scholarly journals Disease and economic burden increase with systemic lupus erythematosus severity 1 year before and after diagnosis: a real-world cohort study, United States, 2004–2015

2021 ◽  
Vol 8 (1) ◽  
pp. e000503
Author(s):  
Miao Jiang ◽  
Aimee M Near ◽  
Barnabas Desta ◽  
Xia Wang ◽  
Edward R Hammond
Keyword(s):  
Disease Severity ◽  
Lupus Erythematosus ◽  
Economic Burden ◽  
Resource Utilisation ◽  
Cost Drivers ◽  
Healthcare Resource Utilisation ◽  
Outpatient Visits ◽  
Before And After ◽  
The Usa ◽  
Generalised Linear Modelling

ObjectiveTo assess the economic burden of patients with SLE by disease severity in the USA 1 year before and after diagnosis.MethodsPatients aged ≥18 years with a first SLE diagnosis (index date) between January 2005 and December 2014 were identified from administrative commercial claims data linked to electronic medical records (EMRs). Disease severity during the year after diagnosis was classified as mild, moderate, or severe using claims-based algorithms and EMR data. Healthcare resource utilisation (HCRU) and all-cause healthcare costs (2017 US$) were reported for 1 year pre-diagnosis and post-diagnosis. Generalised linear modelling examined all-cause costs over 1 year post-index, adjusting for baseline demographics, clinical characteristics, Charlson Comorbidity Index and 1 year pre-diagnosis costs.ResultsAmong 2227 patients, 26.3% had mild, 51.0% moderate and 22.7% severe SLE. Mean per-patient costs were higher for patients with moderate and severe SLE compared with mild SLE during the year before diagnosis: mild US$12 373, moderate $22 559 and severe US$39 261 (p<0.0001); and 1-year post-diagnosis period: mild US$13 415, moderate US$29 512 and severe US$68 260 (p<0.0001). Leading mean cost drivers were outpatient visits (US$13 566) and hospitalisations (US$10 252). Post-diagnosis inpatient utilisation (≥1 stay) was higher for patients with severe (51.2%) and moderate (22.4%) SLE, compared with mild SLE (12.8%), with longer mean hospital stays: mild 0.47 days, moderate 1.31 days and severe 5.52 days (p<0.0001).ConclusionHCRU and costs increase with disease severity in the year before and after diagnosis; leading cost drivers post-diagnosis were outpatient visits and hospitalisations. Earlier diagnosis and treatment may improve health outcomes and reduce HCRU and costs.

scholarly journals Economic burden of paediatric-onset disabilities among young and middle-aged adults in the USA: a cohort study of privately insured beneficiaries

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e030490 ◽  
Author(s):  
Daniel Whitney ◽  
Neil Kamdar ◽  
Richard A Hirth ◽  
Edward A Hurvitz ◽  
Mark D Peterson
Keyword(s):  
Healthcare Resource ◽  
Mean Difference ◽  
Secondary Outcome ◽  
Resource Utilisation ◽  
Service Utilisation ◽  
Total Patient ◽  
Healthcare Resource Utilisation ◽  
Before And After ◽  
The Usa ◽  
Out Of Pocket Costs

ObjectiveIndividuals with paediatric-onset disabilities (PoDs) have complex healthcare needs and are susceptible to adverse health outcomes, which may impose a higher strain on healthcare resources. The burden of healthcare resource utilisation and costs attributed to the population of adults with PoDs is not clearly established. The objective here was to compare healthcare resource utilisation and costs between adults with versus without PoDs.DesignCohort.SettingData were from the 2016 Optum Clinformatics Data Mart, a de-identified nationwide claims database of beneficiaries from a single private payer in the USA.ParticipantsInternational Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes were used to identify beneficiaries with PoDs that were between 18 and 64 years of age.Primary and secondary outcome measuresAnnual all-cause healthcare resource utilisation and total healthcare costs were compared between adults with and without PoDs before and after adjusting for sociodemographics and several costly non-communicable diseases.ResultsAdults with PoDs (n=121 446) had greater annual mean counts of service utilisation for all service types (eg, inpatient, outpatient, emergency visits) compared with adults without PoDs (n=5 415 475) before and after adjustments (all p<0.001). Adults with PoDs had greater unadjusted total standardised reimbursement costs (US$26 702 vs US$8464; mean difference=US$18 238; cost ratio (CR)=3.16; 95% CI=3.13 to 3.18) and total patient out-of-pocket costs (US$2226 vs US$1157; mean difference=US$1069; CR=1.88; 95%CI=1.86 to 1.89). After adjustments, total standardised reimbursement costs were 2.32 times higher (95% CI=2.30 to 2.34) and total patient out-of-pocket costs were 1.65 times higher (95% CI=1.64 to 1.66) compared with adults without PoDs.ConclusionAdults with PoDs had greater healthcare utilisation and costs, even after accounting for costly diseases. Future research is needed to identify the cost drivers for adults with PoDs.

