scholarly journals The direct costs of overdiagnosed asthma in a longitudinal population-based study

2018 ◽  
Author(s):  
Bryan C. Ng ◽  
Mohsen Sadatsafavi ◽  
Abdollah Safari ◽  
J. Mark FitzGerald ◽  
Kate M. Johnson
Keyword(s):  
Resource Use ◽  
Healthcare Costs ◽  
Healthcare Resource ◽  
Medication Use ◽  
Population Based ◽  
Healthcare Resource Use ◽  
Asthma Diagnosis ◽  
Physician Visits ◽  
Direct Healthcare Costs ◽  
Physician Diagnosis

ABSTRACTObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and evaluate strategies to reduce this burden. We assessed the difference in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out.DesignPopulation-based prospective cohort study.SettingParticipants were recruited through random-digit dialling of both landlines and mobile phones in BC, Canada.ParticipantsWe included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma which was confirmed by a bronchodilator reversibility or methacholine challenge test at the end of the 12-month follow-up.Primary and secondary outcome measuresSelf-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits, and medication use from the Canadian healthcare system perspective.ResultsAsthma was ruled out in 86 (24.9%) participants. Average annual asthma-related direct healthcare costs for participants with confirmed asthma were $497.9 (SD $677.9), and $307.7 (SD $424.1) for participants with asthma ruled out. In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (Relative Ratio [RR]=1.60, 95%CI 1.14-2.22), increased rate of specialist visits (RR=2.41, 95%CI 1.05-5.40) and reliever medication use (RR=1.62, 95%CI 1.09-2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11).ConclusionsA quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.Strengths and limitations of this studyParticipants were recruited through random sampling of the general population in the province of British Columbia.Asthma diagnosis was confirmed or ruled out using sequential guideline-recommended objective airway tests.Healthcare resource use was self-reported, potential recall bias may have led to reduced accuracy.The study was unable to evaluate the indirect costs of overdiagnosis or the cost-savings from correcting the diagnosis.The generalizability of the results may be limited by regional differences in medical costs and practices.

scholarly journals Direct costs of overdiagnosed asthma: a longitudinal, population-based cohort study in British Columbia, Canada

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031306 ◽  
Author(s):  
Bryan Ng ◽  
Mohsen Sadatsafavi ◽  
Abdollah Safari ◽  
J Mark FitzGerald ◽  
Kate M Johnson
Keyword(s):  
Cohort Study ◽  
Resource Use ◽  
Healthcare Costs ◽  
Challenge Test ◽  
Medication Use ◽  
Population Based ◽  
Methacholine Challenge ◽  
Physician Visits ◽  
Direct Healthcare Costs ◽  
Physician Diagnosis

ObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and to evaluate strategies to reduce this burden. We assessed differences in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out.DesignPopulation-based, prospective cohort study.SettingParticipants were recruited through random-digit dialling of both landlines and mobile phones in the province of British Columbia, Canada.ParticipantsWe included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma. The diagnosis of asthma was reassessed at the end of 12 months of follow-up using a structured algorithm, which included a bronchodilator reversibility test, methacholine challenge test, and if necessary medication tapering and a second methacholine challenge test.Primary and secondary outcome measuresSelf-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits and medication use from the perspective of the Canadian healthcare system.ResultsAsthma was ruled out in 86 (24.9%) participants. The average annual asthma-related direct healthcare costs for participants with confirmed asthma were $C497.9 (SD $C677.9) and for participants with asthma ruled out, $C307.7 (SD $C424.1). In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (relative ratio (RR)=1.60, 95% CI 1.14 to 2.22), increased rate of specialist visits (RR=2.41, 95% CI 1.05 to 5.40) and reliever medication use (RR=1.62, 95% CI 1.09 to 2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11).ConclusionsA quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027814 ◽  
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.

scholarly journals Healthcare resource use in patients of the Australian Transition Care Program

2015 ◽  
Vol 39 (4) ◽  
pp. 411 ◽  
Author(s):  
Tracy A. Comans ◽  
Nancye M. Peel ◽  
Ian D. Cameron ◽  
Leonard Gray ◽  
Paul A. Scuffham
Keyword(s):  
Resource Use ◽  
Healthcare Costs ◽  
Healthcare Resource ◽  
Hospital Costs ◽  
Care Program ◽  
Healthcare Resource Use ◽  
Admission Rates ◽  
Care Recipients ◽  
Transition Care ◽  
The Cost

Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition care clients over a 6-month period following admission to the program. Methods A prospective cohort observational study of 351 consenting patients entering community-based transition care at six sites in two states in Australia from November 2009 to September 2010 was performed. Patients were followed up 6 months after admission to the TCP to ascertain current living status and hospital re-admissions over the follow-up period. Cost data were collected by transition care teams and from administrative data (hospital and Medicare records). Results The TCP provides a range of services with most costs attributed to provision of personal care support, case management, physiotherapy and occupational therapy. Most healthcare costs up to 6 months after transition care admission were incurred from the hospital admission leading to transition care and from re-admissions. Orthopaedic conditions incurred the highest costs, with many of these for elective procedures and others resulting from falls. Hospital re-admission rates in the present study were 10% lower than in a previous evaluation of the TCP. Over 6 months, approximately 40% of patients in the study were re-admitted to hospital at an average cost of A$7038. Conclusions Although the cost of the TCP is relatively high, it may have some impact on reducing hospital re-admissions and preventing or delaying residential care admissions. What is known about the topic? A majority of healthcare costs occur in older age. What does this paper add? Hospital costs, both initial and re-admissions, are the major contributor to healthcare costs in transition care recipients. Orthopaedic conditions are the most expensive to treat and neurological conditions are the most variable. What are the implications for practitioners? Reducing the length of hospitalisation and reducing re-admissions for older frail people is a key economic concern for health services. Services such as the TCP aim to do both; however, the evidence that this is effective is limited. Streamlining referrals to transition care to enable earlier access and involving the transition care provider in re-admission decisions may help reduce healthcare costs in future.

