The Economic Burden of Pleural Effusions (PE) In Patients with Chronic Myeloid Leukemia (CML).

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3841-3841
Author(s):  
Eric Qiong Wu ◽  
Annie Guerin ◽  
Vamsi Bollu ◽  
Denise Williams ◽  
Amy Guo ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Medical Cost ◽  
Economic Burden ◽  
Regression Models ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Total Medical Cost ◽  
Employment Equity ◽  
Equity Ownership

Abstract Abstract 3841 Background: Ph+ CML patients may develop PE, as an adverse event of some tyrosine kinase inhibitors (TKI) drug therapy. PE is characterized by an excessive accumulation of fluid in the fluid-filled space that surrounds the lungs. PE requires medical care, may compromise the course of CML treatment, and have economic consequence beyond the costs of treating PE. Aim: To compare healthcare resource utilization and costs between CML patients treated with a TKI who developed PE and their matched PE-free controls. Methods: MarketScan and Ingenix Impact databases (2001-2009) were combined to identify adult CML patients (ICD-9CM code 205.1×) who received ≥1 prescription of imatinib, dasatinib, or nilotinib before the index date and had continuous enrollment ≥6 months prior to and after the index date. The index date was defined as 30 days before the first PE diagnosis (ICD-9CM code 511.9×) for patients with PE and was randomly selected among all the eligible calendar dates (i.e., following a prescription for a TKI and a diagnosis for CML) for the PE-free controls. Patients were followed for 6 months after the index date. PE and PE-free patients were matched on a 1:1 ratio using propensity score matching. PE-related (i.e., medical claims with a PE diagnosis) resource utilization (inpatient [IP], outpatient [OP], emergency room [ER] and other medical visits) and costs were estimated for PE patients. To estimate the overall incremental impact of PE, all-cause and CML-related (i.e., medical services associated with a diagnosis code of 205.1×) resource utilization and costs were compared between PE and PE-free controls. All costs were reported in 2009 US dollars. Incidence rate ratios (IRR) for healthcare resource utilization were estimated by Poisson regression models. Incremental costs were estimated using generalized linear models or two-part models. Multivariate regression models controlled for age, gender, treatment duration with tyrosine kinase inhibitor, other chemotherapy, bone marrow or stem cell transplant, CML complexity, Charlson comorbidity index, adverse events, and comorbidities. Results: The study included 179 matched pairs. On average, patients were 63.4 and 63.8 years old with 41% and 49% of the population being female for PE-free and PE patients, respectively. During the study period, PE patients were estimated to have an average of 0.62 PE-related IP admissions, 8.43 IP days, 0.06 ER admissions, and 1.76 OP visits. Compared to PE-free patients, PE patients had more than 7 times as many IP days (IRR=7.23; p<.01), almost 3 times as many IP admissions (IRR=2.96; p<0.01), almost twice as many OP visits (IRR=1.98; p<.01) and ER visits (IRR=1.77; p<.01). Especially, PE patients had almost 10 times as many CML-related IP days (IRR=9.91; p<.01), more than 3 times as many CML-related IP admissions (IRR=3.95; p<0.01), twice as many CML-related OP visits (IRR=2.16; p<.01), and almost 6 times as many CML-related ER visits (IRR=5.60; p<.01). On average, PE-related medical costs were estimated at $11,015 per patient, where 84.2% was accounted for by IP costs. Total costs for all-cause related medical services were estimated at $37,566 for PE patients and $14,841 for PE-free patients. After adjusting for confounding factors, the incremental total medical cost of PE patients was $22,299 (p<.01), mostly due to the incremental OP cost ($12,931; p<.01) and IP cost ($8,737; p<.01). Similarly, PE patients incurred higher CML-related medical costs compared to PE-free patients, with a $15,859 (p<.01) incremental cost. Conclusion: Compared to PE-free patients, PE patients have a substantial economic burden with higher PE-related costs, CML-related costs, and total medical cost. Disclosures: Wu: Analysis Group, Inc.: Employment. Guerin:Analysis Group, Inc.: Employment. Bollu:Novartis: Employment, Equity Ownership. Williams:Novartis: Employment, Equity Ownership. Guo:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Ponce de Leon Barido:Analysis Group, Inc.: Employment. Yu:Analysis Group, Inc.: Employment.

