scholarly journals The Direct Medical Costs of Late Presentation (<350/mm3) of HIV Infection over a 15-Year Period

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Hartmut B. Krentz ◽  
M. John Gill
Keyword(s):  
Cost Savings ◽  
Medical Costs ◽  
Late Presentation ◽  
Hiv Care ◽  
First Year ◽  
Late Presenters ◽  
Cd4 Counts ◽  
Direct Medical Costs ◽  
Southern Alberta ◽  
Routine Hiv Testing

We describe the immediate- and longer-term direct medical costs of care for individuals diagnosed with HIV at CD4 counts <350/mm3(“late presenters”). We collected and stratified by initial CD4 count all inpatient, outpatient, and drug costs for all newly diagnosed patients accessing HIV care within Southern Alberta from 1/1/1995 to 1/1/2010. 59% of new patients were late presenters. We found significantly higher costs for late presenters, especially inpatient costs, during the first year after accessing care. Direct medical costs remained almost twice as high for late presenters in subsequent years compared to patients presenting with CD4 counts >350/mm3despite significantly their improved CD4 counts. The sustained high cost for late presenters has implications for recent recommendations for wider routine HIV testing and the earlier initiation of cART. Earlier diagnosis and treatment, while increasing the immediate expenditures within a population, may produce both direct and indirect cost savings in the longer term.

scholarly journals Desimplification of Single Tablet Antiretroviral (ART) Regimens—A Practical Cost-Savings Strategy?

2019 ◽  
Vol 18 ◽  
pp. 232595821882230 ◽  
Author(s):  
Hartmut Krentz ◽  
Shayna Campbell ◽  
John Gill
Keyword(s):  
Antiretroviral Therapy ◽  
Side Effects ◽  
Cost Control ◽  
Generic Drugs ◽  
Cost Savings ◽  
Hiv Care ◽  
First Year ◽  
Increased Risk ◽  
Southern Alberta ◽  
And Control

Introduction: The use of lifelong antiretroviral therapy (ART) results in increased costs of care; the ability to finance and control sustained costs of ART needs to be discussed. Approach: The Southern Alberta Clinic initiated a practical cost savings approach that switched select patients from a branded ART to a less expensive generic variation. Our approach surveyed physicians and patients on their acceptance of switching and then launched a program asking patients if they would switch to generic variations for cost control purposes. Results: Our early findings found >50% of patients approached agreed to switch. We found no evidence of increased risk of viral breakthrough, resistance, side effects, or displeasure with generic drugs. Measured cost savings in the first year were >$1.1 million with annual projected savings of between $4.3 million and $2.6 million (in 2017 Cdn$). Conclusion: Our approach can provide an option for controlling costs of HIV care without compromising quality.

Costs to healthcare payers associated with clinical trial (CT) participation in metastatic non-small cell lung cancer (NSCLC).

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 3-3
Author(s):  
Cristina Merkhofer ◽  
Shasank Chennupati ◽  
Qin Sun ◽  
Keith D. Eaton ◽  
Renato G. Martins ◽  
...  
Keyword(s):  
Cost Savings ◽  
Medical Costs ◽  
Egfr Mutations ◽  
Cancer Drug ◽  
Trial Participation ◽  
Eligibility Criteria ◽  
Metastatic Nsclc ◽  
Direct Medical Costs ◽  
Academic Center ◽  
The Mean

3 Background: To assess the financial implications of therapeutic CT participation for healthcare payers, we compared first-line (1L) and second-line (2L) total direct medical costs between patients enrolled in 2L CT vs non-CT participants receiving 2L therapy for metastatic NSCLC. Methods: We linked electronic health records from a single academic center with tumor registry and claims data to identify patients with metastatic NSCLC diagnosed from 1/1/2007-12/31/2015. Eligibility criteria included 60 day minimum survival, receipt of ≥ 1 anti-cancer drug within 180 days of diagnosis, insurance enrollment for ≥ 12 months after diagnosis and receipt of ≥ 2 therapy lines. Patients on 1L trials were excluded. We calculated mean per-patient-per-month (PPPM) total direct medical costs from the payer perspective for 1L and 2L. We performed a difference-of-difference analysis to estimate the effect of trial enrollment on costs by calculating the mean PPPM difference between 2L and 1L in trial (Diff trial) and non-trial enrollees (Diff non-trial). Then we calculated the difference between Diff trial and Diff non-trial. We used paired and non-paired t-tests for statistical comparisons and report all costs in 2019 US dollars. Results: Of 63 patients, 22 (35%) enrolled in a 2L CT. CT enrollees were younger (mean age 63.5 vs 66.7 years), female (73% vs 41%), had commercial insurance (36% vs 32%), were never smokers (36% vs 32%), had EGFR mutations (27% vs 22%) and fewer had brain metastases (14% vs 29%). The mean PPPM total direct medical costs decreased between 2L and 1L for patients enrolled in 2L CTs but increased in non-trial participants (Diff trial = -$5,585, SD ± $6,541; Diff non-trial = $1,532, SD ± $14,739). The mean difference of difference (Diff trial - Diff non-trial) was -$7,117 (p = 0.01; Table). Conclusions: This small observational study suggests that CT enrollment results in substantial cost-savings to payers. If confirmed in larger studies, our findings suggest that insurers support trial participation for patients with NSCLC. [Table: see text]

