Characterization of Heavily Treatment-Experienced People With HIV and Impact on Healthcare Resource Utilization in US Commercial and Medicare Advantage Health Plans

Abstract Background This retrospective, administrative claims study aimed to describe clinical characteristics, healthcare resource utilization (HCRU), and costs of people with HIV (PWH) in US commercial and Medicare Advantage health plans by antiretroviral treatment (ART) experience and CD4+ cell count. Methods Data from the national Optum Research Database between January 1, 2014, and March 31, 2018, for adult PWH continuously enrolled 6 months before and ≥12 months after the first ART identified (follow-up) were summarized by treatment (heavily treatment experienced [HTE] with limited remaining ART options, treatment experienced but not HTE [non-HTE], or treatment naive starting a first antiretroviral regimen) and index CD4+ cell count (<200, 200-500, or >500 cells/mm3). Results Compared with non-HTE (n=7604) and treatment-naive PWH (n=4357), HTE PWH (n=2297) were older (53.5 vs 48.8 and 42.3 years), were more likely to have HIV-related emergency department visits (22.3% vs 12.4% and 18.6%) and inpatient stays (15.8% vs 7.1% and 10.3%), had a higher mean (SD) daily pill burden (9.7 [7.7] vs 5.1 [5.9] and 3.6 [5.3] pills/day), and a higher mortality rate (5.9% vs 2.9% and 2.3%) during follow-up (all P<0.001). More HTE (21.8%) and treatment-naive PWH (27.0%) had <200 CD4+ cells/mm 3 vs non-HTE PWH (8.0%; P<0.001). All-cause and HIV-related costs were higher among HTE PWH in all CD4+ cell count strata and treatment-naive PWH with CD4+ cell counts <200 cells/mm 3 vs non-HTE PWH in all CD4+ cell count strata. Conclusions Improved support and clinical monitoring of HTE PWH are needed to prevent worsening outcomes and increased costs.

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Analysis of Healthcare Resource Utilization and Costs after the Initiation of Biologic Treatment in Patients with Ulcerative Colitis and Crohn’s Disease

Journal of Health Economics and Outcomes Research ◽

10.36469/9791 ◽

2018 ◽

Vol 6 (1) ◽

pp. 96-112 ◽

Cited By ~ 1

Author(s):

Sue Perera ◽

Shibing Yang ◽

Marni Stott-Miller ◽

Joanne Brady

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Small Sample ◽

Outpatient Visits ◽

Ed Visits

Background: This retrospective cohort study aimed to describe and quantify healthcare resource utilization and costs for patients with ulcerative colitis (UC) and Crohn’s disease (CD) following initiation of biologic therapy. Methods: Resource utilization and costs were analyzed at baseline and 1- and 2-years after initiating a biologic. Data were extracted from a US administrative health insurance claims database for adults ≥18 years. Eligible patients were continuously enrolled in a health plan with medical and pharmacy benefits for ≥12 months prior to, and 12 months (primary analysis) or 24 months (secondary analysis) after index date (biologic initiation). Results: In total, 4864 and 2692 patients with UC, and 8910 and 5227 patients with CD were identified in the 1- and 2-year follow-up cohorts, respectively. Of 1-year follow-up cohort patients, 45% received the same biologic initiated at index for ≥1 year. Infliximab and adalimumab were the most commonly initiated biologics in patients with UC or CD. The highest proportion of patients who continued with the same biologic after 1-and 2-years had initiated therapy with infliximab for both indications (although at the 1-year follow-up for CD, the highest proportion continued to use natalizumab, but this was a small sample [n=15]). Generally, the proportion of patients having inpatient admissions and emergency department (ED) visits decreased after receiving the same biologic for 1 year compared with baseline, although the proportion having outpatient visits did not change. Mean per patient all-cause costs for inpatient hospitalizations, ED visits and outpatient visits decreased for patients with UC or CD who received the same biologic for 1 year, while mean pharmacy costs per patient increased. Conclusions; This descriptive analysis shows that although biologics effectively reduced inpatient and ED resource utilization and corresponding costs in patients with UC and CD, total management costs increased, driven by increased pharmacy costs.

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24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

10.21203/rs.2.15733/v1 ◽

2019 ◽

Author(s):

Marc Harris Dassi Tchoupa Revegue ◽

Elom Takassi ◽

François Tanoh Eboua ◽

Sophie Desmonde ◽

Ursula Belinda Amoussou-Bouah ◽

...