The Economic Burden of Short-Term Adverse Events Associated with the CHOP Chemotherapy Regimen in Patients with Lymphoproliferative Disorders in the United States: A Comprehensive Literature Review

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5826-5826
Author(s):  
Crystal Watson ◽  
Arie Barlev ◽  
Jodie Worrall ◽  
Steve Duff ◽  
Rachel Beckerman
Keyword(s):  
Adverse Events ◽  
Resource Utilization ◽  
Economic Burden ◽  
Healthcare Resource ◽  
The United States ◽  
Healthcare Resource Utilization ◽  
Short Term ◽  
Employment Equity ◽  
Comprehensive Literature Review ◽  
Equity Ownership

Objectives: CHOP (vincristine, cyclophosphamide, prednisone, doxorubicin) is a treatment option for post-transplant lymphoproliferative disorder (PTLD) following solid organ transplant, an aggressive and potentially fatal disease. The most common and impactful CHOP-related adverse events (AEs) are febrile neutropenia (FN), chemotherapy-induced (CI) peripheral neuropathy (PN), infection, CI-anemia (A), and CI-nausea and vomiting (NV). These CHOP-related AEs have a large humanistic burdensignificant impact to quality of life (QoL) of patients, especially shortly after treatment. The evidence for a positive QoL benefit associated with some AE treatments (e.g., erythropoietin stimulating agents [ESA], granulocyte colony stimulating factors) is inconsistent and many patients likely remain with QoL deficits even after treatment. The impact of these short-term CHOP-related AEs is likely to be accompanied by an increase in healthcare resource utilization and costs. The objective of this study was to explore the economic burden of short-term CHOP-associated AEs in PTLD patients. Since PTLD is a rare disease with limited available data, we expanded our search to include all patients with lymphoproliferative disorders (LPD). Methods: Short-term (within several months after treatment) AEs associated with CHOP with an incidence of >4% in patients with LPDs were determined and sourced from the published literature and cancer websites. A comprehensive literature search was conducted using PubMed and EMBASE to identify economic burden studies published from 2010 to 2018 of the AEs associated with CHOP and its components in the United States (US). Studies incorporating rituximab alongside CHOP (CHOP + R) were also included as this is a valid treatment option for PTLD patients. Economic burden was defined as the management costs and resource utilization associated with treating CHOP-emergent adverse events. The conduct of this comprehensive literature review was guided by the PRISMA protocol wherein the research question (using the PICOS format), search strategy, target short-term AEs, and inclusion and exclusion criteria were pre-specified in detail. Results: Overall, 3,946 non-duplicate citations were screened, 39 studies were included for abstraction and no studies included patients with PTLD. Studies were methodologically heterogenous, with approximately half (56%) based on some form of retrospective analysis or prospective observational study. FN was the AE most commonly encountered, followed by CIA, infection, CI-nausea and vomiting, and CIPN. FN was an important driver of hospitalization (proportion of FN patients with hospitalization was up to 83.2%) and extended length of stay (LOS) was substantial for several AEs (LOS range in days: infection, 8.4-23.6; FN, 7.9-19.7). Mean LOS was longer in FN patients with multiple hospitalizations as well as in FN patients with comorbidities. Rates of transfusion in CI-anemia patients varied dramatically, from 10.8% to 47.4%. Transfusion rates were attenuated by ESA use in LPD patients, although a significant proportion of anemic cancer patients receiving ESAs still required transfusions. Total management costs were highly variable, ranging from nominal for events such as CIPN to over $197,000 in hospitalization costs per infection discharge per patients complicated with clostridium difficile. One recent study showed the inpatient costs attributable to FN were $33,006 per patient per episode. Studies identified CINV as a top reason for unplanned service use, but no studies were identified assessing its economic impact in LPD patients. Outpatient care costs for each AE varied but tended to have a low to moderate economic impact. The costs attributable to several AEs (FN, infection) were highest in the first cycle of chemotherapy. Conclusions: Several common short-term AEs due to CHOP in the LPD population were associated with substantial healthcare resource utilization and costs that were primarily driven by increased hospitalization and length of inpatient stays. Costs for FN and infections associated with CHOP ranged from $33,000 to over $197,000, demonstrating the high economic burden to the US healthcare system. No PTLD-specific studies were found, highlighting the absence of published data addressing the economic burden associated with chemotherapy in PTLD patients and the need for effective and tolerable therapies. Disclosures Watson: Atara Biotherapeutics: Employment, Equity Ownership. Barlev:Atara Biotherapeutics: Employment, Equity Ownership. Worrall:Atara Biotherapeutics, Inc: Consultancy. Duff:Atara Biotherapeutics, Inc: Consultancy. Beckerman:Atara Biotherapeutics, Inc: Consultancy.

