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

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.

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

10.1101/409870 ◽

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.

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The direct healthcare costs associated with psychological distress and major depression: A population-based cohort study in Ontario, Canada

PLoS ONE ◽

10.1371/journal.pone.0184268 ◽

2017 ◽

Vol 12 (9) ◽

pp. e0184268 ◽

Cited By ~ 26

Author(s):

Maria Chiu ◽

Michael Lebenbaum ◽

Joyce Cheng ◽

Claire de Oliveira ◽

Paul Kurdyak

Keyword(s):

Cohort Study ◽

Psychological Distress ◽

Major Depression ◽

Healthcare Costs ◽

Population Based ◽

Direct Healthcare Costs

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Direct Healthcare Costs Associated with Osteoporosis and Bone Fracture in Pharmacologically Treated Chronic Hepatitis B Patients: Results of A United States Population-Based Cohort Study

Gastroenterology ◽

10.1016/s0016-5085(17)31704-3 ◽

2017 ◽

Vol 152 (5) ◽

pp. S447

Author(s):

Stuart C. Gordon ◽

Joseph K. Lim ◽

Iris Liou ◽

A. Burak Ozbay ◽

Laurie A. Costa ◽

...

Keyword(s):

United States ◽

Chronic Hepatitis ◽

Cohort Study ◽

Hepatitis B ◽

Chronic Hepatitis B ◽

Bone Fracture ◽

Healthcare Costs ◽

Population Based ◽

United States Population ◽

Direct Healthcare Costs

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Estimating direct healthcare costs attributable to laboratory‐confirmed Lyme disease in Ontario, Canada: A population‐based matched cohort study using health administrative data

Zoonoses and Public Health ◽

10.1111/zph.12560 ◽

2019 ◽

Vol 66 (4) ◽

pp. 428-435 ◽

Cited By ~ 1

Author(s):

Emily Shing ◽

John Wang ◽

Edwin Khoo ◽

Gerald A. Evans ◽

Stephen Moore ◽

...

Keyword(s):

Cohort Study ◽

Lyme Disease ◽

Administrative Data ◽

Healthcare Costs ◽

Population Based ◽

Matched Cohort ◽

Health Administrative Data ◽

Matched Cohort Study ◽

Direct Healthcare Costs

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PCV28 CHARACTERIZATION OF COSTS AND PATIENTS WITH INCIDENT HEART FAILURE (HF) INCURRING THE HIGHEST HEALTHCARE COSTS FROM SECONDARY CARE: A RETROSPECTIVE, POPULATION-BASED COHORT STUDY IN SWEDEN

Value in Health ◽

10.1016/j.jval.2019.09.753 ◽

2019 ◽

Vol 22 ◽

pp. S546

Author(s):

K. Boman ◽

K. Lindmark ◽

M. Olofsson ◽

J. Stålhammar ◽

A.F. Fonseca ◽

...

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Secondary Care ◽

Healthcare Costs ◽

Population Based ◽

Incident Heart Failure

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Healthcare resource utilisation and cost associated with elevated potassium levels: a Danish population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-026465 ◽

2019 ◽

Vol 9 (4) ◽

pp. e026465 ◽

Cited By ~ 4

Author(s):

Kun Kim ◽

Reimar Wernich Thomsen ◽

Sia Kromann Nicolaisen ◽

Lars Pål Hasvold ◽

Eirini Palaka ◽

...

Keyword(s):

Cohort Study ◽

Healthcare Costs ◽

Healthcare Providers ◽

Population Based ◽

Secondary Outcome ◽

Resource Utilisation ◽

Healthcare Resource Utilisation ◽

Before And After ◽

Patient Groups ◽

Diabetes Patients

ObjectivesTo investigate healthcare costs associated with hyperkalaemia (HK) among patients with chronic kidney disease (CKD), heart failure (HF) or diabetes.DesignBefore–after cohort study of patients with HK and matched patients without HK.SettingPopulation-based databases covering primary and secondary care for the entire of Northern Denmark.ParticipantsPatients with a first incident record of CKD (n=78 372), HF (n=14 233) or diabetes (n=37 479) during 2005–2011. Among all patients experiencing a first HK event (potassium level >5.0 mmol/L), healthcare costs were compared during 6 months before and 6 months after the HK event. The same cost assessment was conducted 6 months before and after a matched index date in a comparison cohort of patients without HK.Primary and secondary outcome measuresMean costs of hospital care, general practice and dispensed drugs converted to 2018 Euros.ResultsOverall, 17 747 (23%) CKD patients, 5141 (36%) HF patients and 4183 (11%) diabetes patients with a first HK event were identified. More than 40% of all HK patients across the patient groups had subsequent HK events with successively shorter times between the events. In CKD patients, overall mean costs were €5518 higher 6 months after versus before first HK, while €441 higher in matched CKD patients without HK, yielding HK-associated costs of €5077. Corresponding costs associated with a HK event were €6018 in HF patients, and €4862 in diabetes patients.ConclusionsAmong CKD, HF and diabetes patients, an incident HK event was common, and a large proportion of the patients experienced recurrent HK events. Substantial increase in healthcare costs associated with a HK event was observed in the HK patients compared with non-HK patients. These results are important to better understand the potential economic impact of HK among high-risk comorbid patients in a real-wold setting and help inform decision-making for clinicians and healthcare providers.