Keyword(s):

Cell Count ◽

Cote D'ivoire ◽

West African ◽

Hiv Disclosure ◽

Virological Suppression ◽

Favorable Outcome ◽

Cd4 Cell Count ◽

Perinatally Acquired ◽

Cd4 Cell

Abstract Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including timely disclosure of their HIV-serostatus that was explored in the West-African COHADO cohort. We assessed the 24-month outcomes in COHADO, among APHIV in relation to the disclosure of their own HIV-serostatus.Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV-care <10 years, in Abidjan (Côte d’Ivoire) and Lomé (Togo) in 2015. A favorable 24-month outcome was defined when combining being retained in care, without progression to WHO-AIDS stage, with CD4 cell count > baseline CD4 (± 10%) and with virological suppression (viral load [VL] <50 copies/mL). We investigated correlates of APHIV favorable 24-month outcome using multivariate logistic regression. Results: Overall, 209 APHIV were included, 51.6% in Abidjan, 54.5% were females. At inclusion, median CD4 cell count was 521/mm3 (IQR[281-757]); only 29.6% had a VL measurement of whom 3.2% in virological suppression. APHIV were younger in Lomé (median age: 12 years (interquartile range [IQR]:11-15) compared to Abidjan (14 years (IQR:12-15, p=0.01). Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, 6 (2.9%) died, 8 (3.8%) were lost to follow-up, 4 (1.9%) were transferred out. Overall, 73.7% did not progress to WHO-AIDS stage, 62.7% had CD4 count above (± 10%) of the baseline value (48.6% in Abidjan versus 69.0% in Lomé, p<0.001). Among the 83.7% with VL measurements, 48.8% were in virological suppression (Abidjan: 45.4%, Lomé: 52.5%, p<0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p<0.01). Adjusted on sex, age, a 24-month favorable outcome was not associated with HIV-disclosure status but was significantly higher for APHIV living in Lomé compared to those living Abidjan (adjusted odds ratio =4.41, 95%CI:2.29-8.50). Conclusions: 24-month favorable outcome rates were low among West-African APHIV and differed accross countries. HIV-disclosure frequency improved over time but remained low. Context-specific responses are urgently needed to improve adolescent’s care to reach the UNAIDS 90% target of virological success for those on ART.

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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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PDG6 HEALTHCARE RESOURCE UTILIZATION, COST, AND TREATMENT PERSISTENCE AMONG TREATMENT-NAIVE PAH PATIENTS INITIATING MONOTHERAPY VS. COMBINATION THERAPY

Value in Health ◽

10.1016/j.jval.2019.04.685 ◽

2019 ◽

Vol 22 ◽

pp. S164

Author(s):

S.A. Mandras ◽

L. Liao ◽

W. Lin ◽

S. Bansilal ◽

J. Lin

Keyword(s):

Combination Therapy ◽

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Treatment Persistence ◽

Treatment Naïve ◽

Utilization Cost

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IS IT SAFE AND COST SAVING TO DEFER THE CD4+ CELL COUNT MONITORING IN STABLE PATIENTS ON ART WITH MORE THAN 350 OR 500 CELLS/µL?

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2019.063 ◽

2019 ◽

Vol 11 (1) ◽

pp. e2019063

Author(s):

Benedetto Maurizio Celesia ◽

Andrea Marino ◽

Rosa Fontana del Vecchio ◽

Roberto Bruno ◽

Filippo Palermo ◽

...

Keyword(s):

Cell Count ◽

Mean Value ◽

Cd4 Count ◽

Cd4 Cells ◽

Cd4 Cell Count ◽

The Third ◽

Cd4 Lymphocyte ◽

Mean Cost ◽

Cd4 Cell

Background CD4 lymphocyte cell count represents the main immunological marker used to monitor HIV infection. However, frequent monitoring may be unnecessary, could cause anxiety to the patient as well as burdening healthcare with extra expenses. Objectives and methods To analyse the probability of maintaining a safe number of CD4 in HIV-positive subjects under treatment with ≥350 cells/µl at baseline during a three-year follow up. We conducted a retrospective study performing three analyses with Kaplan-Meyer method considering: 1) all patients independently from their viral load (VL); 2) patients with 500 > CD4 ≥ 350 cells/µl versus (vs) CD4 ≥ 500 cells/µl at baseline; 3) patients with VL < 20 copies/ml vs VL > 20 copies/ml. Results 253 subjects were enrolled. The median CD4 count was 623 (489-805) cells/µl. Subjects maintaining ≥ 350 cells/µl in the first, second and third year were respectively 238 (94.1%), 229 (90.5%) and 226 (89.3%), independently from VL. Within subjects with ≥ 350 CD4/µl vs ≥ 500 CD4/µl at baseline, those who maintained ≥ 350 cells/µl until the third year were respectively 241 (95.3%) and 158 (98.1%). The probability of maintaining these values in the third year was 89.3% for those who had CD4 ≥ 350/µl at baseline and 98.1% for those who had CD4 ≥ 500/µl. This probability was around 90% vs 99% for subjects with HIV-RNA above or below 20 copies/ml. Secondly, we tried to estimate the costs of CD4 determinations in a three-year period (from April 1, 2013 to March 31, 2016). We analysed respectively 343 subjects in the first period, 364 in the second and 383 in the third, with a median value of 500 CD4/µl during the research time taken into account. We found a mean value of about two determinations patient/year (2.41 in 2013/2014; 2.32 in 2014/2015; 2.18 in 2015/2016), with a significant decrease between the first and the last period (p<0.001). The mean cost patient/year was €101.51 in the first year, €97.61 in the second, €92.00 in the third (p<0,001). Assuming to extend these procedures to all our patients with stable CD4 cells/µl and monitoring CD4 cell count once in a year, it could be possible to obtain an overall saving of €19,152/year. Conclusions A very high percentage of subjects maintained a high and safe number of CD4 cells (>350 cells/µl) during a three-year follow up. It could be possible to save up to 66% of the costs by reducing the number of CD4 count determinations in a year, to have other favourable consequences as well, releasing new resources for patient’s management.

