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

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.

Consumer Cost-Sharing as a Means to Reduce Health Care Costs

PEDIATRICS ◽  
1980 ◽  
Vol 65 (1) ◽  
pp. 168-170
Author(s):  
Stephen M. Davidson ◽  
John P. Connelly ◽  
R. Don Blim ◽  
James E. Strain ◽  
H. Doyl Taylor
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Cost Sharing ◽  
Cost Of Care ◽  
National Commission ◽  
Insurance Policies ◽  
National Medical ◽  
Use Of Services ◽  
The Cost ◽  
Care Costs

The National Commission on the Cost of Medical Care1 states in part (Recommendation 2) that "insurance policies should include provisions through which the consumer shares in the cost of care received, at the time of service, for selected benefits and for selected groups...." These cost-sharing provisions are expected to reduce national medical care expenditures by encouraging consumers to reduce their use of services in order to avoid paying additional money out of their own pockets. They will thus moderate the demand-inducing tendency of insurance, leading the rational consumer to seek only necessary services and to forego those services contributing to what is believed to be over-utilization. As the Commission states in its supporting statement:

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

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Heesun Eom ◽  
Stella S Yi ◽  
Daniel Bu ◽  
Rienna Russo ◽  
Brandon Bellows ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Health Care ◽  
New York ◽  
New York City ◽  
Health Care Costs ◽  
York City ◽  
Fruits And Vegetables ◽  
The Cost ◽  
The Impact ◽  
Care Costs

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.

A Preoperative Grading Scale that Predicts Two-Year Health Care Costs Following Revision Lumbar Fusion Procedures: How We Can Improve the Cost of Care We Provide

2012 ◽  
Vol 12 (9) ◽  
pp. S103-S104
Author(s):  
Scott L. Parker ◽  
Saniya S. Godil ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Clinton J. Devin ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Lumbar Fusion ◽  
Cost Of Care ◽  
Grading Scale ◽  
The Cost ◽  
Care Costs

scholarly journals THU0548 THE ECONOMIC BURDEN OF ANKYLOSING SPONDYLITIS IN SPAIN. RESULTS OF THE SPANISH ATLAS 2017

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 514.2-514
Author(s):  
M. Merino ◽  
O. Braçe ◽  
A. González ◽  
Á. Hidalgo-Vega ◽  
M. Garrido-Cumbrera ◽  
...  
Keyword(s):  
Health Care ◽  
Ankylosing Spondylitis ◽  
Health Care Costs ◽  
Health Care Cost ◽  
Labour Productivity ◽  
General Health Questionnaire ◽  
Indirect Costs ◽  
Productivity Losses ◽  
The Cost ◽  
Care Costs

