriate and optimal (AP&OP) and inappropriate or suboptimal (IA/SO) antibiotic (AB) prescribing in females with uUTI using US RWD. Methods This retrospective cohort study used RWD from IBM MarketScan (commercial/Medicare claims) to examine uUTI-related HRU and costs (inpatient, emergency room, outpatient, pharmacy) per index uUTI episode and during 1-year follow-up among females (age ≥ 12 years) diagnosed with uUTI from July 1, 2013–December 31, 2017 (index date). Patients had an oral AB prescription ± 5 days of the index date, and continuous health plan enrollment ≥ 6 months pre/1 year post-index date; those with complicated UTI were excluded. Patients were stratified by AB prescription as follows: AP&OP = guideline-compliant and correct duration; IA/SO = guideline non-compliant/incorrect duration or re-prescription/switch within 28 days. Results The study included 557,669 patients. In the commercial population (n=517,664, mean age 37.7 years), fewer patients were prescribed AP&OP (11.8%) than IA/SO (88.2%) ABs, a trend also seen in the Medicare population (n=40,005, mean age 74.5 years). In both populations, adjusted average numbers of uUTI-related ambulatory visits and pharmacy claims were lower for the AP&OP cohort than the IA/SO cohort during index episode and 1-year followup (p < 0.0001, Table 1). In the commercial population, total adjusted uUTI-related costs were &194 (AP&OP) versus &274 (IA/SO; p < 0.0001); in the Medicare population, total adjusted uUTI-related costs were &253 (AP&OP) versus &355 (IA/SO; p < 0.0001) (Table 2). Table 1. uUTI-related HRU for commercial and Medicare populations calculated using the GLM model Table 2. uUTI-related costs for commercial and Medicare populations calculated using the GLM model Conclusion Overall uUTI-related HRU and costs in the US were low during index episodes and follow-up. However, females with uUTI prescribed IA/SO ABs were more likely to incur higher HRU and costs than those prescribed AP&OP ABs, suggesting an unmet need for training to optimize uUTI prescribing per US guidelines. Disclosures Madison T. Preib, MPH, STATinMED Research (Employee, Former employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Xiaoxi Sun, MA, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Christopher Adams, MPH, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

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197. Healthcare Resource Utilization and Costs Associated with Inappropriate and Suboptimal Prescribing of Antibiotics for Uncomplicated Urinary Tract Infection in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.197 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S120-S120

Author(s):

Rena Moon ◽

Alen Marijam ◽

Fanny S Mitrani-Gold ◽

Daniel C Gibbons ◽

Alex Kartashov ◽

...

Keyword(s):