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Retention in Care among Patients with Early HIV Disease in Haiti

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957417742670 ◽

2017 ◽

Vol 16 (6) ◽

pp. 523-526 ◽

Cited By ~ 3

Author(s):

Kelly A. Hennessey ◽

Taina Dadaille Leger ◽

Vanessa R. Rivera ◽

Adias Marcelin ◽

Margaret L. McNairy ◽

...

Keyword(s):

Cell Count ◽

Retention In Care ◽

Hiv Treatment ◽

World Health ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Hiv Test ◽

Lost To Follow Up ◽

Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

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Effect of BMI and fat mass on HIV disease progression in HIV-infected, antiretroviral treatment-naïve adults in Botswana

British Journal Of Nutrition ◽

10.1017/s0007114516001409 ◽

2016 ◽

Vol 115 (12) ◽

pp. 2114-2121 ◽

Cited By ~ 7

Author(s):

S. S. Martinez ◽

A. Campa ◽

H. Bussmann ◽

S. Moyo ◽

J. Makhema ◽

...

Keyword(s):

Cell Count ◽

Disease Progression ◽

Fat Mass ◽

Antiretroviral Treatment ◽

Obesity Paradox ◽

Hiv Disease ◽

Time To Event ◽

Cd4 Cell Count ◽

Cd4 Cell

AbstractAn obesity paradox has been proposed in many conditions including HIV. Studies conducted to investigate obesity and its effect on HIV disease progression have been inconclusive and are lacking for African settings. This study investigated the relationship between overweight/obesity (BMI≥25 kg/m2) and HIV disease progression in HIV+ asymptomatic adults not on antiretroviral treatment (ART) in Botswana over 18 months. A cohort study in asymptomatic, ART-naïve, HIV+ adults included 217 participants, 139 with BMI of 18·0–24·9 kg/m2 and seventy-eight participants with BMI≥25 kg/m2. The primary outcome was time to event (≥25 % decrease in cluster of differentiation 4 (CD4) cell count) during 18 months of follow-up; secondary outcomes were time to event of CD4 cell count<250 cells/µl and AIDS-defining conditions. Proportional survival hazard models were used to compare hazard ratios (HR) on time to events of HIV disease progression over 18 months. Higher baseline BMI was associated with significantly lower risk of an AIDS-defining condition during the follow-up (HR 0·218; 95 % CI 0·068, 0·701; P=0·011). Higher fat mass at baseline was also significantly associated with decreased risk of AIDS-defining conditions during the follow-up (HR 0·855; 95 % CI 0·741, 0·987; P=0·033) and the combined outcome of having CD4 cell count≤250/µl and AIDS-defining conditions, whichever occurred earlier (HR 0·918; 95 % CI 0·847, 0·994; P=0·036). All models were adjusted for covariates. Higher BMI and fat mass among the HIV-infected, ART-naïve participants were associated with slower disease progression. Mechanistic research is needed to evaluate the association between BMI, fat mass and HIV disease progression.

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Healthcare Resource Utilization Trends over Time with Continuous Lenalidomide Treatment (Tx) in Patients (Pts) with Newly Diagnosed Multiple Myeloma (NDMM)

Blood ◽

10.1182/blood.v124.21.1326.1326 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1326-1326

Author(s):

Katja Weisel ◽

Dan T. Vogl ◽

Michel Delforge ◽

Kevin Song ◽

Meletios Dimopoulos ◽

...