scholarly journals TRANSCEND: Lisocabtagene Maraleucel (liso-cel; JCAR017) Healthcare Resource Utilization in Patients with Relapsed/Refractory Diffuse Large B-Cell Lymphoma (DLBCL)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3545-3545 ◽  
Author(s):  
M. Lia Palomba ◽  
Jacob Garcia ◽  
Lei Wang ◽  
Christine Dehner ◽  
Karen C. Chung ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Healthcare Resource ◽  
Outpatient Setting ◽  
Healthcare Resource Utilization ◽  
Inpatient Setting ◽  
Employment Equity ◽  
Car T ◽  
Equity Ownership ◽  
Hospital Days

Abstract Background: Relapsed/refractory (R/R) DLBCL is associated with high healthcare resource utilization (HRU) and cost (Danese 2017). Patients with R/R DLBCL have poor outcome with median OS <10 months (Van den Neste 2015). As transformative therapies are being developed for these patients, resource utilization may become an issue. Liso-cel is an investigational defined composition, CD19-directed 4-1BB CAR T cell product administered at a precise dose of CD8 and CD4 CAR T cells in a multicenter, seamless design Phase 1 pivotal trial of (R/R) DLBCL (TRANSCEND NHL 001; NCT02631044). In a recent analysis with 6 months follow-up, liso-cel treatment demonstrated a best overall response rate of 75% (55% CR) with low rates of severe cytokine release syndrome (1%) and neurologic events (13%) (Abramson 2018). The objective of this analysis is to characterize HRU, including site of care, associated with liso-cel in an interim analysis of the TRANSCEND pivotal trial. Methods: Eligible patients with R/R DLBCL, PMBCL, FL grade 3B, or MCL (≥18 years who received ≥2 lines of therapy) and adequate organ function (no minimum ALC requirement for apheresis) received lymphodepletion (LD) with fludarabine and cyclophosphamide, followed by a single flat-dose infusion of liso-cel at one of two dose levels (DL1, 5 × 107 cells; DL2, 1 × 108 cells). Clinical site of care for liso-cel infusion was not protocol-defined. HRU was collected at all sites. Results: 94 patients (91 patients in the efficacy database and 3 patients from the safety database that were not in the electronic clinical as of data cut) were included in the preliminary site of care analysis. 86 patients received liso-cel in the inpatient setting and 8 patients in the outpatient setting. Mean (SD) number of hospital days was 15.6 (9.6) and 9.3 (11.9) among patients receiving inpatient and outpatient liso-cel infusion, respectively, reflecting a 40% lower duration in mean hospital days. The median time to hospitalization following outpatient infusion was 5 days (range: 4-22). No patients infused in the outpatient setting required subsequent ICU care or received corticosteroids, and only one received tocilizumab for cytokine release syndrome (CRS). Of all treated patients in the efficacy database (n=91), 12% (11/91) of patients required ICU care for management of toxicity, including 10% (9/91) for CRS or neurotoxicity and 3% (3/91) for management of acute respiratory events. Rates of hemofiltration and ventilation for patients in this cohort were 2% (2/91) and 7% (6/91), respectively. Outcomes based on site of administration will be presented (based on longer follow-up). Conclusions: CAR T cell therapy represents an additional treatment option for patients with R/R DLBCL. Liso-cel has been infused in both the inpatient and outpatient setting. Outpatient infusion was associated with 40% lower mean hospital days compared with infusions administered in the inpatient setting. As enrollment is ongoing, updated data will be reported. Disclosures Palomba: Celgene: Consultancy; Pharmacyclics: Consultancy. Garcia:Juno Therapeutics, a fully owned subsidiary of Celgene: Employment, Equity Ownership. Wang:Juno Therapeutics, a fully owned subsidiary of Celgene: Employment, Equity Ownership. Dehner:Juno Therapeutics, a fully owned subsidiary of Celgene: Employment, Equity Ownership. Chung:Juno Therapeutics, a fully owned subsidiary of Celgene: Employment. Maloney:Janssen Scientific Affairs: Honoraria; GlaxoSmithKline: Research Funding; Seattle Genetics: Honoraria; Juno Therapeutics: Research Funding; Roche/Genentech: Honoraria.