Background:Ankylosing Spondylitis (AS) is a disease associated with a high number of comorbidities, chronic pain, functional disability, and resource consumption.Objectives:This study aimed to estimate the burden of disease for patients diagnosed with AS in Spain.Methods:Data from 578 unselected patients with AS were collected in 2016 for the Spanish Atlas of Axial Spondyloarthritis via an online survey. The estimated costs were: Direct Health Care Costs (borne by the National Health System, NHS) and Direct Non-Health Care Costs (borne by patients) were estimated with the bottom-up method, multiplying the resource consumption by the unit price of each resource. Indirect Costs (labour productivity losses) were estimated using the human capital method. Costs were compared between levels of disease activity using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score (<4 or low inflammation versus ≥4 or high inflammation) and risk of mental distress using the 12-item General Health Questionnaire (GHQ-12) score (<3 or low risk versus ≥3 or high risk).Results:The average annual cost per patient with AS in 2015 amounted to €11,462.3 (± 13,745.5) per patient. Direct Health Care Cost meant an annual average of €6,999.8 (± 9,216.8) per patient, to which an annual average of €611.3 (± 1,276.5) per patient associated with Direct Non-Health Care Cost borne by patients must be added. Pharmacological treatment accounted for the largest percentage of the costs borne by the NHS (64.6%), while for patients most of the cost was attributed to rehabilitative therapies and/or physical activity (91%). The average annual Indirect Costs derived from labour productivity losses were €3,851.2 (± 8,484.0) per patient, mainly associated to absenteeism. All categories showed statistically significant differences (p<0.05) between BASDAI groups (<4 vs ≥4) except for the Direct Non-Healthcare Cost, showing a progressive rise in cost from low to high inflammation. Regarding the 12-item General Health Questionnaire (GHQ-12), all categories showed statistically significant differences between GHQ-12 (<3 vs ≥3), with higher costs associated with higher risk of poor mental health (Table 1).Table 1.Average annual costs per patient according to BASDAI and GHQ-12 groups (in Euros, 2015)NDirect Health CostsDirect Non-Health CostsIndirect CostsTotal CostBASDAI<4917,592.0*557.32,426.5*10,575.8*≥43769,706.9*768.05,104.8*15,579.7*Psychological distress (GHQ-12)<31468,146.8*493.6*3,927.2*12,567.6*≥32609,772.9*807.2*4,512.3*15,092.5*Total5786,999.8611.33,851.211,462.3* p <0.05Conclusion:Direct Health Care Costs, and those attributed to pharmacological treatment in particular, accounted for the largest component of the cost associated with AS. However, a significant proportion of the overall costs can be further attributed to labour productivity losses.Acknowledgments:Funded by Novartis Farmacéutica S.A.Disclosure of Interests:María Merino: None declared, Olta Braçe: None declared, Almudena González: None declared, Álvaro Hidalgo-Vega: None declared, Marco Garrido-Cumbrera: None declared, Jordi Gratacos-Masmitja Grant/research support from: a grant from Pfizzer to study implementation of multidisciplinary units to manage PSA in SPAIN, Consultant of: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly, Speakers bureau: Pfizzer, MSD, ABBVIE, Janssen, Amgen, BMS, Novartis, Lilly

What's Cheaper Than Pediatric Care?

PEDIATRICS ◽  
1976 ◽  
Vol 58 (5) ◽  
pp. 772-772
Author(s):  
Richard M. Narkewicz
Keyword(s):  
Health Care ◽  
Child Care ◽  
Health Care Costs ◽  
Pediatric Care ◽  
Continuing Care ◽  
Well Child Care ◽  
Fee Structure ◽  
The Cost ◽  
Care Costs

In these days of rising health care costs, the finger has been pointed at physicians as the cause of these increases. Because of these charges each physician should look critically at his own fee structure and try to compare it with other commodities in today's budgets. I have done just that. In totaling the cost of complete well-child care for a child and continuing care through the age of 20 years, I was surprised to find that in the present fee structure it costs a family $464.25.

scholarly journals The effect of bariatric surgery on health care costs: A synthetic control approach using Bayesian structural time series

2019 ◽  
Vol 28 (11) ◽  
pp. 1293-1307
Author(s):  
Christoph F. Kurz ◽  
Martin Rehm ◽  
Rolf Holle ◽  
Christina Teuner ◽  
Michael Laxy ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Health Care ◽  
Time Series ◽  
Health Care Costs ◽  
Synthetic Control ◽  
Control Approach ◽  
Structural Time Series ◽  
Structural Time ◽  
Care Costs

scholarly journals Health Care Costs by Type of Expenditure across eGFR Stages among Patients with and without Diabetes, Cardiovascular Disease, and Heart Failure

2020 ◽  
Vol 31 (7) ◽  
pp. 1594-1601 ◽  
Author(s):  
Gregory A. Nichols ◽  
Anastasia Ustyugova ◽  
Anouk Déruaz-Luyet ◽  
Maureen O’Keeffe-Rosetti ◽  
Kimberly G. Brodovicz
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Kidney Function ◽  
Health Care Costs ◽  
Large Contribution ◽  
Integrated Delivery System ◽  
Comorbidity Burden ◽  
Care Costs

