Abstract MP76: Assessing the Impact of the "Health Bucks" Program on Cardiovascular Disease in New York City: A Modeling Study

Background: Low fruit and vegetable (FV) consumption is considered one of the leading causes of deteriorating health outcomes, and has been linked to obesity, diabetes, and cardiovascular disease. Yet, few adults in New York City (NYC) consume the daily recommended amounts. In order to address the need for fresh and affordable fruits and vegetables, the NYC Department of Health and Mental Hygiene has implemented the “Health Bucks” program, which provides low-income population with coupons that can be used to purchase fruits and vegetetabls. Previous studies have shown the impact of the Health Bucks program on fruit and vegetable consumption; however, it is unclear how the program would influence cardiovascular health and the associated health care costs in the long term. Objective: To estimate the health and economic impact of the Health Bucks program using a validated microsimulation model of cardiovascular disease (CVD) in NYC. Methods: We used the Simulations for Health Improvement and Equity (SHINE) CVD Model to estimate the impact of the Health Bucks program on lifetime CVD events and direct medical costs (2019 USD). We considered different program strengths by assuming the program can reduce the cost of fruits and vegetables by 20%, 30%, and 40%. Population characteristics were estimated based on data from the 2013-2014 NYC Health and Nutrition Examination Survey. CVD risk factor trajectories and risk of incident CVD events were derived from six pooled longitudinal US cohorts. Policy effects were derived from the literature. We run 1,000 simulations to account for uncertainties in the parameter. We discounted costs by 3% and reported health care costs in 2019 dollars. Results: A Health Bucks program that can reduce the cost of fruits and vegetables by 20%, 30%, and 40% would prevent 2,690 (95% CI: -14,793, 20,173), 27,386 (95% CI: 9,967, 44,805), and 50,014 (95% CI: 15,227, 50,014) coronary heart disease events, respectively, over the simulated lifetimes of the NYC population. The program would also prevent 47,469 (95% CI: 35,008, 59,931), 59,127 (95% CI: 46,676, 71,579), and 85,359 (95% CI: 72,902, 97,815) stroke events based on the price reduction level. The program would result in savings in health care costs, ranged from $937 million to $1.8 billion based on the price reduction level over the lifetime or from $19 million to $37 million annually. Conclusions: We projected that the Health Bucks program could prevent a significant number of CVD events among adults in NYC and yield substantial health care cost savings. Public health practitioners and policymakers may consider adopting this program in other locations.

Download Full-text

Abstract 7: Increasing Use of Cardiovascular Devices and Rising Health Care Costs

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.a7 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Peter W Groeneveld ◽

Andrew J Epstein ◽

Feifei Yang ◽

Lin Yang ◽

Daniel Polsky

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

Time Series ◽

Health Care Costs ◽

Technology Use ◽

Cost Of Care ◽

Cost Increase ◽

Total Growth ◽

The Cost ◽

Care Costs

Background: Drug-eluting stents (DES) and implantable cardioverter-defibrillators (ICDs) are among the most common, and most costly, interventional therapies used in patients with cardiovascular disease. Medicare coverage decisions for DES and ICDs in 2003-2005 portended a large growth in health care costs for patients with coronary artery disease (CAD) and chronic heart failure (CHF). However, the actual fiscal impact of DES and ICDs is uncertain. Methods: We examined Medicare claims from 2003-2006 and separately identified cohorts of patients between ages 65-84 in each year diagnosed with CAD and CHF. Patients were assigned to one of 306 contiguous geographic localities (i.e., Dartmouth Atlas Hospital Referral Regions [HRRs]). For each disease group in each locality in each year, we calculated the average cost of care (including Medicare payments, supplemental insurance, and patient payments) as well as the average use rate of DES (for CAD) and ICDs (for CHF). We estimated time-series HRR-fixed-effects regression models predicting average costs, with % technology use as an independent variable. We included a measure of the annual change in costs of care for non-cardiovascular disease in each HRR to control for annual cost increases unrelated to ICDs/DES. Results: Average inflation-adjusted costs for CAD patients increased from $13,558 in 2003 to $14,215 in 2006 (p<0.001), while average costs for CHF patients increased from $18,930 in 2003 to $20,235 in 2006 (p<0.001). Time-series regressions indicated that a 1% increase in DES use among the CAD population resulted in $394 in higher mean costs (p<0.001), and 1% increased ICD use in the CHF population resulted in $627 in higher mean costs (p<0.001). In aggregate, between 2003-2006 the cost increase attributable to DES in the Medicare CAD population ages 65-84 was $4.97 billion (89% of total growth), and the cost increase in the Medicare CHF population attributable to ICDs was $893 million (29% of total growth). Conclusions: Rising use of DES and ICDs between 2003-2006 was associated with significantly higher costs for patients with CAD and CHF, respectively. Increased use of these technologies explained substantial fractions of the growth in health care costs for CAD and CHF patients during these years.