scholarly journals VTE-Related Healthcare Resource Utilization and Costs Associated with Venous Thromboembolism in Cancer Patients Treated with Anticoagulants

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 3524-3524 ◽  
Author(s):  
Michael Streiff ◽  
Dejan Milentijevic ◽  
Keith R. McCrae ◽  
Jonathan Fortier ◽  
François Laliberté ◽  
...  
Keyword(s):  
Health Care ◽  
Cancer Patients ◽  
Resource Utilization ◽  
Research Funding ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Employment Equity ◽  
Outpatient Visits ◽  
Equity Ownership ◽  
Care Costs

Abstract Introduction: The standard of care for treatment of cancer-related venous thromboembolism (VTE) is a low molecular heparin (LMWH). In our previous claimsbased analysis, we showed that besides LMWH oral anticoagulants, warafrin and rivaroxaban are widely prescribed in clinical practice (Khorana, 2015). The objective of this study is to compare VTE-related healthcare resource utilization and costs of cancer patients treated with anticoagulant therapies. Methods: Medical and pharmacy claims from the Humana Database between 1/1/2013 and 05/31/2015 were analyzed. Newly diagnosed cancer patients with a first VTE diagnosis occurring after their first cancer diagnosis and with ≥1 dispensing of an anticoagulant agent within 7 days after their VTE diagnosis, were selected. Based on the first anticoagulant agent received, patients were classified into one of the following cohorts: LMWH, warfarin, and rivaroxaban. Inverse probability of treatment weights based on propensity score was used to adjust for differences between treatment cohorts. Baseline characteristics were evaluated during the 6 month period prior to the index VTE. VTE-related resource utilization and costs were identified with a primary or secondary diagnosis of deep vein thrombosis or pulmonary embolism and were evaluated for the entire follow up period, starting from the initiation of the anticoagulant therapy until the earliest either end of enrollment or end of data availability (05/31/2015). Resource utilization components included: number of hospitalizations, hospitalization days, emergency room (ER) visits, and outpatient visits. Comparisons between the different treatment cohorts were performed using rate ratios (RR) and statistical differences between groups as well as 95% confidence intervals [95% CI] were calculated using Poisson regression models. Healthcare costs were evaluated in per-patient-per-year (PPPY) and compared using mean cost difference. Results: A total of 2,428 patients (LMWH: n=660; warfarin; n=1,061; rivaroxaban: n=707) were included. Baseline demographic and clinical characteristics were well balanced across the treatment cohorts including hospitalizations, emergency room (ER) visits, and outpatient visits. Compared to patients treated with LMWH, patients treated with rivaroxaban had significantly fewer VTE-related hospitalizations, hospitalization days, ER visits, and outpatient visits (Figure 1). This resulted in significantly higher VTE-related health care cost difference of $12,000 for LMWH relative to rivaroxaban treatment cohort (Table 1). Patients treated with rivaroxaban had significantly lower VTE-related resource utilization compared to patients treated with warfarin (Figure 1). The total VTE-related costs were however similar between two cohorts (Table 1). The higher drug costs ($1,519) were offset by significantly lower outpatient (-$1,039) and hospitalization costs (-$522) in rivaroxaban relative to warfarin cohort. Conclusion: Healthcare resource use and costs associated with VTE treatment in cancer patients are the highest with LMWH relative to warfarin and rivaroxaban treatments. Healthcare resources use and costs are significantly higher in warfarin relative to rivaroxaban cohort but these resource costs were offset by higher drug costs of rivaroxaban. These results are in line with previous study in cancer patients that found fewer re-hospitalizations related to VTE recurrences in patients treated with rivaroxaban compared to patient treated with LMWH or warfarin (Streiff, 2016). Figure 1 VTE-Related Healthcare Resource Utilization Figure 1. VTE-Related Healthcare Resource Utilization Table VTE-Related Health Care Costs, PPPY Table. VTE-Related Health Care Costs, PPPY Disclosures Streiff: Roche: Research Funding; Portola: Research Funding; Janssen: Consultancy, Research Funding; CSL Behring: Consultancy, Research Funding. Milentijevic:Janssen Scientific Affairs: Employment, Equity Ownership. McCrae:Janssen: Membership on an entity's Board of Directors or advisory committees. Fortier:Janssen Pharmaceuticals: Research Funding. Laliberté:Janssen Scientific Affairs: Research Funding. Lefebvre:Janssen Scientific Affairs: Research Funding. Schein:Johnson & Johnson: Employment, Equity Ownership, Other: Own in excess of $10,000 of J&J stock. Khorana:Sanofi: Consultancy, Honoraria; Leo: Consultancy, Honoraria, Research Funding; Amgen: Consultancy, Honoraria, Research Funding; Bayer: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria.

