Abstract 19672: Comparison of Major-bleeding Risk and Health Care Costs Among Treatment-naïve Non-valvular Atrial Fibrillation Patients Initiating Apixaban, Dabigatran, Rivaroxaban or Warfarin

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Alpesh Amin ◽  
Allison Keshishian ◽  
Lin Xie ◽  
Onur Baser ◽  
Kwanza Price ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Major Bleeding ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
Medical Costs ◽  
Medicare Advantage ◽  
Major Bleeding Event ◽  
Treatment Naïve ◽  
Care Costs

Objective: The study aim was to compare major bleeding risk and health care costs after initiating oral anticoagulants (OACs) for treatment-naïve non-valvular atrial fibrillation (NVAF) patients. Methods: Patients in the Medicare advantage population prescribed apixaban, rivaroxaban, dabigatran or warfarin were selected from the Optum Research Database 01JAN2013-31DEC2014. The first OAC prescription date was designated as the index date. Patients were required to have a NVAF diagnosis, continuous health plan enrollment for 6 months and no OAC claims before the index date. Patients were classified into four cohorts based on their index OAC prescription. Major bleeding events, identified by the Cunningham algorithm plus additional bleeding sites, were compared using a Cox proportional hazards model. Health care costs were calculated per patient per month and compared using generalized linear models. Results: The study included 36,260 patients: 3,762 apixaban, 2,677 dabigatran, 8,740 rivaroxaban, and 21,081 warfarin patients. CHA2DS2-VASc score was higher in apixaban patients (4.2) compared to dabigatran and rivaroxaban (both 4.0; p<0.001), but lower than in warfarin patients (4.3; p<0.001). After adjusting for baseline characteristics, apixaban patients were significantly less likely to have a major-bleeding event within one year of treatment initiation compared to rivaroxaban (HR=0.69; 95% CI=0.59-0.81) and warfarin (HR=0.71; 95% CI=0.61-0.82) patients and trended towards numerically lower major bleeding compared to dabigatran patients (HR=0.87; 95% CI=0.72-1.06). Major bleeding-related medical costs were lower in apixaban patients ($53) compared to rivaroxaban ($111) and warfarin ($138) patients (p<0.001) and similar to dabigatran patients ($44, p=0.370). Furthermore, apixaban patients incurred lower all-cause medical costs ($1,646) compared to dabigatran ($1,974, p=0.02), rivaroxaban ($1,909, p=0.002) and warfarin ($2,162, p<0.001) patients. Conclusion: In a large national Medicare advantage population, treatment-naïve NVAF patients treated with apixaban were significantly less likely to have a major-bleeding event compared to those prescribed rivaroxaban or warfarin and had significantly lower medical costs.

Virtual Diabetes Prevention Program—Effects on Medicare Advantage Health Care Costs and Utilization

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 45-LB
Author(s):  
VINAY CHIGULURI ◽  
DOUGLAS BARTHOLD ◽  
RAJIV GUMPINA ◽  
CYNTHIA CASTRO SWEET ◽  
JASON PIERATT ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Prevention Program ◽  
Diabetes Prevention ◽  
Diabetes Prevention Program ◽  
Medicare Advantage ◽  
Program Effects ◽  
Care Costs

scholarly journals Heterogeneity of health care costs among medicare advantage patients with type 1 diabetes

2014 ◽  
Vol 17 (3) ◽  
pp. A246
Author(s):  
G.S. Clore ◽  
S.L. Slabaugh ◽  
B.H. Curtis ◽  
H. Fu ◽  
D.P. Schuster
Keyword(s):  
Health Care ◽  
Type 1 Diabetes ◽  
Health Care Costs ◽  
Medicare Advantage ◽  
Care Costs

Treatment Persistence with Azacitdine (Vidaza) Is Associated with Lower Inpatient Hospitalization Costs Over Time

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4231-4231
Author(s):  
B. Douglas Smith ◽  
Dalia Mahmoud ◽  
Stacey Dacosta Byfield ◽  
Henry J Henk
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Medical Costs ◽  
Sensitivity Analyses ◽  
Bleeding Complications ◽  
Inpatient Hospitalization ◽  
Treatment Persistence ◽  
Hospitalization Costs ◽  
The Relationship ◽  
Care Costs