Applied Sciences ◽

Urinary Tract Infection ◽

Urinary Tract ◽

Tract Infection ◽

Claims Data ◽

Healthcare Resource ◽

The United States ◽

Charlson Comorbidity Index Score ◽

Uncomplicated Urinary Tract Infection

Abstract Background Despite well-established guidelines for urinary tract infection (UTI) treatment, prescribing practices vary. We examined the association between inappropriate (IA) or suboptimal (SO) antibiotic (AB) prescribing (RX) and hospitalization, healthcare resource use (HRU), and costs among patients with uncomplicated UTI (uUTI) in the US. Methods This retrospective cohort study used linked Premier Healthcare/Optum claims data from female outpatients (≥ 12 years old) with a uUTI diagnosis (January 1, 2013 to December 31, 2018). Patients with complicated UTIs (eg, urological abnormalities, medications/procedures associated with complicated UTI, or intravenous AB receipt at index) were excluded. HRU and costs between patients with IA/SO and appropriate and optimal (AP&OP) AB RX (defined in Table 1) were assessed from Optum claims data during index episode (within 28 days of index) and 12-month follow-up. Table 1. Definitions of appropriateness of AB RX Results Of 5870 patients, 1856 (31.6%) had IA and 1255 (21.4%) had SO AB RX. Patients with IA/SO AB RX (47.1%) were older and more likely to have a Charlson Comorbidity Index score > 0 than those with AP&OP AB RX (52.9%; Table 2). During index episode, mean ambulatory care and pharmacy claims were significantly higher for IA/SO versus AP&OP AB RX (8.0 vs 6.3, 3.3 vs 2.6, respectively; p < 0.01), and total HRU cost per patient was higher for IA/SO (&2616) versus AP&OP AB RX (&649; p < 0.01). During follow-up, 267 (9.7%) patients with IA/SO AB RX had a UTI-related emergency department (ED) visit versus 202 (6.5%) patients with AP&OP AB RX (p < 0.001). Mean UTI-related HRU costs were significantly higher for IA/SO (&5048) versus AP&OP AB RX (&3633; p = 0.01). After adjusting for patient characteristics, patients with IA/SO AB RX were 40% more likely than those with AP&OP AB RX to have a UTI-related ED visit (odds ratio 1.40; 95% confidence interval 1.15–1.71) during follow-up (Table 3). Adjusted HRU costs for IA/SO AB RX (vs AP&OP) were numerically higher for index uUTI episode (by &1772), and UTI-related (by &1102) and all-cause (by &1528) charges during follow-up (Figure). Table 2. Baseline characteristics of patients stratified by appropriateness of AB RX Table 3. Associations of AP&OP AB RX and HRU charges for index episode and 12-month follow-up Figure. Total 12-month UTI-related and all-cause visit charges (adjusted), stratified by appropriateness of AB RX at index and during follow-up Conclusion IA/SO AB RX was associated with higher overall and UTI-related HRU and costs during index episode and 12-month follow-up, highlighting a need for education on applying prescription guidelines and the use of culture-based RX. Disclosures Rena Moon, MD, Premier Applied Sciences, Premier Inc. (Employee) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Alex Kartashov, PhD, Premier Applied Sciences, Premier Inc. (Employee) Ning Rosenthal, MD, Premier Applied Sciences, Premier Inc. (Employee, Shareholder) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

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Characteristics, Treatment Patterns, Healthcare Resource Use, and Costs among Pediatric Patients Diagnosed with Neurofibromatosis Type 1 and Plexiform Neurofibromas: A Retrospective Database Analysis of a Medicaid Population

10.21203/rs.3.rs-98302/v1 ◽

2020 ◽

Author(s):

Xiaoqin Yang ◽

Kaushal Desai ◽

Neha Agrawal ◽

Kirti Mirchandani ◽

Sagnik Chatterjee ◽

...

Keyword(s):

Resource Use ◽

Neurofibromatosis Type 1 ◽

Pediatric Patients ◽

Healthcare Resource ◽

Neurofibromatosis Type ◽

Treatment Patterns ◽

Healthcare Resource Use ◽

The Mean

Abstract Background: Neurofibromatosis type 1 (NF1)-related plexiform neurofibromas (PN) can cause substantial morbidity by disfigurement and compression of vital structures. Real-world data on the burden and cost of disease among pediatric patients with NF1 and PN is limited. The objectives of this study were to describe the characteristics, treatment patterns, healthcare resource use (HCRU), and costs of these patients.Results: A total of 383 patients were included in the retrospective analysis of patients aged ≤18 with at least 1 ICD-10-CM diagnosis code for both NF1 and PN enrolled in the MarketScan® Multistate Medicaid database from October 1, 2014 to December 31, 2017. The mean follow-up was 448 days. The mean age was 11.4 years and 52.0% of patients were male. Most patients were diagnosed by a specialist (63.5%). During the follow-up period, pain medications were used by 58.5% of patients, 25.1% were treated with chemotherapy, 7.1% received surgery for PN, 1.6% received MEK inhibitors, and 0.8% received radiation. Mean per patient per year inpatient, outpatient, emergency room, pharmacy, and other visits were 1.4, 17.3, 1.6, 13.6, and 25.8, respectively. Mean ±SD (median) total per patient per year healthcare costs (2018 USD) were $17,275 ±$61,903 ($2,889), with total medical costs of $14,628 ±$56,203 ($2,334) and pharmacy costs of $2,646 ±$13,303 ($26). Inpatient costs were the largest drivers of medical cost, with a mean per patient per year cost of $6,739.Conclusions: This study showed that many pediatric patients diagnosed with NF1 and PN were treated with supportive care only, highlighting a substantial unmet medical need. This study also highlights the considerable economic burden among patients with NF1 and PN.