Treatment Patterns and Healthcare Resource Utilization in Patients with Multiple Myeloma and Baseline Renal Impairment

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 17-18
Author(s):  
Parameswaran Hari ◽  
Lita Araujo ◽  
Dominick Latremouille-Viau ◽  
Peggy Lin ◽  
Mikhail Davidson ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Renal Impairment ◽  
Resource Utilization ◽  
Real World ◽  
Economic Burden ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Treatment Patterns ◽  
Analysis Group

Background: Renal impairment (RI) is associated with substantial clinical and economic burden in patients with multiple myeloma (MM), but real-world data reporting on healthcare resource utilization (HRU) and outcomes in these patients are lacking. We assessed treatment patterns, overall survival (OS), HRU and associated costs across lines of therapy (LoT) in patients with MM who had baseline RI. Methods: We identified patients (aged ≥18 years) with continuous Part A, B and D coverage who initiated pharmacologic therapy for MM between January 1, 2012 and December 31, 2016. Baseline demographics, disease characteristics, and treatment patterns from first-line to fourth-line (1L-4L) were reported for all eligible patients (main cohort). Within this cohort, a subgroup of patients diagnosed with RI at baseline (RI subgroup) were identified using appropriate International Classification of Diseases (ICD)-9 and ICD-10 codes. Treatment regimens were identified during the first 60 days following start of each LoT; stem cell transplantation (SCT) in 1L was considered part of the 1L regimen. The end of each LoT was indicated by treatment augmentation, treatment switching (after &gt;60 days), discontinuation of all agents (for &gt;90 days), or death. Overall survival (Kaplan-Meier analysis) was defined as time from start of each LoT until death or censoring (end of data/Medicare coverage). All-cause HRU categories were identified during each LoT and reported as incidence rate per patient per month (PPPM); associated all-cause healthcare costs during LoT were reported in 2017 US$. Results are presented using standard descriptive statistics. Results: A main cohort of 10,026 patients was identified; of these, a RI subgroup of 714 patients with baseline RI was identified (7.1% of main cohort). At 1L initiation, the RI subgroup was generally younger (71.9 vs. 74.6 years), had a lower proportion of females (47.8% vs. 53.1%) and had a higher proportion of Medicare coverage for end-stage renal disease (62.9% vs. 6.3%) than the main cohort. Patients with RI had a higher mean Charlson Comorbidity Index score (excluding MM; 4.8 vs. 3.3) and a higher proportion of patients with comorbidities (anemia: 72.5% vs. 57.9%; diabetes with chronic complications: 38.7% vs. 27.1%; cardiovascular diseases: 97.2% vs. 82.5%) than the main cohort. In the RI subgroup, among patients who received SCT in 1L (n=76), bortezomib-dexamethasone (Vd) was the most frequent 1L regimen (39.5%), followed by bortezomib-lenalidomide-dexamethasone (VRd; 17.1%) and bortezomib-cyclophosphamide-dexamethasone (VCd; 15.8%). In patients who had no SCT in 1L, Vd was the most frequent 1L regimen (59.5%), followed by VCd (12.7%) and lenalidomide-dexamethasone (Rd; 12.1%). Among patients in the RI subgroup who progressed to 2L therapy, 61.7% received lenalidomide-based regimens in 1L. Newer MM therapies such as carfilzomib, pomalidomide, ixazomib, daratumumab, and elotuzumab were used more frequently in later LoTs (2L: 25.6%; 3L: 50.0%; 4L: 68.8%). Median OS from start of 1L was shorter in the RI subgroup than in the main cohort (29.9 vs. 46.5 months; Table), and this difference was consistent across each subsequent LoT. Incidence of HRU during 1L (Table) was generally higher in the RI subgroup than the main cohort, particularly for inpatient days (1.3 vs. 0.7 PPPM) and home health services (0.9 vs. 0.5 PPPM); this pattern was consistent between cohorts across each subsequent LoT. Total costs in the 1L RI subgroup vs. main cohort (Table) were $14,782 vs. $12,451; the cost differential was maintained across each subsequent LoT. The key driver of this difference was the additional medical service costs ($12,047 vs. $7,459 in 1L) incurred by patients with RI. Conclusion: Patients with MM who had baseline RI were shown to experience higher clinical and economic burden in real-world clinical practice than the overall MM population. This burden was maintained across LoTs. Efficacious regimens that help improve renal function with minimal toxicity would enable patients with MM and RI to persist with treatment and may help address unmet need in this subgroup of patients. Table Disclosures Hari: BMS: Consultancy; GSK: Consultancy; Janssen: Consultancy; Amgen: Consultancy; Takeda: Consultancy; Incyte Corporation: Consultancy. Araujo:Sanofi Genzyme: Current Employment. Latremouille-Viau:Sanofi Genzyme: Consultancy, Other: Dominique Latremouille-Viau is an employee of Analysis Group, Inc. which received consultancy fees from Sanofi Genzyme.; Novartis Pharmaceutical Corporation: Consultancy, Other: Dominique Latremouille-Viau is an employee of Analysis Group, Inc. which received consultancy fees from Novartis.. Lin:Sanofi Genzyme: Current Employment. Davidson:Sanofi Genzyme: Other: Mikhail Davidson is an employee of Analysis Group, Inc which received consultancy fees from Sanofi Genzyme.. Guerin:Sanofi Genzyme: Consultancy, Other: Annie Guerin is an employee of Analysis Group, Inc. which received consultancy fees from Sanofi Genzyme.; Abbvie: Consultancy, Other; Novartis Pharmaceuticals Corporation: Consultancy, Other: Annie Guerin is an employee of Analysis Group, Inc. which received consultancy fees from Novartis.. Sasane:Sanofi Genzyme: Current Employment.