Does faster rituximab infusion for patients with NHL lower cancer care costs?

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e17561-e17561
Author(s):  
Carolina Reyes ◽  
Minghan Dai ◽  
Hans-Peter Goertz ◽  
Keith L Dawson ◽  
John C. Hornberger
Keyword(s):  
Adverse Events ◽  
Productivity Loss ◽  
Cost Savings ◽  
B Cell Lymphoma ◽  
Target Population ◽  
Medical Costs ◽  
Phase Iii ◽  
Medical Decision ◽  
Medication Cost ◽  
Direct Medical Costs

e17561 Background: Rituximab in combination with chemotherapy is recommended for non-Hodgkin’s lymphoma. A faster (90-minute) infusion schedule for rituximab has been found to be safe and feasible in NHL patients who tolerate their first infusion administered at the standard rate (Phase III study RATE trial; NCT00719472). This study’s objective was to assess the economic impact of adopting the 90-minute rituximab infusion from a US societal perspective. Methods: The analysis complied with the jointly published Good Research Practice guidelines of the International Society of Pharmacoeconomic and Outcome Research and the Society of Medical Decision Making. The target population was US patients in 2013 with previously untreated diffuse large B-cell lymphoma (DLBCL) or follicular lymphoma (FL) who were scheduled to receive rituximab plus CHOP or CVP. Costs included direct medical costs (drug and administration cost, pre-medication cost, cost of adverse events) and indirect costs (income foregone by patients and informal caregivers due to visit duration for infusion). Data sources included RATE trial, Medicare Fee Schedules, and US Labor Department statistics. Results: Of the 23,519 newly diagnosed DLBCL and FL patients in the target population, the estimated direct medical costs and foregone (patient and caregiver) income for conventional infusion totaled $825,005,088 and $9,293,180 respectively. The 90-minute infusion reduced direct medical costs by $2,205,689 (0.3%) and foregone patient income by $3,628,185 (39%). The average cost savings for each patient was $42 per infusion and $248 per course. The factors that most influenced savings included cost to treat adverse events, administration costs, and patient wage rates. As a result from a shorter infusion duration, the increased center capacity may lead to a larger saving as the fixed center costs can be distributed across more patients. Conclusions: In the context of tremendous focus on affordably improving population health, this study confirms that compared with conventional rituximab infusion regimen, a novel, validated regimen that is 3-4 fold faster to administer and is as safe results in direct medical savings and reduces productivity loss for patients and caregivers.

scholarly journals Burden of Type 2 Diabetes from the Healthcare Payer Perspective in Slovenia / Breme Sladkorne Bolezni Tipa 2 S Stališča Plačnika Zdravstvenega Varstva V Sloveniji

2013 ◽  
Vol 52 (3) ◽  
pp. 162-180 ◽  
Author(s):  
Tomaž Nerat ◽  
Mitja Kos
Keyword(s):  
Type 2 Diabetes ◽  
Medical Costs ◽  
Healthcare Payer ◽  
First Year ◽  
Direct Medical Costs ◽  
Payer Perspective ◽  
Per Capita ◽  
Treatment Medication ◽  
Cost Studies

Abstract Introduction: Diabetes prevalence and costs are rising on aglobal scale. Therefore, it is necessary to periodically conduct cost studies for assessing the healthcare burden impact. In Slovenia, the last type 2 diabetes cost assessment was conducted in 2006, not including all diabetes complication costs. The aim of this study was to revise, update and compare to previously published datadirect healthcare costs of type 2 diabetes in Slovenia with additional complications costs consideration. Methods: The study was performed from the healthcare payer perspective using the bottom-up approach, was prevalence based and estimated direct medical costs. Results: We estimated total yearly direct medical costs of type 2 diabetes in Slovenia to 99,120,419 euro with annual per capita costs of 834.70 euro. The highest cost shares were attributed to cardiovascular complication costs (21,683,919 euro), diabetes co-medication (20,977,269 euro) and diabetes treatment medication (18,505,015 euro). Highest yearly costs per complication (all cases, all occurrences) were estimated for dialysis I and III (9,162,635 euro), stroke first year costs (4,951,306 euro) and congestive heart failure first year costs (4,879,533 euro). Yearly per one patient, the complication costs were highest for kidney transplantation, followed by dialysis I and III (78,621.25 euro and 36,797.73 euro) Conclusions: In comparison to the costs published in the literature before, our estimated total yearly direct medical costs were comparable, although annual per capita costs were assessed lower than elsewhere. Further, regarding the complication costs estimations, our assessed expenses were comparable to those published in other countries.