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Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Thorax ◽

10.1136/thoraxjnl-2017-210531 ◽

2017 ◽

Vol 73 (2) ◽

pp. 116-124 ◽

Cited By ~ 42

Author(s):

Marjan Kerkhof ◽

Trung N Tran ◽

Joan B Soriano ◽

Sarowar Golam ◽

Danny Gibson ◽

...

Keyword(s):

Resource Use ◽

Eosinophil Count ◽

Healthcare Resource ◽

Clinical Practice Research Datalink ◽

Blood Eosinophil ◽

Diagnostic Code ◽

Research Database ◽

Healthcare Resource Use ◽

Eosinophilic Asthma

BackgroundLittle is known about the prevalence of severe, uncontrolled eosinophilic asthma (SUEA) and associated costs.AimsWe sought to determine the prevalence of SUEA and compare asthma-related healthcare resource use (HCRU) and associated costs with overall means for a general asthma population.MethodsThis cohort study evaluated anonymised medical record data (December 1989 through June 2015) from the Clinical Practice Research Datalink and the Optimum Patient Care Research Database to study UK patients with active asthma (diagnostic code and one or more drug prescriptions in the baseline year), aged 5 years and older, without concomitant COPD, and with recorded eosinophil count. SUEA was defined as two or more asthma attacks during 1 baseline year preceding a high blood eosinophil count (≥0.3×109/L) for patients prescribed long-acting β2-agonist (LABA) and high-dosage inhaled corticosteroids (ICS) during baseline plus 1 follow-up year. We compared asthma-related HCRU and associated direct costs (2015 pounds sterling, £) during the follow-up year for SUEA versus the general asthma population.ResultsOf 363 558 patients with active asthma and recorded eosinophil count, 64% were women, mean (SD) age was 49 (21) years; 43% had high eosinophil counts, 7% had two or more attacks in the baseline year and 10% were prescribed high-dosage ICS/LABA for 2 study years. Overall, 2940 (0.81%; 95% CI 0.78% to 0.84%) patients had SUEA. Total mean per-patient HCRU and associated costs were four times greater for SUEA versus all patients (HCRU and cost ratios 3.9; 95% CI 3.7 to 4.1).ConclusionsLess than 1% of patients in a general asthma population had SUEA. These patients accounted for substantially greater asthma-related HCRU and costs than average patients with asthma.

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1429. Real-World Study of Patients with Uncomplicated Urinary Tract Infection in the United States: High-Risk Comorbid Conditions and Burden of Illness

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1621 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S796-S797

Author(s):

Madison T Preib ◽

Alen Marijam ◽

Fanny S Mitrani-Gold ◽

Daniel C Gibbons ◽

Xiaoxi Sun ◽

...

Keyword(s):