Abstract P147: Healthcare Resource Utilization and Associated Costs in Type 2 Diabetes Mellitus Patients with Uncontrolled Glycemic Level or Blood Pressure

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Chien-Chia Chuang ◽  
Edward Lee ◽  
Sharvari Bhurke ◽  
Sabyasachi Ghosh ◽  
Alie Tawah ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Regression Models ◽  
Index Date ◽  
Healthcare Resource ◽  
Baseline Period ◽  
Healthcare Resource Utilization ◽  
Office Visits ◽  
Medical Encounter ◽  
Outpatient Visits

Background: Poor glycemic and blood pressure (BP) control in patients with type 2 diabetes mellitus (T2DM) may lead to higher risk of complications with varying healthcare resource utilization (HRU). We hypothesize that poor glycemic and BP control are associated with higher HRU/costs. Methods: This study analyzed electronic health records from integrated delivery networks across the US between 2008 and 2012. Adult T2DM patients with at least two HbA1c and BP measures over a 12-month baseline period were selected. The end of this baseline period marks the index date. Patients were required to have an additional 12-month follow-up after the index date to evaluate HRU/costs. Uncontrolled HbA1c was defined as ≥ 1 HbA1c measure that was ≥7% during the baseline period. Uncontrolled BP was defined as ≥ 2 measures with systolic BP ≥ 130mmHg or diastolic BP ≥ 80mmHg during the baseline period. Descriptive analysis was conducted to compare HRU/costs across study cohorts. Unit cost approach was applied to derive total medical encounter costs. Logistic regression models were performed to assess the association between uncontrolled HbA1c/BP and HRU. Results: Of the 96,312 T2DM patients included in this study (mean age: 62.4 years; female: 51.5%), 55.9% had uncontrolled HbA1c (mean age: 61.2 years; female: 49.4%) and 74.6% had uncontrolled BP (mean age: 62.3 years; female: 52.8%). Patients with uncontrolled HbA1c had a higher proportion of hospitalizations (16.6% vs. 15.0%) , ER visits (21.0% vs. 18.3%), and higher total medical encounter costs ($4,168 vs. $3,773) than controlled patients, but lower utilization of outpatient visits (28.5% vs. 33.1%) and physician office visits (93.9% vs. 94.3%) (all p<0.05). Patients with uncontrolled BP had a higher proportion of hospitalization (17.1% vs. 12.3%), ER visits (21.3% vs. 15.5%), and outpatient visits (33.3% vs. 22.5%) and higher total medical encounter costs ($4,236 vs. $3,282) than controlled patients, but lower utilization of physician office visits (93.6% vs. 95.4%) (all p<0.05). In regression models, uncontrolled HbA1c was associated with greater odds of having any hospitalization (odds ratio [OR]: 1.10; 95% confidence interval [CI]: 1.06–1.14) and ER visits (OR: 1.10; 95% CI: 1.07–1.14). Uncontrolled BP was also associated with greater odds of having any hospitalization (OR: 1.39; 95% CI: 1.33–1.45) and ER visits (OR: 1.37; 95% CI: 1.31–1.43). Conclusions: T2DM patients with uncontrolled HbA1c or BP had higher HRU in inpatient/ER settings and incurred higher costs. The findings highlight the clinical/economic significance of managing HbA1c and co-morbid hypertension among T2DM patients.