Abstract P90: Cardiovascular and Economic Outcomes Following Initiation of Atorvastatin versus Simvastatin in an Employed Population Stratified by Cardiovascular Risk

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Ross Simpson ◽  
James Signorovitch ◽  
Karthik Ramakrishnan ◽  
Jasmina Ivanova ◽  
Howard Birnbaum ◽  
...  
Keyword(s):  
High Risk ◽  
Cost Savings ◽  
Indirect Costs ◽  
Medical Costs ◽  
Matched Pairs ◽  
Intermediate Risk ◽  
Direct Medical Costs ◽  
Significant Difference ◽  
Risk Patients ◽  
Employer Perspective

OBJECTIVE: To compare initiation with atorvastatin versus simvastatin among higher- and lower-risk employees in terms of subsequent risk of cardiovascular (CV) events and direct and indirect costs from the employer perspective. METHODS: Employees initiating atorvastatin or simvastatin were identified from a claims database (1999-2006) spanning 23 large, self-insured employers and stratified as 1) high-risk employees with prior CV events, diabetes or renal disorders and 2) low-to-intermediate-risk employees without these conditions. Propensity score matching was used to adjust for baseline differences between the atorvastatin and simvastatin cohorts, and two-year outcomes were compared between matched cohorts. Indirect costs included disability payments and medically-related absenteeism. Atorvastatin and simvastatin drug costs were imputed with recent prices to account for availability of generic simvastatin. RESULTS: Among 4,167 matched pairs of high-risk employees, initiation with atorvastatin vs. simvastatin was associated with similar rates of subsequent CV events (17.6 vs. 18.4%, P=0.37), higher direct medical costs ($17,590 vs. $17,377, P=0.002), similar indirect costs ($4,830 vs. $4,989, P=0.29) and higher total costs by $54 ($22,420 vs. $22,366, P=0.034). The majority of high-risk employees (62%) received low initial statin doses (atorvastatin ≤ 10 mg or simvastatin ≤ 20 mg). Among 9,326 matched pairs of low-to-intermediate risk employees, initiation with atorvastatin vs. simvastatin was associated with a lower rate of CV events (3.1 vs. 3.7%, p=0.030), lower direct medical costs ($8,400 vs. $8,436, P<0.001), similar indirect costs ($2,781 vs. $2,807; P=0.12) and lower total costs by $61 ($11,181 vs. $11,243, P<0.001). CONCLUSIONS: Among high-risk patients, initiation with atorvastatin vs. simvastatin was associated with no significant difference in CV events and higher total costs to employers. Among low-to-intermediate risk patients, initiation with atorvastatin vs. simvastatin was associated with fewer CV events and net cost savings to employers. Formulary policies reserving atorvastatin for higher-risk patients may not be beneficial from the employer perspective.

Comparing Expenditures in Depressed Patients Treated with Venlafaxine ER and SSRIs

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S13) ◽  
pp. 1-7
Author(s):  
Diane M. Sloan ◽  
Jacques LeLorier
Keyword(s):  
Cost Effectiveness ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Cost Savings ◽  
Indirect Costs ◽  
Patient Characteristics ◽  
Medical Costs ◽  
Direct Medical Costs ◽  
Medical Visits ◽  
Study Results ◽  
The Cost

AbstractDepression is a chronic illness whose true costs to society are unclear. The costs associated with depression are direct (drugs and treatment), indirect (absenteeism and loss of productivity), and intangible (quality of life). Direct costs are usually easy to quantify. Indirect costs often test the ingenuity of researchers whose results are, at best, crude approximations. Intangible costs are elusive and may never be measured with any degree of accuracy. To compound matters further, many patients with depression have never been diagnosed, which complicates the cost accounting analysis of depression from a societal perspective. What is clear is that the worldwide costs of depression are climbing The overall costs of treating depression attributable to drug therapy are modest. The appropriate choice of antidepressant therapy is likely to be the product that provides the highest effectiveness in terms of overall costs. As a result, it is important that prescribers have an idea of the benefit derived from the cost of drugs, and how the cost effectiveness of different drugs compare.Previous studies of antidepressant cost effectiveness have suggested that the use of venlafaxine, which costs more than generic selective serotonin reuptake inhibitors (SSRIs), may be no more costly when total costs (eg, how many drugs were prescribed, how many medical or emergency room visits patients had, and how often they were hospitalized) are calculated. The objectives of this retrospective, populationbased, database study were to identify patient characteristics and factors associated with the choice of antidepressant in order to assess differences in persistence, healthcare utilization, and direct medical costs associated with venlafaxine and SSRI pharmacotherapy.Study results indicated that in this real-world setting, medical costs were similar among depressive patients treated with venlafaxine and SSRIs. The higher purchase price of venlafaxine was balanced by cost savings due to fewer hospitalizations and fewer outpatient medical visits. Differences in drug treatment may also partially explicate the observed differences in average direct medical costs between venlafaxine and SSRIs.