Urinary Tract ◽

High Risk ◽

Real World ◽

Index Date ◽

Oral Antibiotic ◽

Uncomplicated Urinary Tract Infection ◽

Comorbid Conditions ◽

Tract Infections ◽

High Risk Cohort

Abstract Background Urinary tract infections (UTIs) are associated with significant morbidity and economic burden, particularly in the elderly and patients with comorbidities. We used real-world data (RWD) to assess healthcare resource use (HRU) and costs in patients with uncomplicated UTI (uUTI) and high-risk comorbid conditions in the US. Methods This was a retrospective cohort study (IBM MarketScan RWD, commercial/Medicare Supplemental claims January 1, 2014–December 31, 2017) of females ≥ 12 years of age with uUTI who had an oral antibiotic prescription ± 5 days of uUTI diagnosis (index date) and continuous health-plan enrollment for ≥ 1 year pre-/post index date. Five high-risk cohorts and matched-control cohorts (baseline age, region) were identified: controlled type 2 diabetes (T2D), mild/moderate chronic kidney disease (CKD), recurrent UTI (rUTI), elderly (ELD), and postmenopausal (PMP) (Table 1). Sample sizes were balanced via random match selection (1:5 case:control). uUTI-related HRU and costs were compared between cases and controls (index episode/1-year follow-up) using multivariable generalized linear models. Table 1. Cohort assignment for high-risk cohorts and controls Results Of 339,100 patients with uUTI, case/control cohorts comprised T2D, n=15,423/n=77,115; CKD, n=1041/n=5205; rUTI, n=7937/n=39,685; ELD, n=23,666/n=118,330; and PMP, n=105,608/n=211,216 patients. HRU trends across cohorts varied. During 1-year followup, outpatient visits were significantly different for cases versus controls in the T2D, rUTI, and PMP cohorts (p ≤ 0.0079), with higher case than control values in the rUTI and PMP cohorts; pharmacy claims were significantly higher for rUTI, ELD, and PMP cases, and inpatient visits were significantly higher for ELD and PMP cases, versus controls (all p < 0.0001; Table 2). Adjusted total uUTI-related costs (emergency room + outpatient + pharmacy) were significantly different (p < 0.0001) for cases versus controls at index episode and during follow-up in all cohorts except CKD: case values were higher than controls at index episode and during follow-up in the T2D cohort, and during follow-up in the rUTI and ELD cohorts (Table 3). Table 2. uUTI-related HRU* for cases versus controls according to high-risk cohort Table 3. uUTI-related costs* for cases versus controls according to high-risk cohort Conclusion Females in some high-risk case cohorts had higher uUTI-related HRU and costs versus controls. Further studies of relationships between comorbidities and uUTI burden are needed. Disclosures Madison T. Preib, MPH, STATinMED Research (Employee, Former employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Xiaoxi Sun, MA, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Christopher Adams, MPH, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

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1422. Real-World Study of the Effects of Inappropriate or Suboptimal Treatment on the Burden of Illness Among Patients with Uncomplicated Urinary Tract Infection and High-Risk Comorbid Conditions in the United States

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1614 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S794-S795

Author(s):

Madison T Preib ◽

Alen Marijam ◽

Fanny S Mitrani-Gold ◽

Daniel C Gibbons ◽

Xiaoxi Sun ◽

...

Keyword(s):