Abstract Abstract 4231 Background: In the US, understanding the costs associated with Myelodysplastic Syndromes (MDS) is challenging given that multiple channels including pharmacy, ambulatory, and inpatient hospitalization (IPH) settings make up the total expenses to manage patients. Recent studies suggest that MDS patients under active medical management experience fewer cytopenia-related medical problems compared to untreated, transfusion dependent (TD) patients who require more medical treatments, often for recurrent infections and bleeding complications. It is clear that persistence of drug therapy is essential to achieve optimal clinical responses for MDS patients and we sought to determine if continued therapy also optimized costs related to the disease. Aim: To evaluate the relationship between treatment persistence with AZA and health care costs encountered for patients with MDS. Methods: Commercial and Medicare Advantage enrollees with a diagnosis of high grade MDS (ICD-9, 238.73) who initiated AZA with pharmacy and medical benefits in the prior 6 months and who had a variable follow up period from initiation of AZA to disenrollment or end of study were identified in a US health plan claims database (1/1/2007-6/30/2010). The number of AZA “cycles” was calculated by dividing the total number of AZA administrations by 7 days, with a sensitivity analysis for 5 day administration, - commonly utilized in the “real-world”. Persistence was defined as the number of cycles of AZA. Eligible patientshad to have at least 2 AZA cycles. An independent analysis identified health care costs for the same patients during periods of transfusion-dependence (TD) - defined as periods in which they received 2 transfusions in an 8 week period and did not receive erythropoietin-stimulating agents (ESAs) or AZA. Average Per Patient Per Month (PPPM) costs were examined among patients with various lengths of TD periods, up to 1 year. Linear models were used to examine the relationship between persistence on AZA and PPPM health care costs. Healthcare costs included both payer and patient paid amounts under the medical and pharmacy benefit. Medical costs were further broken out into IPHs, ambulatory, and other costs captured. Several sensitivity analyses were performed to confirm the robustness of the results such as excluding patients with IPH prior to AZA initiation, and including patients with <2 cycles of AZA. Results: The baseline cost breakdown for MDS patients (n=225) who were transfusion dependent and not receiving treatment are outlined in Figure 1. Interestingly, the largest proportion of the medical costs for TD patients comes from IPHs. In fact, the PPPM IPH costs among TD periods account for approximately 65–75% of total health care costs - even at one year of their diagnosis. A similar analysis was done for patients completing at least 2 cycles of AZA (n = 100) which suggested that the proportion of cost related to IPHs was closer to 40%. This cohort averaged 6.3 cycles (median = 5) with 24% of patients completing at least 8 cycles. Importantly, completion of every additional AZA cycle (baseline 7day analysis) was found to be associated with, on average, a 6% decrease in medical care costs (p=0.005) driven largely by an 18% decrease in IPH costs (p<0.001; Figure 2) due to fewer medical events. Even a single additional AZA cycle was found to be associated with 5% lower total health care cost (p=0.006). These results also hold in the sensitivity analyses. As expected, an examination of medical needs of both TD and AZA treated patients led infections as a frequent driver of IPHs. Conclusions: Patients who persist with AZA therapy have lower PPPM medical costs, driven by decreased expenditures on IPHs. This is consistent with results identified in the AZA-001 clinical trial in which patients receiving AZA experienced reduced IPHs driven by less transfusions and need for IV antibiotics, antifungals, and antivirals. These lower overall costs offset the expected increase in continuing therapy based on the cost of drug alone. Improving duration of therapy of AZA may not only optimize clinical outcomes but may decrease cumulative costs of care among high risk MDS patients. Disclosures: Smith: Celgene: Consultancy. Mahmoud:celgene: Employment. Dacosta Byfield:Celgene: Consultancy. Henk:Celgene: Consultancy.

Relationship between compliance with imatinib mesylate and medical costs for patients with CML and GIST

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6618-6618
Author(s):  
R. Halpern ◽  
V. Barghout ◽  
D. Williams
Keyword(s):  
Health Care ◽  
Imatinib Mesylate ◽  
Health Care Costs ◽  
Kinase Inhibitor ◽  
Medication Possession Ratio ◽  
Medical Costs ◽  
Poor Compliance ◽  
Good Compliance ◽  
Care Costs