scholarly journals Burden of pulmonary arterial hypertension in England: retrospective HES database analysis

2021 ◽  
Vol 15 ◽  
pp. 175346662199504
Author(s):  
Fernando Exposto ◽  
Ruben Hermans ◽  
Åsa Nordgren ◽  
Luke Taylor ◽  
Sanam Sikander Rehman ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Economic Burden ◽  
Treatment Strategies ◽  
The United States ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation ◽  
Outpatient Visits ◽  
Specialist Centre ◽  
Pulmonary Arterial

Background: The clinical and economic burden of pulmonary arterial hypertension (PAH) is poorly understood outside the United States. This retrospective database study describes the characteristics of patients with PAH in England, including their healthcare resource utilisation (HCRU) and associated costs. Methods: Data from 1 April 2012 to 31 March 2018 were obtained from the National Health Service (NHS) Digital Hospital Episode Statistics database, which provides full coverage of patient events occurring in NHS England hospitals. An adult patient cohort was defined using an algorithm incorporating pulmonary hypertension (PH) diagnosis codes, PAH-associated procedures, PH specialist centre visits and PAH-specific medications. HCRU included inpatient admissions, outpatient visits and Accident and Emergency (A&E) attendances. Associated costs, calculated using national tariffs inflation-adjusted to 2017, did not include PAH-specific drugs on the High Cost Drugs list. Results: The analysis cohort included 2527 patients (68.4% female; 63.6% aged ⩾50 years). Mean annual HCRU rates ranged from 2.9 to 3.2 for admissions (21–25% of patients had ⩾5 admissions), 9.4–10.3 for outpatient visits and 0.8–0.9 for A&E attendances. Costs from 2013 to 2017 totalled £43.2M (£33.9M admissions, £8.3M outpatient visits and £0.9M A&E attendances). From 2013 to 2017, mean cost per patient decreased 13% (from £4400 to £3833) for admissions and 13% (from £1031 to £896) for outpatient visits, but increased 52% (from £81 to £123) for A&E attendances. Conclusion: PAH incurs a heavy economic burden on a per-patient basis, highlighting the need for improved treatment strategies able to reduce disease progression and hospitalisations. The reviews of this paper are available via the supplemental material section.

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

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026465 ◽  
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.

scholarly journals Functional neurological disorders in Parkinson disease

2018 ◽  
Vol 89 (6) ◽  
pp. 566-571 ◽  
Author(s):  
Benjamin D Wissel ◽  
Alok K Dwivedi ◽  
Aristide Merola ◽  
Danielle Chin ◽  
Cara Jacob ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Neurological Disorders ◽  
Resource Utilisation ◽  
Motor Disability ◽  
Healthcare Resource Utilisation ◽  
The Usa ◽  
Neurological Features ◽  
Functional Features ◽  
Predominantly Female ◽  
Functional Neurological Disorders

ObjectiveTo ascertain demographic and clinical features of Parkinson disease (PD) associated with functional neurological features.MethodsA standardised form was used to extract data from electronic records of 53 PD patients with associated functional neurological disorders (PD-FND) across eight movement disorders centres in the USA, Canada and Europe. These subjects were matched for age, gender and disease duration to PD patients without functional features (PD-only). Logistic regression analysis was used to compare both groups after adjusting for clustering effect.ResultsFunctional symptoms preceded or co-occurred with PD onset in 34% of cases, nearly always in the most affected body side. Compared with PD-only subjects, PD-FND were predominantly female (68%), had longer delay to PD diagnosis, greater prevalence of dyskinesia (42% vs 18%; P=0.023), worse depression and anxiety (P=0.033 and 0.025, respectively), higher levodopa-equivalent daily dose (972±701 vs 741±559 mg; P=0.029) and lower motor severity (P=0.019). These patients also exhibited greater healthcare resource utilisation, higher use of [(123)I]FP-CIT SPECT and were more likely to have had a pre-existing psychiatric disorder (P=0.008) and family history of PD (P=0.036).ConclusionsA subtype of PD with functional neurological features is familial in one-fourth of cases and associated with more psychiatric than motor disability and greater use of diagnostic and healthcare resources than those without functional features. Functional manifestations may be prodromal to PD in one-third of patients.