Urinary Tract ◽

High Risk ◽

Real World ◽

Index Date ◽

The United States ◽

Uncomplicated Urinary Tract Infection ◽

Comorbid Conditions ◽

Tract Infections ◽

High Risk Cohort

Abstract Background Urinary tract infections (UTIs) are associated with significant morbidity and economic burden. Nitrofurantoin (NFT) and fosfomycin are among the first-line treatments for uncomplicated UTI (uUTI) recommended by Infectious Diseases Society of America (IDSA) 2011 guidance. We used real-world data (RWD) to assess patterns of appropriate and optimal (AP&OP) and inappropriate or suboptimal (IA/SO) antibiotic (AB) prescribing (RX), and related healthcare resource use (HRU) and costs, in US uUTI patients with high-risk comorbid conditions. Methods This was a retrospective cohort study of RWD (IBM MarketScan, commercial/Medicare Supplemental claims January 1, 2014–December 31, 2017) in females ≥ 12 years of age with uUTI, who had an oral AB prescription ± 5 days of uUTI diagnosis (index date) and continuous health-plan enrollment ≥ 1 year pre-/post-index date. Patients were stratified into high-risk cohorts (Table 1) and by AB RX (AP&OP and IA/SO) during first uUTI episode (within 28 days of index). AP&OP RX followed IDSA guidance, IA RX did not; SO RX was considered a proxy for treatment failure (e.g., AB switch or a second UTI diagnosis [acute care setting] in index episode). Sample size was balanced via random match selection, AP&OP:IA/SO ratio 1:5 (age and region). uUTIrelated HRU and costs were compared between cohorts (at index episode and 1-year follow-up) via multivariable analysis. Table 1. High-risk cohorts identified in the study Results IA/SO AB RX was highest in the elderly cohort (94.3%, likely influenced by renal impairment/no NFT RX in this group) and > 90% in other cohorts; AP&OP AB RX was highest in the postmenopausal cohort (9.0%). IA/SO AB RX in all cohorts was associated with significantly higher uUTI-related HRU (outpatient visits and pharmacy claims) per index episode/during follow-up versus AP&OP AB RX (p ≤ 0.0237, Table 2). IA/SO AB RX in all cohorts was associated with significantly higher adjusted total costs per index episode/during follow-up versus AP&OP AB RX (p < 0.05; Table 3). Table 2. uUTI-related HRU* per patient according to high-risk cohort and stratified by AB RX Table 3. uUTI-related costs* per patient according to high-risk cohort and stratified by AB RX Conclusion Over 90% of females in each high-risk cohort identified had IA/SO AB RX (outside IDSA 2011 guidance for uUTI treatment), leading to high HRU and cost burden. This suggests an unmet need for uUTI symptom relief, new treatments, training, and improved RX practices in the US and, furthermore, a need for additional research in this area. Disclosures Madison T. Preib, MPH, STATinMED Research (Employee, Former employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Alen Marijam, MSc, GlaxoSmithKline plc. (Employee, Shareholder) Fanny S. Mitrani-Gold, MPH, GlaxoSmithKline plc. (Employee, Shareholder) Daniel C. Gibbons, PhD, GlaxoSmithKline plc. (Employee, Shareholder) Xiaoxi Sun, MA, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Christopher Adams, MPH, STATinMED Research (Employee, Employee of STATinMED Research, which received funding from GlaxoSmithKline plc. to conduct this study) Ashish V. Joshi, PhD, GlaxoSmithKline plc. (Employee, Shareholder)

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Comparison of healthcare resource utilization and costs among patients with migraine with potentially adequate and insufficient triptan response

Cephalalgia ◽

10.1177/0333102420915167 ◽

2020 ◽

Vol 40 (7) ◽

pp. 639-649 ◽

Cited By ~ 1

Author(s):

Steven C Marcus ◽

Anand R Shewale ◽

Stephen D Silberstein ◽

Richard B Lipton ◽

William B Young ◽

...

Keyword(s):

Health Plan ◽

Resource Use ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Healthcare Resource Use ◽

Claims Analysis ◽

Adequate Response ◽

Response Information ◽

Insufficient Response

Background Triptans are the most commonly prescribed acute treatments for migraine; however, not all triptan users experience adequate response. Information on real-world resource use and costs associated with triptan insufficient response are limited. Methods A retrospective claims analysis using US commercial health plan data between 2012 and 2015 assessed healthcare resource use and costs in adults with a migraine diagnosis newly initiating triptans. Patients who either did not refill triptans but used other non-triptan medications or refilled triptans but also filled non-triptan medications over a 24-month follow-up period were designated as potential triptan insufficient responders. Patients who continued filling only triptans (i.e. triptan-only continuers) were designated as potential adequate responders. All-cause and migraine-related resource use and total (medical and pharmacy) costs over months 1–12 and months 13–24 were compared between triptan-only continuers and potential triptan insufficient responders. Results Among 10,509 new triptan users, 4371 (41%) were triptan-only continuers, 3102 (30%) were potential triptan insufficient responders, and 3036 (29%) did not refill their index triptan or fill non-triptan medications over 24 months’ follow-up. Opioids were the most commonly used non-triptan treatment (68%) among potential triptan insufficient responders over 24 months of follow-up. Adjusted mean all-cause and migraine-related total costs were $5449 and $2905 higher, respectively, among potential triptan insufficient responders versus triptan-only continuers over the first 12 months. Conclusions In a US commercial health plan, almost one-third of new triptan users were potential triptan insufficient responders and the majority filled opioid prescriptions. Potential triptan insufficient responder patients had significantly higher all-cause and migraine-related healthcare utilization and costs than triptan-only continuers.