Download Full-text

383. Increased Need for Antimicrobial Stewardship during a COVID-19 Outbreak in New York City

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.578 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S261-S261

Author(s):

Maurice Policar ◽

Peter Barber ◽

Yesha Malik

Keyword(s):

Health Care ◽

New York ◽

New York City ◽

Antimicrobial Stewardship ◽

York City ◽

Antibiotic Usage ◽

Antimicrobial Use ◽

Time Period ◽

Number Of Patients ◽

The Impact

Abstract Background The impact of COVID-19 on the health care system in New York City (NYC) cannot be overstated. The first documented cases of COVID-19 in Queens NYC occurred in early March of 2020. The total number of patients with proven or suspected COVID-19 at Elmhurst Hospital peaked in early April. A dramatic increase in the use of antimicrobials occurred in April, and correlated with the increased number of intubated COVID-19 patients at Elmhurst Hospital. Methods Antimicrobial Stewardship Committee activities and meetings had been suspended for the months of March and April due to the increased clinical demands associated with the COVID-19 outbreak. In preparation for the May meeting, a retrospective analysis of antimicrobial use for March and April of 2020 was performed. Results The analysis revealed a 30% increase in the use of antimicrobials. The average total days of antimicrobials per 1000 patient days (TDA/TPD) was 445 for January through March of 2020. In April, this number climbed to 580. TDA/TPD increased from 57 to 90 (58%) for vancomycin, 25 to 35 (40%) for meropenem, and 31 to 89 (187%) for cefepime. The number of intervention by the Antibiotic Stewardship team remained low during this time period. Total Days of Antimicrobials per 1000 Patient Days (TDA/TPD) Conclusion A dramatic increase in the use of antimicrobials correlated with an increase in the number of intubated patients at Elmhurst Hospital during a COVID-19 outbreak. It is likely that the frequent appearance of fever and leukocytosis in intubated patients with COVID-19 prompted an increase in empiric antimicrobial use. The 48 hour time outs and prospective review of antimicrobial use may be necessary to maintain stewardship efforts during the COVID-19 epidemic. Further review of antibiotic usage in critically ill COVID-19 patients is needed to help define stewardship practices as we go forward in this pandemic. Disclosures All Authors: No reported disclosures

Download Full-text

Abstract P265: Trends In Cardiovascular Disease Risk Factors Among Older Adults (65+ Years) In New York City

Circulation ◽

10.1161/circ.141.suppl_1.p265 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Rienna Russo ◽