scholarly journals Using a Physician Survey to Estimate the Economic Burden of Fibromyalgia in China

2020 ◽  
Author(s):  
Wesley Furnback ◽  
Feifei Chen ◽  
Jim Li ◽  
Bruce CM Wang ◽  
Dongfeng Liang
Keyword(s):  
Chronic Pain ◽  
Resource Utilization ◽  
Economic Burden ◽  
Economic Model ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Physician Survey ◽  
Physician Visits ◽  
Blood Tests ◽  
Illness Model

Abstract Background: Fibromyalgia (FM) is a chronic pain disorder with a global prevalence estimated to be between 2 and 3%. In addition to the chronic pain incurred by patients, FM is commonly associated with comorbidities and complications such as depression, anxiety, and sleep disturbances. This study estimates the economic burden of patients with FM in China using a physician survey. Methods: A burden of illness model was constructed using a micro-costing approach to estimate the direct cost associated with FM patients in China. FM-related comorbidities of anxiety, depression, and sleep disturbance were included in the model. Treatment utilization and costs for FM and FM-related comorbidities were included as well as FM-related healthcare resource utilization (physician visits, hospitalizations, blood tests, and radiologic tests). FM treatments included nonsteroidal anti-inflammatory drugs, pregabalin, duloxetine, amitriptyline, tramadol, Chinese medicine, physiotherapy, and acupuncture. The model leveraged the results of a physician survey, which targeted 6 rheumatologists and pain experts each with 5-10 FM patients per month in China. All costs are presented in Renminbi (¥) using spot exchange rates as of May 1, 2020.Results: From the physician survey, the prevalence rate of FM in China was estimated to be 2.8% with 75.8% as female. The economic model estimated the annual per patient direct medical cost of FM to be ¥17,377. Within these costs, FM-medication and treatment costs (¥11,216), healthcare resource utilization (¥4,297), and costs for medications treating FM-related comorbidities (¥1,863) were the highest contributors. Healthcare resource utilization costs were driven by physician visits (¥2,787) followed by radiographic tests (¥808), blood tests (¥508), and hospitalizations (¥194). Conclusion: The prevalence and gender distribution of FM patients in China is similar to those of other countries. The economic model estimates patients with fibromyalgia in China to incur significant economic costs.

scholarly journals Real-World Healthcare Resource Utilization in Patients with Indolent Non-Hodgkin's Lymphoma: Differences between Patients Treated First-Line with Ibrutinib or Bendamustine + Rituximab

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3549-3549
Author(s):  
Debra Irwin ◽  
Lu Zhang ◽  
Kathleen Wilson ◽  
Gerard Hoehn ◽  
Erika Szabo ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Healthcare Utilization ◽  
Resource Utilization ◽  
Real World ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Hodgkin's Lymphoma ◽  
First Line