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Cohort study of healthcare use, costs and diagnoses from onset to 6 months after discharge for takotsubo syndrome in Sweden

BMJ Open ◽

10.1136/bmjopen-2018-027814 ◽

2019 ◽

Vol 9 (2) ◽

pp. e027814 ◽

Cited By ~ 2

Author(s):

Sara Wallström ◽

Inger Ekman ◽

Elmir Omerovic ◽

Kerstin Ulin ◽

Hanna Gyllensten

Keyword(s):

Primary Care ◽

Resource Use ◽

Healthcare Costs ◽

Healthcare Resource ◽

Takotsubo Syndrome ◽

Healthcare Resource Use ◽

Direct Healthcare Costs ◽

The Mean ◽

Discharge From Hospital

ObjectiveLittle is known about the economic impact of takotsubo syndrome (TS) for patients and the health system after initial discharge from hospital. Therefore, the aim of this study was to describe the healthcare resource use and calculate direct healthcare costs for TS, from hospitalisation to 6 months after discharge, and explore the distribution of costs between TS and other diagnoses among patients with TS.Method, participants and settingCohort study investigating direct healthcare costs from hospitalisation, open specialised outpatient and primary care. Healthcare resource use during 6 months after diagnosis with TS was collected for 58 consecutive patients from the Regional Patient Register. Incidence-based direct healthcare costs, in 2015 values, were calculated using diagnosis-related group weights and unit costs from national statistics on healthcare costs.ResultsThe mean length of hospital stay was 10.2 days, index 6.4 and re-admissions 3.8 days. The mean number of follow-up encounters per patient was 15.6, of which two-thirds was specialised outpatient and one-third was primary care. This resulted in an average cost of €10 360. Of this, costs of €8026 (77.5%) occurred during encounters for which at least one of the registered conditions was cardiovascular. Costs differed little according to background characteristics.ConclusionThis study shows that patients utilise hospital, specialised outpatient and primary care after discharge for TS. Most direct healthcare costs relate to cardiac diagnoses. Patients with TS would probably benefit from a supportive follow-up programme after discharge from hospital.

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Treatment Patterns and Healthcare Resource Utilization in Patients with Relapsed/Refractory Acute Myeloid Leukemia and a Subset with IDH1-Mutation: A United States Medical Chart Review Study

Blood ◽

10.1182/blood-2018-99-116495 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 5864-5864

Author(s):

James D. Griffin ◽

Mike Storm ◽

Ken Wilhelm ◽

Audra Boscoe ◽

Dendy Macaulay ◽

...

Keyword(s):