Yan Li ◽

Simona Kwon ◽

Chau Trinh-Shevrin ◽

Stella S Yi

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Older Adults ◽

New York ◽

New York City ◽

Older Adult ◽

York City ◽

Fruits And Vegetables ◽

Adult Population ◽

Older Adult Population

Introduction: There was a 19% increase in the older adult population ages 65 and older in New York City (NYC) between 2005 and 2015, which now comprises about 1.13 million people. Cardiovascular disease (CVD) is the leading cause of death among this older adult population. Dietary modification has been linked to improved CVD outcomes in older adults, demonstrating that prevention efforts are still effective in older age. Over the past decade, NYC has led numerous initiatives to improve dietary and physical activity behaviors. Little is known about the impact of these policies on CVD health and behavioral risk factors among older adults. Hypothesis: We anticipate that cardiovascular disease risk factors (fruit and vegetable intake; sugar-sweetened beverage (SSB) intake; exercise; diabetes; cholesterol; and hypertension) will have remained stagnant over an eight year period, from 2009 to 2017, as older adults remain a largely under-reached population. Methods: The New York City Community Health Survey (CHS) is an annual cross-sectional survey among NYC residents. A trend analysis was conducted using data from 2009 to 2017. Adults aged 65 years and older were included in the analysis (n= 20,771). Annual estimates of the percentage of persons with select CVD risk factors were calculated. Linear regression was used to measure changes over time; binary variables were scaled as 0 to 100 to represent percentages. Nonlinearity assessments were conducted and segmented regression models were used when appropriate. All analyses were conducted in SUDAAN v.11.0.3, using appropriate sample weights incorporating the complex survey design. Results: In 2017, over one-quarter (27.3%; 703/2,576) of older adults were diagnosed with diabetes, and almost two-thirds (64.8%; 1,664 /2,568) were diagnosed with hypertension. Only 10.4% (257/2,475) of older adults consumed 5 or more servings of fruits and vegetables and 17.3% (440/2,548) consumed at least one serving of SSB per day. From 2009-2017, there was an increase in the prevalence of diabetes among older adults (Average Percent Change [APC] 0.68; p<0.0001). There were decreases in the percentages of older adults consuming five or more servings of fruits and vegetables (APC -0.30; p=0.007) and one or more SSB across the years (APC -0.38; p=0.010). From 2010-2014, there was a decrease in the prevalence of older adults with high cholesterol (APC -1.06; p=0.047). There were no significant changes in hypertension or exercise rates over time. Conclusion: Decreases in SSB consumption and cholesterol indicate that some prevention efforts may have reached the older adult population. Despite these successes, more older adults suffer from diabetes and hypertension and fewer consume the recommended five servings of fruits and vegetables. In conclusion, more targeted policies and programs are needed to address CVD risks among older adults, as this population continues to grow.

Download Full-text

Reflections on the Cost Consequences of the New Gene Technology for Health Policy

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462300008151 ◽

1994 ◽

Vol 10 (4) ◽

pp. 546-561 ◽

Cited By ~ 4

Author(s):

Pauline Vaillancourt Rosenau

Keyword(s):

Health Care ◽

Health Care Costs ◽

Subjective Assessment ◽

Genetically Engineered ◽

Gene Technology ◽

Short Term ◽

New Gene ◽

The Cost ◽

The Impact ◽

Care Costs

AbstractThis article presents a preliminary and necessarily tentative and subjective assessment of the impact of new gene technology on health care costs. In the short term, diagnosis and treatment of genetic disease are likely to increase costs. Treatment with nongene therapy will continue to be far less expensive than gene therapy where it is available. Research developments to monitor as indicators of forthcoming cost reductions in genetic therapy are set forth. Some forms of genetic screening may soon reduce health care costs, and an example is provided. Genetically engineered Pharmaceuticals are described and their impact on costs reviewed. Conditions under which they are likely to reduce health care costs are indicated.

Download Full-text

Abstract P206: Modeling The Impact Of The Tobacco 21 Policy In El Paso, Texas

Circulation ◽

10.1161/circ.143.suppl_1.p206 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Sonya S Panjwani ◽

Yan Li ◽

Whitney R Garney

Keyword(s):