Household Members of Persons with Alzheimer's Disease: Health Conditions, Healthcare Resource Use, and Healthcare Costs

2014 ◽  
Vol 62 (3) ◽  
pp. 435-441 ◽  
Author(s):  
Brandon T. Suehs ◽  
Sonali N. Shah ◽  
Cralen D. Davis ◽  
Jose Alvir ◽  
Warachal E. Faison ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Resource Use ◽  
Healthcare Costs ◽  
Healthcare Resource ◽  
Health Conditions ◽  
Healthcare Resource Use ◽  
Household Members

scholarly journals Economic burden of cirrhosis in Catalonia: a population-based analysis

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018012 ◽  
Author(s):  
Mireia Miquel ◽  
Montserrat Clèries ◽  
Mercedes Vergara ◽  
Emili Vela
Keyword(s):  
Resource Use ◽  
Healthcare Resource ◽  
Population Level ◽  
Population Based ◽  
Point Prevalence ◽  
Receiver Operating Curve ◽  
High Morbidity ◽  
Healthcare Resource Use ◽  
Healthcare Budget ◽  
Comorbidity Burden

BackgroundCirrhosis is a chronic disease with high morbidity and mortality. Few studies have evaluated healthcare resource use in patients with cirrhosis.ObjectiveWe aimed to describe the point prevalence of cirrhosis on 31 December 2012 and the population-level distribution of healthcare resource use and expenditures in a non-selected population of patients with cirrhosis, stratified by whether their disease was compensated or decompensated, and by comorbidity burden.MethodsThis population study included all known patients aged >18 years with cirrhosis (according to International Classification of Diseases, ninth revision) in Catalonia, Spain, on 31 December 2012. We evaluated healthcare resource use and expenditure during 2013, taking into account the presence of decompensation before or during 2012.ResultsWe documented 34 740 patients diagnosed with cirrhosis (58.7% men; mean age 61.8±14 years), yielding a point prevalence of 460 per 100 000 inhabitants on 31 December 2012. Annual mortality was 9.1%. During 2013, healthcare expenditures on patients with cirrhosis totalled €142.1 million (€4234 per patient), representing 1.8% of the total 2013 healthcare budget of Catalonia. Hospitalisation costs accounted for 35.1% of the total expenditure and outpatient care accounted for 22.4%. MultivariateMultivariate logistic regression identified morbidity burden, HIV infection, hospitalisation and emergency room visits during 2012 as independent predictors of expenditure above the 85th centile (area under the receiver operating curve, 0.88 (95% CI 0.883 to 0.893, P<0.001)).ConclusionsCirrhosis accounts for a high proportion of healthcare resource usage and expenditures; hospitalisation accounted for the highest expenditures.

scholarly journals Economic consequences of the overuse of short-acting beta-adrenergic agonists (SABA) in the treatment of asthma in Spain

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
A Valero ◽  
J Molina ◽  
J Nuevo ◽  
S Simon ◽  
M Capel ◽  
...  
Keyword(s):  
Resource Use ◽  
Healthcare Costs ◽  
Healthcare Resource ◽  
National Health System ◽  
Asthma Severity ◽  
Healthcare Resource Use ◽  
Beta Adrenergic ◽  
Short Acting ◽  
Asthma Patients ◽  
The Relationship

Objective: To determine the relationship between short-acting beta-adrenergic agonist (SABA) overuse and healthcare resource use and costs in asthma patients in routine clinical practice. Methods: A longitudinal retrospective study in Spanish primary and specialized care using the BIG-PAC® Medical Records Database was conducted. Asthma patients ≥12 years of age who attended ≥ 2 consultations during 2017 and had 1-year follow-up data available were included. Main outcomes were demographics, comorbidities, medication, clinical and healthcare resource use and costs. The relationship between SABA overuseand healthcare costs, and between asthma severity and healthcare costs was determined. Results: This SABA use IN Asthma (SABINA) study included 39,555 patients, mean (standard deviation, SD) age 49.8 (20.7) years; 64.2% were female. Charlson comorbidity index was 0.7 (1.0). SABA overuse (≥ 3 canisters/year) was 28.7% (95% CI: 27.7–29.7), with an overall mean number of 3.3 (3.6) canisters/year. Overall, 5.1% of patients were prescribed ≥12 canisters/year. SABA overuse was correlated with healthcare costs (ρ = 0.621; p < 0.001).The adjusted mean annual cost/patient, according to the Global Initiative for Asthma (GINA 2019) classification of asthma severity, was €2,231, €2,345, €2,735, €3,473, and €4,243,for GINA steps 1−5, respectively (p < 0.001). Regardless of asthma severity, SABA overuse yielded a significant increase in healthcare costs per patient and year (€5,702 vs. €1,917, p < 0.001) compared with recommended use (< 2 canisters/year). Conclusions: SABA overuse yields greater costs for the Spanish National Health System. Costs increased according to asthma severity.

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