6618 Background: Imatinib mesylate, an oral tyrosine kinase inhibitor for treatment of chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST), has been found both effective and cost-effective. This study examines the relationship between imatinib compliance and health care costs for patients (pts) with CML and GIST. Methods: This retrospective study used claims data from a large national US health plan. Pts had =2 imatinib claims from 6/1/01–3/31/05; =1-year follow-up after the 1st imatinib claim; and diagnosis of CML (ICD9 205.1x) or GIST (ICD9 159.0, 159.8, 159.9 or evaluation of claims and attribution of GIST by independent hematologist/oncologist). Compliance was measured with a medication possession ratio ((days of imatinib during follow-up / days of follow- up)*100). Compliance categories were good, =90%; medium, 70–89.9%; poor, <70%. Total follow-up medical and health care (medical + pharmacy) costs were measured and compared across compliance categories; t-tests compared mean costs. Results: 374 CML and 91 GIST pts had mean age of 52.1 ± 14.0 years. 274 (59%) pts were male. 234 (50%) of pts had 12–24 months follow-up; 231 (50%) had 25–57 months. Mean and median compliance across all pts were 69.4% and 79.7%, respectively. 122 (33%) CML and 32 (35%) GIST pts had good compliance; 149 (40%) CML and 42 (46%) GIST pts had poor compliance. Mean medical costs across all pts were lower and less variable with good compliance ($22,882 ± 22,791) than with medium ($40,366 ± 68,186), p=0.007) and poor ($104,961 ± 190,559), p<0.001). Similarly, mean medical costs for CML pts with good, medium, and poor compliance were $21,456 (±22,127), $41,537 (±72,238, p=0.008), and $117,004 (±211,292, p<0.001), respectively. Mean medical costs for GIST pts were: good=$28,318 (±24,781); medium=$33,270 (±35,356, p=0.584); and poor=$62,235 (±68,751, p<0.001). Mean total health care costs were 21.7% lower for pts with good compliance relative to those with poor. Conclusions: Good imatinib compliance was associated with significantly lower medical costs. Mean total medical costs were 78% lower with good compliance relative to poor. Compliance is an important treatment issue for both clinical and medical cost outcomes. No significant financial relationships to disclose.

What are the health care costs for chronic lymphocytic leukemia?

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 15-15 ◽  
Author(s):  
Matthew J. Matasar ◽  
Stacey DaCosta Byfield ◽  
Cori Blauer-Peterson ◽  
Melissa Montez ◽  
Carolina Reyes ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Lymphocytic Leukemia ◽  
Health Care Costs ◽  
Fixed Number ◽  
Lymphocytic Leukemia ◽  
New Drugs ◽  
Patient Treatment ◽  
Medicare Advantage ◽  
Care Costs

15 Background: New drugs for chronic lymphocytic leukemia (CLL) have recently been approved, including oral therapies. We examined total health care costs, including drug and patient out-of-pocket (OOP) costs, in patients (pts) initiating CLL treatment. Methods: This retrospective studyused a U.S. health insurance claims database. Adult commercially insured and Medicare Advantage pts from 5/2013 - 6/2015, with ≥2 medical claims for CLL were included. Pts required ≥1 claim for NCCN-recommended systemic cancer therapy. Pts were categorized based on first-line of therapy. Aggregate costs during a fixed 9-month follow-up period (treatment switch or discontinuation were possible) were investigated. Mean and standard deviation (SD) of total healthcare costs, regimen costs, and pt OOP regimen costs are presented. Results: A total of 707 CLL pts met all study criteria during the study period; 40% were commercially insured and 60% had Medicare Advantage. Mean age was 70 years (SD 11). Some of the most common regimens received included Bendamustine+Rituximab (BR) (N=186), Ibrutinib (Ibr) (N=101), Fludarabine, Cyclophosphamide, and Rituximab (FCR) (N=62), and Obinutuzumab +/- Chlorambucil (Ob+/-Chl) (N=51). Mean length of therapy varied by regimen; BR 4.2 months (m) (SD 2.7), Ibr 6.7m (SD 4.8), FCR 4.7m (SD 2.1), and Ob±Chl 4.0m (SD 2.1). The table shows aggregate costs among pts with ≥ 9 months follow-up. Ob±Chl had lower costs compared to other cohorts. Ibr had the highest drug costs. Conclusions: While the study has limited follow-up, Ob+/-Cl had the lowest drug and total costs. Oral therapy with Ibr had the highest drug and OOP costs compared to those associated with a prescribed fixed number of cycles. The magnitude of the difference between orals and infusions is expected to be greater with a longer follow-up and is a consideration in patient treatment decision-making in CLL.[Table: see text]

Abstract 14931: Low-Dose Prasugrel Has Prognostic Superiority to Clopidogrel in High-Bleeding Risk Patients Undergoing Contemporary Percutaneous Coronary Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Takuro Abe ◽  
Kentaro Jujo ◽  
Takehiro Hata ◽  
KAZUHO KAMISHIMA ◽  
Hiroshi Koganei ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Major Bleeding ◽  
Low Dose ◽  
Bleeding Event ◽  
Composite Endpoint ◽  
Bleeding Risk ◽  
Coronary Intervention ◽  
Major Bleeding Event ◽  
Percutaneous Coronary ◽  
High Bleeding Risk