Keyword(s):

Multiple Myeloma ◽

Resource Utilization ◽

Research Funding ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Medical Utilization ◽

Fixed Duration ◽

Advisory Committees ◽

Over Time

Abstract Introduction: Multiple myeloma (MM) is an incurable hematologic condition that is associated with high Tx costs. Resource consumption is driven by hospitalization and medical utilization, which is highest during periods of uncontrolled disease, such as after diagnosis and during relapses (De Portu 2013). In the pivotal phase 3 FIRST trial, continuous Tx with lenalidomide plus low-dose dexamethasone (Rd) was compared with fixed-duration Rd (Rd18) or fixed-duration combination Tx with melphalan, prednisone, and thalidomide (MPT), each for 18 months (mos), in NDMM pts who were ineligible for stem cell transplantation. Continuous Rd extended progression-free survival (PFS) and overall survival (interim analysis) vs. MPT. However, it is still unclear whether extending Tx duration with Rd adversely affects healthcare resource utilization. This analysis quantifies the rates of hospitalizations and medical utilization with continuous Rd over time based on data collected in the FIRST trial. Methods: The FIRST trial (N = 1,623) was a pivotal multinational, randomized, open-label study with a median follow up of 37 mos. Non-protocol-driven resource-use data was collected until subjects discontinued study Tx. To assess whether continuous Rd increases healthcare resource utilization over time, the rates of resource utilization for subjects treated with continuous Rd (N = 535) were plotted for up to 48 mos. In addition, hospitalization and medical utilization rates during the Tx period (18 mos) were estimated and compared between the 2 fixed-duration Tx arms. Results: Resource utilization amongst pts treated with continuous Rd declined over time (Figure). The annualized hospitalization rate in the first 3 mos was 3.2 times higher than the average rate for the remaining 45 mos of follow-up (2.02 vs. 0.62), and 4.2 times higher for medical utilization (5.66 vs. 1.34). After 4 years (yrs) of continuous Rd Tx, hospitalization and medical utilization rates were estimated to be 83% and 84% lower than those observed in the first 3 mos of Tx, reflecting the long-term disease control observed with continuous Rd in the FIRST trial. The highest hospitalization rates were associated with infections (0.20 per patient year), cardiovascular disorders (0.06), and respiratory and thoracic disorders (0.05). The mean (standard deviation) length of stay per admission was 14.08 (21.19) days. The highest medical utilization rates were associated with blood transfusions (0.76 interventions per patient year), general imaging procedures (0.21), respiratory and thoracic imaging procedures (0.20), and therapeutic interventions (0.09).The hospitalization rates for the fixed dose Tx arms were 0.91 (Rd18) and 0.79 (MPT) per patient year of follow-up during the Tx period of 18 mos, resulting in a rate ratio (RR) of 1.15 (1.01–1.30). The equivalent rates for medical utilization were 3.00 (Rd18) and 2.86 (MPT) medical interventions per patient year (RR = 1.05 [0.98–1.12]). Conclusions: The rates of resource utilization among pts treated with continuous Rd dropped substantially after the first 3 mos of Tx, and then gradually declined as Tx duration increased. The findings suggest that continuous Tx with Rd does not further increase resource utilization in hospitalizations and medical utilization compared to fixed-duration Tx. A comparison between the 2 fixed arms showed a 15% increase in hospitalization with Rd18 vs. MPT, and no differences in medical utilization between the 2 arms. A limitation of this analysis is that the resources were collected only while pts were receiving their respective Txs. Future analysis should include all costs generated by healthcare resources throughout pts Tx, including Tx-free intervals, and the costs associated with relapses. Figure 1: Hospitalization and medical utilization rates per patient year for patients treated with continuous Rd Figure 1:. Hospitalization and medical utilization rates per patient year for patients treated with continuous Rd Disclosures Weisel: BMS: Consultancy; Onyx: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Celgene Corporation: Consultancy, Honoraria; Noxxon: Consultancy. Off Label Use: Lenalidomide used in newly diagnosed multiple myeloma patients. Vogl:Amgen: Consultancy; Millennium/Takeda: Research Funding; GSK: Research Funding; Acetylon: Research Funding; Celgene Corporation: Consultancy. Delforge:Janssen: Honoraria; Celgene Corporation: Honoraria. Song:Celgene Corporation: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Dimopoulos:Celgene Corporation: Consultancy, Honoraria. Cavenagh:Celgene Corporation: Honoraria. Hulin:Celgene Corporation: Honoraria. Foá:Celgene Corporation: Consultancy. Oriol:Janssen: Consultancy, Speakers Bureau; Celgene Corporation: Consultancy, Speakers Bureau. Guo:Celgene Corporation: Consultancy. Monzini:Celgene Corporation: Employment, Equity Ownership. Van Oostendorp:Celgene: Employment. Ervin-Haynes:Celgene: Employment. Facon:Celgene Corporation: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

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