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Population-based analysis of patients with COPD in Catalonia: a cohort study with implications for clinical management

BMJ Open ◽

10.1136/bmjopen-2017-017283 ◽

2018 ◽

Vol 8 (3) ◽

pp. e017283 ◽

Cited By ~ 8

Author(s):

Emili Vela ◽

Ákos Tényi ◽

Isaac Cano ◽

David Monterde ◽

Montserrat Cleries ◽

...

Keyword(s):

Risk Assessment ◽

Cohort Study ◽

Clinical Management ◽

Healthcare Costs ◽

High Performance ◽

Health Indicators ◽

International Classification Of Diseases ◽

Population Based ◽

Chronic Obstructive ◽

The Impact

BackgroundClinical management of patients with chronic obstructive pulmonary disease (COPD) shows potential for improvement provided that patients’ heterogeneities are better understood. The study addresses the impact of comorbidities and its role in health risk assessment.ObjectiveTo explore the potential of health registry information to enhance clinical risk assessment and stratification.DesignFixed cohort study including all registered patients with COPD in Catalonia (Spain) (7.5 million citizens) at 31 December 2014 with 1-year (2015) follow-up.MethodsA total of 264 830 patients with COPD diagnosis, based on the International Classification of Diseases (Ninth Revision) coding, were assessed. Performance of multiple logistic regression models for the six main dependent variables of the study: mortality, hospitalisations (patients with one or more admissions; all cases and COPD-related), multiple hospitalisations (patients with at least two admissions; all causes and COPD-related) and users with high healthcare costs. Neither clinical nor forced spirometry data were available.ResultsMultimorbidity, assessed with the adjusted morbidity grouper, was the covariate with the highest impact in the predictive models, which in turn showed high performance measured by the C-statistics: (1) mortality (0.83), (2 and 3) hospitalisations (all causes: 0.77; COPD-related: 0.81), (4 and 5) multiple hospitalisations (all causes: 0.80; COPD-related: 0.87) and (6) users with high healthcare costs (0.76). Fifteen per cent of individuals with highest healthcare costs to year ratio represented 59% of the overall costs of patients with COPD.ConclusionsThe results stress the impact of assessing multimorbidity with the adjusted morbidity grouper on considered health indicators, which has implications for enhanced COPD staging and clinical management.Trial registration numberNCT02956395.

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Hospitalization Resource Use and Costs Before and After TIA and Stroke: Results from a Population-Based Cohort Study (OXVASC)

Value in Health ◽

10.1016/j.jval.2012.10.013 ◽

2013 ◽

Vol 16 (2) ◽

pp. 280-287 ◽

Cited By ~ 10

Author(s):

Ramon Luengo-Fernandez ◽

Louise E. Silver ◽

Sergei A. Gutnikov ◽

Alastair M. Gray ◽

Peter M. Rothwell

Keyword(s):

Cohort Study ◽

Resource Use ◽

Population Based ◽

Before And After

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Characteristics and resource utilization of high-cost users in the intensive care unit: a population-based cohort study

BMC Health Services Research ◽

10.1186/s12913-021-07318-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Claudia Dziegielewski ◽

Robert Talarico ◽

Haris Imsirovic ◽

Danial Qureshi ◽

Yasmeen Choudhri ◽

...

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Length Of Stay ◽

Hospital Mortality ◽

Healthcare Costs ◽

Healthcare Expenditure ◽

Healthcare Spending ◽

Population Based ◽

Icu Length Of Stay

Abstract Background Healthcare expenditure within the intensive care unit (ICU) is costly. A cost reduction strategy may be to target patients accounting for a disproportionate amount of healthcare spending, or high-cost users. This study aims to describe high-cost users in the ICU, including health outcomes and cost patterns. Methods We conducted a population-based retrospective cohort study of patients with ICU admissions in Ontario from 2011 to 2018. Patients with total healthcare costs in the year following ICU admission (including the admission itself) in the upper 10th percentile were defined as high-cost users. We compared characteristics and outcomes including length of stay, mortality, disposition, and costs between groups. Results Among 370,061 patients included, 37,006 were high-cost users. High-cost users were 64.2 years old, 58.3% male, and had more comorbidities (41.2% had ≥3) when likened to non-high cost users (66.1 years old, 57.2% male, 27.9% had ≥3 comorbidities). ICU length of stay was four times greater for high-cost users compared to non-high cost users (22.4 days, 95% confidence interval [CI] 22.0–22.7 days vs. 5.56 days, 95% CI 5.54–5.57 days). High-cost users had lower in-hospital mortality (10.0% vs.14.2%), but increased dispositioning outside of home (77.4% vs. 42.2%) compared to non-high-cost users. Total healthcare costs were five-fold higher for high-cost users ($238,231, 95% CI $237,020–$239,442) compared to non-high-cost users ($45,155, 95% CI $45,046–$45,264). High-cost users accounted for 37.0% of total healthcare costs. Conclusion High-cost users have increased length of stay, lower in-hospital mortality, and higher total healthcare costs when compared to non-high-cost users. Further studies into cost patterns and predictors of high-cost users are necessary to identify methods of decreasing healthcare expenditure.

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