Introduction: The combination of aspirin and P2Y12 receptor antagonist is the standard antiplatelet therapy after percutaneous coronary intervention (PCI). Previous trials reported that prasugrel reduced the risk of ischemic events, but increased bleeding events compared to clopidogrel. Hypothesis: The prognostic impact of low-dose prasugrel (3.75 mg/day), which the dose was determined by phase II trial, is different from that of clopidogrel, depending on patient’s bleeding risk. Methods: This study is a subanalysis from the TWINCRE registry that is a multicentral prospective cohort including patients who underwent PCI. We analyzed 1,001 patients who received the combination of aspirin and prasugrel or clopidogrel after PCI. The primary endpoint was a composite of major bleeding event and major adverse cardiovascular and cerebrovascular events (MACCE) including any death, acute coronary syndrome, stent thrombosis, stroke and heart failure hospitalization. Results: There were 490 patients with high bleeding risk (HBR) and 511 patients with low bleeding risk (LBR), based on ARC-HBR criteria. In HBR patients, the Low-dose prasugrel group had significantly lower rates of MACCE (Log-rank, p=0.003) and the composite endpoint than the Clopidogrel group (p=0.001). While, in LBR patients, there was no significant difference in rates of MACCE or the composite endpoint between the groups (p=0.76, p=0.15, respectively), and a higher rate of major bleeding event in the Low-dose prasugrel group (p=0.002). With Cox proportional hazards analysis, low-dose prasugrel has still retained the superiority to clopidogrel regarding with the composite endpoint in HBR patients, even after adjusting with diverse covariates (hazard ratio: 0.33, 95% confidence interval: 0.16-0.65). Conclusion: In the multicenter cohort study in Japan, low-dose prasugrel showed a long-term prognostic superiority to clopidogrel only in HBR patients undergoing contemporary PCI.

Abstract 124: The Effect of Renal Impairment on The Venous Thromboembolism Recurrence and Major Bleeding Risk and Total Health Care Costs in Patients With Acute Venous Thromboembolism

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Jennifer Cai ◽  
Jackie Kwong ◽  
Ron Preblick ◽  
Qiaoyi Zhang
Keyword(s):  
Health Care ◽  
Venous Thromboembolism ◽  
Renal Impairment ◽  
Health Care Costs ◽  
Anticoagulant Therapy ◽  
Major Bleeding ◽  
Index Date ◽  
Disease Stage ◽  
Care Costs

Background: Renal impairment could be a risk factor for venous thromboembolism (VTE) recurrence and anticoagulation related bleeding in VTE patients. The objective of this study was to assess the effect of renal impairment on the risk of VTE recurrence, major bleeding and total health care costs in patients with acute VTE. Methods: In this retrospective analysis of IMS PharMetrics Plus TM claims database, patients (≥18 years old) who had ≥ 1 inpatient or ≥ 2 outpatient VTE claims during January 2010-December 2013 (the index period) were identified. Patients who had continuous enrollment eligibility for at least 12 months before (baseline) and 12 months after (follow-up) the index date (first VTE claim) and had no VTE diagnosis and anticoagulant treatment during baseline period were included. Patients who required dialysis or had end stage renal disease were excluded. VTE patients with chronic kidney disease (stage I-IV or equivalent) during baseline based on ICD- 9 diagnosis codes were compared with those without renal impairment. Recurrent VTE was identified by inpatient or emergency department claims associated with VTE diagnosis after hospital discharge of the index VTE event or 7 days after index date for patients with index VTE events treated in the outpatient setting during the follow-up period. Major bleeding events were identified by inpatient claims with a bleeding diagnosis that occurred after an anticoagulant prescription fill among patients receiving anticoagulant therapy. Cox proportional hazards models adjusted for age, gender, index VTE type, health insurance type, outpatient anticoagulant therapy use, and baseline comorbidities was used to assess the risk of VTE recurrence and anticoagulation related major bleeding. Generalized linear model with gamma distribution and log link was used to evaluate the total health care costs (inclusive of medical and pharmacy costs) over the 1-year follow-up period adjusting for the same baseline characteristics. Results: Of 20,873 eligible VTE patients (median age 57 years; 50% female), 238 had diagnosed renal impairment. Compared with patients without renal impairment, patients with renal impairment had higher rates for VTE recurrence (24% vs. 18%; adjusted hazard ratio (HR) = 1.32, 95% CI 1.06-1.63, p<0.01), and post anticoagulation major bleeding (4% vs 1%; HR=1.75, 95% CI 1.01-3.03, p=0.046). Patients with renal impairment had higher adjusted mean total health care costs ($41,283 vs. $30,757, p<0.01) than patients without renal impairment. Conclusion: VTE patients with renal impairment had higher risk for VTE recurrence and major bleeding associated with anticoagulant therapy, resulting in increased utilization of health care resources than VTE patients without renal impairment. Sponsorship: This research was funded by Daiichi Sankyo Inc, Parsippany, NJ.