BackgroundCKD is associated with higher health care costs that increase with disease progression. However, research is lacking on the type of health care costs associated with CKD across all stages in a general population with a substantial comorbidity burden.MethodsUsing electronic medical records of an integrated delivery system, we evaluated health care costs by expenditure type in general and in patients with CKD by eGFR and presence of comorbidities. We categorized 146,132 patients with eGFR data in 2016 or 2017 and examined nonmutually exclusive groups according to presence of diabetes mellitus, cardiovascular disease, or heart failure. We used 1 year of follow-up data to calculate outpatient, inpatient, emergency, pharmaceutical, dialysis, and total health care costs by eGFR (Kidney Disease Improving Global Outcomes–defined eGFR categories), adjusted for age, sex, and nonwhite race.ResultsMean total health care costs among patients with CKD without comorbidities were 31% higher than among patients without CKD ($7374 versus $5631, respectively). Hospitalizations accounted for 35% of total costs among those with CKD and no comorbidities but up to 55% among patients with CKD and heart failure. The proportion of costs attributable to hospitalizations accelerated with declining kidney function, reaching as high as 66%.ConclusionsPoorer kidney function and the presence of diabetes mellitus, cardiovascular disease, or heart failure drive substantial health care costs and increase the proportion of costs attributable to inpatient care. The large contribution of inpatient costs begins in earlier stages of CKD and escalates as kidney function declines. Additional therapies to reduce CKD incidence, slow CKD progression, and lower hospitalization risk are needed to benefit patients and reduce CKD’s economic burden.

Cost analysis of a randomized trial of early palliative care (PC) in patients with metastatic non-small cell lung cancer (NSCLC).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 4-4 ◽  
Author(s):  
Joseph A. Greer ◽  
Angela Tramontano ◽  
Pamela M McMahon ◽  
Areej El-Jawahri ◽  
Ravi Bharat Parikh ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Health Care Costs ◽  
Standard Care ◽  
Secondary Analysis ◽  
Cost Of Care ◽  
Average Total Cost ◽  
Total Cost ◽  
Metastatic Nsclc ◽  
Care Costs

4 Background: Several randomized, controlled trials have shown that early, integrated palliative and oncology care improves quality of life, mood, and symptom burden in patients with advanced cancers. However, the degree to which early involvement of specialty PC in the ambulatory care setting impacts the cost of care remains unknown. We investigated the health care costs for patients with metastatic NSCLC enrolled in a clinical trial of early PC. Methods: For this secondary analysis, we examined data from a randomized trial of 151 patients with newly-diagnosed metastatic NSCLC from 06/2006 to 07/2009. Patients received either early PC integrated with standard care or standard care (SC) alone. We abstracted costs for emergency and inpatient care, outpatient visits, intravenous chemotherapy, and physician services from the hospital’s accounting system. Oral chemotherapy costs were estimated based on actual drug charges for patients. To estimate hospice costs, we used Medicare reimbursement rates. For each participant, we calculated the average total cost of care per day for the entire study period as well as the total cost of care for the final 30 days prior to death. Costs differences between groups were examined with the Wilcoxon Rank-Sum Test. Results: We analyzed health care costs of the 138 patients who died by 07/15/2013 (early PC N=68; SC N=70). The mean number of days on study was longer for patients assigned to early PC (M=397, SD=360) versus SC (M=299, SD=266). Over the study period, early PC was associated with a lower average total cost per day of $117 (SD=$436) compared to SC (p=.09). In the final 30 days of life, patients in the early PC group incurred higher total costs for hospice care (Mean difference=$1,053, SD=$3,162, p=.11), while expenses for chemotherapy were less (Mean difference=$757, SD=$2,143, p=.06). No cost differences between groups met the threshold for statistical significance. Conclusions: Although this secondary analysis was inconclusive due to the lack of statistical power to examine differences in cost outcomes, the delivery of early PC for patients with metastatic NSCLC does not appear to increase health care expenses over the course of disease or at the end of life. Clinical trial information: NCT01038271.

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