scholarly journals Real-world treatment patterns, healthcare resource utilisation and costs in patients with systemic lupus erythematosus treated with belimumab: a retrospective analysis of claims data in the USA

2020 ◽  
Vol 7 (1) ◽  
pp. e000357 ◽  
Author(s):  
Christopher F Bell ◽  
Julie Priest ◽  
Marni Stott-Miller ◽  
Hong Kan ◽  
Justyna Amelio ◽  
...  
Keyword(s):  
Emergency Department ◽  
Real World ◽  
Lupus Erythematosus ◽  
Claims Data ◽  
Healthcare Resource ◽  
Emergency Department Visits ◽  
Resource Utilisation ◽  
Administrative Claims ◽  
Office Visits ◽  
Healthcare Resource Utilisation

ObjectiveTo examine the effects of belimumab initiation on healthcare resource utilisation (HCRU) and costs in SLE.MethodsThis retrospective observational cohort study used healthcare administrative claims data from the IBM MarketScan Commercial Claims and Encounters Database to identify patients with SLE billing codes who received ≥1 intravenous belimumab infusion between March 2011 and December 2015. The first belimumab administration was the ‘index date’. During the 6-month postindex period, nine belimumab infusions were recommended: three during the initiation period and six during the maintenance period. HCRU and cost data for inpatient admissions, emergency department visits, physician office visits, hospital-based outpatient visits, laboratory services, other outpatient services and outpatient pharmacy prescriptions were compared in the 6-month pre/postindex periods.ResultsOf the 1879 patients with SLE included, 43% received ≥3 intravenous initiation administrations. An average of 5.3 (SD: 2.4) of the nine recommended belimumab administrations were received within 6 months. In the 6-month preindex versus postindex periods, significant reductions were noted for inpatient hospitalisations (18% vs 9%, p<0.001; mean visits: 0.3 vs 0.14, p<0.001) and emergency department visits (40% vs 24%, p<0.001; mean visits; 3.53 vs 1.96, p<0.001). Mean total costs were higher in the 6-month postindex versus preindex period ($41 426 vs $29 270; p<0.001).ConclusionsIn this study of real-world intravenous belimumab for SLE, adherence to recommended infusion schedules was low. Outpatient healthcare and associated costs were higher in the 6 months after belimumab was initiated, although inpatient costs were lower. Reasons for non-adherence with belimumab and implications should be investigated.

scholarly journals Contemporary issues in the implementation of lung cancer screening

2021 ◽  
Vol 30 (161) ◽  
pp. 200288
Author(s):  
Stephen Lam ◽  
Martin Tammemagi
Keyword(s):  
Lung Cancer ◽  
Cancer Screening ◽  
Lung Cancer Screening ◽  
Population Level ◽  
Lung Cancer Mortality ◽  
Cost Effective ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation ◽  
The Usa ◽  
Screening Sensitivity

Lung cancer screening with low-dose computed tomography can reduce death from lung cancer by 20–24% in high-risk smokers. National lung cancer screening programmes have been implemented in the USA and Korea and are being implemented in Europe, Canada and other countries. Lung cancer screening is a process, not a test. It requires an organised programmatic approach to replicate the lung cancer mortality reduction and safety of pivotal clinical trials. Cost-effectiveness of a screening programme is strongly influenced by screening sensitivity and specificity, age to stop screening, integration of smoking cessation intervention for current smokers, screening uptake, nodule management and treatment costs. Appropriate management of screen-detected lung nodules has significant implications for healthcare resource utilisation and minimising harm from radiation exposure related to imaging studies, invasive procedures and clinically significant distress. This review focuses on selected contemporary issues in the path to implement a cost-effective lung cancer screening at the population level. The future impact of emerging technologies such as deep learning and biomarkers are also discussed.

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