Persistence to Lenalidomide Improves Patient Outcomes While Remaining Cost-Neutral for the Treatment of Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4688-4688
Author(s):  
Henry J Henk ◽  
Satyin Kaura ◽  
Zeba M. Khan ◽  
April Teitelbaum
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Disease Control ◽  
Disease Progression ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Medicare Advantage ◽  
Pharmacy Benefit ◽  
The Relationship ◽  
Care Costs

Abstract Abstract 4688 Background: While persistence to drug therapy is essential to achieve optimal patient benefits, poorly controlled MM results in more rapid disease progression, disease-related complications, impact on quality of life, and premature death. Additionally, the cost of delivering medical care for myeloma patients is also an important consideration for society and payers. Aim: To evaluate the real-world persistence with lenalidomide treatment in MM patients, and assess the relationship between treatment persistence and (1) indicators of poor disease control and disease-related complications and (2) the total health care costs for patients with MM. Methods: Commercial and Medicare Advantage enrollees initiating LEN for treatment of MM with pharmacy and medical benefits in the 6 months prior and 1 year following initiation of LEN were identified in a US health plan claims database (7/1/2007–6/30/2011). MM was identified by at least 2 medical claims at least 7 days apart with a MM diagnosis code (ICD-9: 203.0x). Treatment discontinuation was defined as the first appearance of a gap greater than 30 days between runout date (prescription fill date + days supply) and next lenalidomide prescription fill. Persistence was defined as days from the first LEN treatment to the earlier of either the date of discontinuation or end of the follow-up period (i.e., 6/30/2011). Disease-related complications included sepsis, indictors of relapse or disease progression (defined as the addition of bortezomib (BORT) to a LEN regimen, a switch to BORT from a LEN regimen, or discontinuation of LEN followed by restarting LEN), sepsis, and evidence of skeletal-related events (SREs) defined as fracture, spinal cord compression, surgery and/or radiation to the bone. Total health care costs include combined payer and patient paid amounts under the medical benefit (e.g., hospital, office, ER) and retail pharmacy benefit (inclusive of specialty pharmacy). Multivariate regression-based models were used to examine the relationship between persistence and measures of disease control and complications, as well as the relationship between persistence and first-year health care costs controlling for age, gender, comorbidity score, prior stem cell transplant, prior SREs, and insurance type (commercial or Medicare Advantage). Results: Among the 605 patients meeting the inclusion criteria, persistency with lenalidomide averaged 6.0 months (median = 4.9) with 57.9% of patients being persistent for the entire year. A one month increase in persistence was associated with a lower probability of SREs (OR=0.96; p=0.078), sepsis (OR=0.86; p<0.001), and relapse or disease progression (OR=0.78; p<0.001). The probability of an inpatient hospitalization (OR=0.68; p-value<0.001) and additional ER visits (OR=0.83; p=0.002) were both lower with longer duration. When examining the relationship between persistence and health care costs, a one-month increase in persistence was found to be associated with, on average, a 8% decrease in medical care costs (p=0.007) and an 8% increase in pharmacy costs (p<0.001). Conclusions: Improved persistence with lenalidomide therapy was associated with improved patient outcomes as demonstrated by fewer SREs and lower likelihood of developing sepsis, consequently leading to cost saving due to fewer hospitalizations and ER visits. The reduction in medical costs offsets the expected increase in pharmacy costs as lenalidomide is covered under the pharmacy benefit. This analysis demonstrates that continuous treatment with lenalidomide can not only improve disease control in MM patients, but in addition also reduces health care utilization and related costs as indicated by the lower risk of a hospitalization and number of ER visits, and could therefore be budget neutral in terms of overall societal burden of health care costs associated with MM. * p<0.001; ** p=0.078. Disclosures: Henk: OptumInsight: Consultancy. Kaura:Celgene: Employment. Khan:Celgene: Employment.

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