Cardiovascular Disease ◽

Health Care ◽

Health Care Costs ◽

National Health ◽

Smoking Prevalence ◽

El Paso ◽

Population Characteristics ◽

The Us ◽

The Impact ◽

Care Costs

Introduction: On December 20, 2019, the federal Tobacco 21 (T21) law was passed. This new legislation raised the minimum legal purchase age for tobacco products from 18 to 21 years. Thirty-three states in the US have implemented the law, but 19 states have yet to enact it. Public health practitioners and policymakers need more evidence on the impact of the T21 Policy at the local level to encourage adequate enforcement. Objective: To project the health and economic impact of the T21 Policy in El Paso, Texas, which is the focus area of the Heart Racial and Ethnic Approaches to Community Health (REACH) Program implemented by the American Heart Association. Methods: Using an agent-based model of smoking behavior and a microsimulation model of cardiovascular disease, we projected the long-term effects of the T21 Policy on smoking prevalence and cardiovascular health outcomes in El Paso, Texas. Population characteristics and model parameters were estimated based on data from the National Health Interview Survey, US Life Tables, and the National Health and Nutrition Examination Survey. Annual smoking prevalence was derived from the Texas Behavioral Risk Factor Surveillance System and County Health Rankings. The policy effects were determined from established effect sizes from published literature. Results: The estimated prevalence of smoking in El Paso, Texas decreased by 2.7% among 18-24 year olds and by 5.2% among 25-44 year olds in 20 years with the implementation of the T21 policy; these results are statistically significant (p<0.01 for both population groups). Our results also revealed that the T21 Policy could prevent cardiovascular disease such as coronary heart disease (CHD) and stroke. Specifically, compared to the no-policy situation, the policy would prevent 5.4 CHD events (from 305.2 to 299.8) per 1,000 adults and 10.8 stroke events (from 232.6 to 221.8) per 1,000 adults over lifetime. The model also projected a reduction in health care costs due to the T21 Policy, as the estimated lifetime health care costs decreased from $425,672 per person without the T21 Policy to $423,376 per person with the policy. Conclusions: This study provides important information for policymakers to understand the potential impacts of the T21 Policy in El Paso, Texas. The projected decreases in tobacco use, cardiovascular disease, and health care costs as a result of the T21 Policy could assist in advocating for T21 Policy enactment in other areas of the US.

Download Full-text

Does New Technology Increase or Decrease Health Care Costs? The Treatment of Peptic Ulceration

Journal of Health Services Research & Policy ◽

10.1177/135581969800300407 ◽

1998 ◽

Vol 3 (4) ◽

pp. 215-218 ◽

Cited By ~ 3

Author(s):

Shaun Murphy

Keyword(s):

Health Care ◽

Health Care Costs ◽

New Technology ◽

Peptic Ulceration ◽

Peptic Ulcers ◽

Cost Of Treatment ◽

The Cost ◽

The Impact ◽

Care Costs ◽

Formal Health Care

Objectives: To determine whether new technology increases or decreases formal health care costs, with reference to the diagnosis and treatment of peptic ulcers. Methods: A costing method has been devised which is designed to investigate directly the way in which the costs to formal health services of diagnosing and treating an individual illness have changed with changes in technology. Results: The cost of diagnosis has increased almost entirely as a result of the high cost of endoscopy compared with X-ray examination. The introduction of H2-receptor antagonist drugs increased the cost of treatment compared with the earlier phases of surgical treatment. Subsequently, Helicobacter pylori eradication treatment has reduced the cost of treatment compared with all earlier phases of technology. Conclusions: A method has been devised that allows the impact of changes in medical technology on formal health care costs to be investigated for individual illnesses. In the treatment of peptic ulceration, the current technology, H. pylori eradication, has lower treatment costs than all previous technologies. The evidence from previous studies and this study is insufficient to support the assertion that new technology in general leads either to an increase or to a decrease in health care costs.

Download Full-text

Corporate Financial Statements And The Impact Of Health Care Costs Recognition

Journal of Applied Business Research (JABR) ◽

10.19030/jabr.v7i3.6226 ◽

2011 ◽

Vol 7 (3) ◽

pp. 45 ◽

Cited By ~ 1

Author(s):

V. Gopalakrishnan ◽

Timothy F. Sugrue

Keyword(s):

Health Care ◽

Health Care Costs ◽

Financial Statements ◽

Economic Consequences ◽

Financial Ratios ◽

Accrual Basis ◽

The Cost ◽

The Impact ◽

Care Costs

This paper empirically analyzes the economic consequences of a forthcoming rule on accounting for post-retirement obligations. This rule calls for the recognition of health care liabilities on the employers financial statements and prescribes that the cost associated with these obligations be accounted for on the accrual basis. Based on a sample of 103 firms, this study reports that compliance with this rule could have a dramatic impact on firms equity, leverage, income and key financial ratios.

Download Full-text