Effect of Clinical Trial Participation on Costs to Payers in Metastatic Non–Small-Cell Lung Cancer

2021 ◽  
Vol 17 (8) ◽  
pp. e1225-e1234
Author(s):  
Cristina Merkhofer ◽  
Shasank Chennupati ◽  
Qin Sun ◽  
Keith D. Eaton ◽  
Renato G. Martins ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Health Care ◽  
Clinical Trial ◽  
Cost Savings ◽  
Medical Costs ◽  
Small Cell ◽  
Trial Participation ◽  
Difference In Difference ◽  
Small Cell Lung ◽  
Direct Medical Costs

PURPOSE: The costs associated with clinical trial enrollment remain uncertain. We hypothesized that trial participation is associated with decreased total direct medical costs to health care payers in metastatic non–small-cell lung cancer. METHODS: In this retrospective cohort study, we linked clinical data from electronic medical records to sociodemographic data from a cancer registry and claims data from Medicare and two private insurance plans. We used a difference-in-difference analysis to estimate mean per patient per month total direct medical costs for patients enrolled on a second-line (2L) trial versus patients receiving standard-of-care 2L systemic therapy. RESULTS: Among 70 eligible patients, the difference-in-difference of mean per patient per month total direct medical costs between 2L trial participants and nonparticipants was –$6,663 ( P = .01), for a mean savings of $45,308 per patient for the duration of 2L trial therapy. In a secondary analysis by primary insurance payer, this difference-in-difference was –$5,526 ( P = .26) for patients with commercial insurance and –$7,432 ( P = .01) for patients with Medicare. CONCLUSION: Participation in a 2L trial was associated with a $6,663 per month cost savings to health care payers for the duration of trial participation. Further studies are necessary to elucidate differences in cost savings from trial participation for Medicare and commercial payers. If confirmed, these results support health care payer investment in programs to improve clinical trial access and enrollment.

scholarly journals Determinants of HIV-1 late presentation in a cohort of Portuguese HIV-1 patients

2020 ◽  
Author(s):  
Ana Cláudia Miranda ◽  
Mafalda Miranda ◽  
Marta Pingarilho ◽  
Victor Pimentel ◽  
João Torres ◽  
...  
Keyword(s):  
Late Presentation ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Late Presenters ◽  
Factors Associated ◽  
Exposure Category ◽  
Undiagnosed Hiv ◽  
Hiv Exposure ◽  
Sub Saharan ◽  
Hiv 1

AbstractBackgroundUndiagnosed HIV-1 patients still account for 25% of worldwide HIV patients. Studying late presenters for HIV care may help to identify characteristics of such patients.ObjectiveThe present study aims to identify factors associated with late presentation (LP) and late presentation with advanced disease (LPAD) based on a population of patients followed in a Portuguese hospital between 1984 and 2017.MethodsSociodemographic and clinical data from infected patients with HIV-1 aged 18 years and older, followed in Egas Moniz Hospital, in Portugal were collected.ResultsOf the 907 patients included in this study, 68.7% were males and the median age was 37 years (IQR 30-47). 459 patients (50.6%) were LP and, of these, 284 patients (61.9%) were LPAD. The LP population mostly originated from Portugal and Sub-Saharan Africa (64.4% and 28.8%; p=0.004) and the HIV exposure category mainly heterosexuals and MSM (57.0% and 24.9%; p<0.001). The stage of disease and viral load at diagnosis were significantly associated with both LP and LPAD (p<0.001). Factors associated with LP in the logistic regression included age at diagnosis lower than 30y (aOR 0.34; 0.17-0.68; p=0.002) and origin from Sub-Saharan Africa (aOR 2.24; 1.44-3.50; p<0.001).ConclusionLate presentation is a major obstacle to halt the HIV epidemic. In this population, the majority of newly diagnosed HIV-infected individuals were late presenters. Our results characterize vulnerable populations that should be frequently tested for HIV.

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