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

Thorax ◽  
2017 ◽  
Vol 73 (2) ◽  
pp. 116-124 ◽  
Author(s):  
Marjan Kerkhof ◽  
Trung N Tran ◽  
Joan B Soriano ◽  
Sarowar Golam ◽  
Danny Gibson ◽  
...  

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.

2021 ◽  
pp. 1-8
Author(s):  
Han-I. Wang ◽  
Lu Han ◽  
Rowena Jacobs ◽  
Tim Doran ◽  
Richard I. G. Holt ◽  
...  

Background Approximately 60 000 people in England have coexisting type 2 diabetes mellitus (T2DM) and severe mental illness (SMI). They are more likely to have poorer health outcomes and require more complex care pathways compared with those with T2DM alone. Despite increasing prevalence, little is known about the healthcare resource use and costs for people with both conditions. Aims To assess the impact of SMI on healthcare resource use and service costs for adults with T2DM, and explore the predictors of healthcare costs and lifetime costs for people with both conditions. Method This was a matched-cohort study using data from the Clinical Practice Research Datalink linked to Hospital Episode Statistics for 1620 people with comorbid SMI and T2DM and 4763 people with T2DM alone. Generalised linear models and the Bang and Tsiatis method were used to explore cost predictors and mean lifetime costs respectively. Results There were higher average annual costs for people with T2DM and SMI (£1930 higher) than people with T2DM alone, driven primarily by mental health and non-mental health-related hospital admissions. Key predictors of higher total costs were older age, comorbid hypertension, use of antidepressants, use of first-generation antipsychotics, and increased duration of living with both conditions. Expected lifetime costs were approximately £35 000 per person with both SMI and T2DM. Extrapolating nationally, this would generate total annual costs to the National Health Service of around £250 m per year. Conclusions Our estimates of resource use and costs for people with both T2DM and SMI will aid policymakers and commissioners in service planning and resource allocation.


2020 ◽  
Author(s):  
Xiaoqin Yang ◽  
Kaushal Desai ◽  
Neha Agrawal ◽  
Kirti Mirchandani ◽  
Sagnik Chatterjee ◽  
...  

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.


2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S819-S819
Author(s):  
Winnie Nelson ◽  
Laura Stong ◽  
Naomi Sacks ◽  
Alexandria Portelli ◽  
Bridget Healey ◽  
...  

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.


Cephalalgia ◽  
2020 ◽  
Vol 40 (7) ◽  
pp. 639-649 ◽  
Author(s):  
Steven C Marcus ◽  
Anand R Shewale ◽  
Stephen D Silberstein ◽  
Richard B Lipton ◽  
William B Young ◽  
...  

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.


BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e027814 ◽  
Author(s):  
Sara Wallström ◽  
Inger Ekman ◽  
Elmir Omerovic ◽  
Kerstin Ulin ◽  
Hanna Gyllensten

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.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S798-S799
Author(s):  
Rena Moon ◽  
Alen Marijam ◽  
Fanny S Mitrani-Gold ◽  
Daniel C Gibbons ◽  
Alex Kartashov ◽  
...  

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)


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 5864-5864
Author(s):  
James D. Griffin ◽  
Mike Storm ◽  
Ken Wilhelm ◽  
Audra Boscoe ◽  
Dendy Macaulay ◽  
...  

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.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S792-S792
Author(s):  
Madison T Preib ◽  
Fanny S Mitrani-Gold ◽  
Xiaoxi Sun ◽  
Christopher Adams ◽  
Ashish V Joshi

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)


Sign in / Sign up

Export Citation Format

Share Document