Resource Use ◽

Patient Population ◽

Myeloid Leukemia ◽

Chart Review ◽

Healthcare Resource ◽

Intensive Chemotherapy ◽

Healthcare Resource Use ◽

Analysis Group ◽

Acute Myeloid

Abstract Introduction: In the United States (US), acute myeloid leukemia (AML) is the most common form of acute leukemia in adults. Patients with relapsed or refractory AML (R/R) have a particularly poor prognosis, and more effective and less toxic treatments are urgently needed. The gene encoding isocitrate dehydrogenase 1 (IDH1) is mutated in 6-10% of AML patients. Drugs that target the altered enzyme have shown significant clinical activity in the R/R setting, with the first such agent, ivosidenib, recently receiving FDA approval. We conducted a retrospective chart review to evaluate current treatments and healthcare resource use in an R/R AML population, with a sub-analysis focusing on the population with IDH1 mutations (mIDH1). Findings from this study will help to better understand the future impact of targeted IDH1 inhibitors in this difficult-to-treat patient population. Methods:US-based hematologists and oncologists were recruited from existing physician panels to extract information from eligible patients' medical charts. Each physician extracted information, including patient demographics, medical history, AML treatment, and AML-related healthcare resource use. Eligible patients must have been initially diagnosed with R/R AML and tested for mIDH1 between January 2012 and June 2017. Patients were excluded if they had ever been enrolled in a clinical trial for an IDH1 inhibitor. The index date was defined as the date of initial R/R diagnosis and information was collected through end of follow-up, defined as the end date of care, date of death, or date of data collection, whichever occurred first. Patient characteristics, treatments, and AML-related healthcare resource use were described. mIDH1 patients were oversampled to achieve the targeted sample size of 300 patient charts, evenly split between mIDH1-positive and IDH1 wild type (wt) patients. As a result, findings reported for the overall patient population were reweighted to reflect an 8.0% prevalence of mIDH1. Results:Data were collected from 182 oncologists/hematologists, providing chart information for 304 patients (154 mIDH1-positivepatients and 150 mIDH1-negativepatients). Median follow-up time for all patients was 11.1 months. After reweighting, the mean age for the overall patient population was 57.7 years old and most patients were first diagnosed with de novoAML (92.8%), as opposed to secondary AML (7.2%). The population had a higher percentage of relapsed patients than primary refractory patients (73.7% versus 26.3%) and a higher percentage of patients treated in a community-based setting than an academic-based setting (64.2% versus 35.8%). After the initial diagnosis of R/R AML, 90.9% of all patients received some type of active treatment, with intensive chemotherapy being the most common initial treatment (65.0%), followed by less-intensive chemotherapy regimens (19.3%), and hypomethylating agents (14.9%). 44.8% and 11.0% of patients also received a second- or third-line treatment regimen, respectively. 10.4% of patients received a stem cell transplant during the follow-up period. There was significant health resource utilization in this population. 82.0% of patients had at least one inpatient admission during the follow-up period, with the overall population averaging 0.28 admissions per-patient-per-month. The most common reason for AML-related inpatient admissions was chemotherapy administration. 66.4% of patients were hospitalized for treatment administration, 31.8% for infections, and 27.1% for febrile neutropenia. In addition, 39.6% of patients had at least one emergency room (ER) visit and 14.2% of patients had at least one intensive care unit (ICU) admission. The treatment and healthcare resource use burden was similarly high for the subset of mIDH1-positive patients. No significant differences were found between the mIDH1-positive and IDH1 wtpatients. Conclusions:Using retrospective medical chart data, this study highlights current treatment and healthcare resource use for adult patients with R/R AML. There is a high burden associated with R/R AML due to the health issues associated with rapidly progressive disease and the toxicity of available treatments, which require inpatient admissions. As more targeted drugs become available for patients in the R/R setting, such as ivosidenib, it will be of interest to re-evaluate the burden and clinical outcomes in the R/R AML population. Disclosures Griffin: RXi Pharmaceuticals: Consultancy; Analysis Group: Consultancy; Myeloproliferative Neoplasia Foundation: Other: Grant ; Lilly Pharmaceuticals: Other: Grant; Sun Pharmaceuticals: Consultancy; Novartis Pharma: Other: Grant, Patents & Royalties: Royalties ; Astellas Pharma: Consultancy. Storm:Agios Pharmaceuticals: Employment. Wilhelm:Agios Pharmaceuticals: Employment. Boscoe:Agios Pharmaceuticals: Employment. Macaulay:Analysis Group, Inc.: Employment. Zhou:Celgene Corporation: Research Funding; Analysis Group, Inc.: Employment. Faust:Analysis Group, Inc.: Employment. Cheung:Analysis Group, Inc.: Employment.

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