Abstract OBJECTIVES: The purpose of this study was to examine real-world differences in healthcare resource utilization of indolent non-Hodgkin's Lymphoma (iNHL) patients treated with first-line ibrutinib monotherapy (IM) or first-line bendamustine + rituximab (BR) combination therapy using U.S. administrative claims data. METHODS: The MarketScan® Research Databases were used to identify patients aged 18 years or older with commercial or Medicare supplemental insurance plans based on their first prescription (index date) of either IM or BR therapy between 02/01/2014 and 08/30/2017. Patients were required to be diagnosed with iNHL and be treatment naïve, as well as be continuously enrolled (CE) for 6 months prior to and at least 30 days following the index date. All-cause and iNHL-related healthcare resource utilization (e.g., inpatient admission (IP) and emergency room (ER) visits) were evaluated during a 12-month follow-up period from the index date among the subset of patients with 12 months of continuous enrollment and reported per-patient per-month (PPPM). Statistical differences in the distribution of IP and ER visits between the IM versus BR therapy groups were estimated using chi-squared test for categorical variables and t-test for continuous variables. RESULTS: A total of 1,544 iNHL patients were identified, with 207 patients in the IM cohort and 1,337 patients in the BR cohort. The IM cohort was significantly older (mean = 68.3 years; SD = 11.8) then the BR cohort (mean age = 62.1 years; SD = 11.1). The proportion of females was significantly (p<.05) lower in the IM cohort (36%) relative to the BR cohort (49%). The two cohorts did not differ in comorbidity as assessed by National Cancer Institute Comorbidity Index score (IM=0.7 vs. BR=0.8, p=0.40). The results of the comparisons between the two groups with 12 months of follow-up (IM = 110; BR = 745) are provided in Table 1. For all-cause healthcare utilization, the proportion of IM patients experiencing at least one IP admission was significantly higher than the BR cohort as were the PPPM number of admissions. The proportion of patients with at least one ER visit was similar in the IM and BR cohorts. However, the average PPPM number of ER visits was significantly higher in the IM cohort relative to the BR cohort. A similar pattern was found for the iNHL-related healthcare utilization variables with one exception. The proportion of patients with at least one iNHL-related ER visit was significantly higher in the IM relative to the BR cohort. Conclusions: The current study examined differences in healthcare utilization among iNHL-patients treated in a front-line setting with either ibrutinib or BR combination therapy. Results indicated that not only did more ibrutinib patients experience an IP admission and ER visits, including both all-cause and iNHL-related, but they also experienced more repeat admissions and ER visits. These real-world findings highlight the importance of considering the healthcare resource utilization of iNHL patients which may be associated with their first-line therapy. Disclosures Irwin: Teva: Consultancy. Zhang:Teva: Consultancy. Wilson:Teva: Consultancy. Hoehn:Teva: Employment. Szabo:Teva: Employment. Tang:Teva: Employment.

Healthcare Resource Utilization and Costs Associated with Venous Thromboembolism Recurrence in Patients with Cancer

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4734-4734
Author(s):  
Alok A. Khorana ◽  
Keith R. McCrae ◽  
Dejan Milentijevic ◽  
Jonathan Fortier ◽  
François Laliberté ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Resource Utilization ◽  
Healthcare Costs ◽  
Research Funding ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Patients With Cancer ◽  
Equity Ownership ◽  
Recurrent Vte

Abstract Introduction: Patients with cancer are not only at a high risk for developing primary but also recurrent venous thromboembolism (VTE). These events lead to increased burden of cancer management and healthcare costs. It was estimated that all-cause health care costs for cancer patients with VTE were $30,538/patient higher than in those without VTE (Khorana, 2013). To our knowledge, very little information exists on cost of VTE recurrence among cancer patients. The objective of this study was to analyze resource utilization and costs of patients with cancer experiencing a VTE recurrence using a large claims database. Methods: Medical and pharmacy claims from the Humana Database between 1/1/2013 and 05/31/2015 were analyzed. Newly diagnosed cancer patients with a first VTE diagnosis occurring after their first cancer diagnosis and with ≥1 dispensing of an anticoagulant agent within 7 days after their VTE diagnosis, were selected. Baseline characteristics were evaluated during the 6 month period prior to the index VTE. VTE recurrences were defined as hospitalizations with a primary diagnosis of VTE. Patients were classified into two groups: patients who experienced a VTE recurrence and patients who did not. Resource utilization and costs were evaluated for the entire follow up period, starting with the initiation of the anticoagulant therapy until whichever was earlier, end of eligibility or end of data. Healthcare resource utilization evaluated included number of hospitalizations, hospitalization days, emergency room (ER) visits, and outpatient visits. All-cause and VTE-related healthcare resource utilization was evaluated. Comparisons between patients with a VTE recurrence and patients without a VTE recurrence were performed using rate ratios (RR) and statistical differences between groups as well as 95% confidence intervals [95% CI] were calculated using Poisson regression models. All-cause and VTE-related healthcare costs were evaluated in per-patient-per-year (PPPY) and compared using mean cost difference. Results: A total of 2,428 newly diagnosed cancer patients who developed VTE and were treated with anticoagulants were identified. Of these, 413 (17.1%) experienced recurrent VTE during the follow up period. Patients who developed recurrent VTE and those who did not were similar in terms of age, gender, race, and region. No statistically significant differences between groups were observed in Charlson comorbidity index or in selected comorbidities during the 6 month baseline period. However, more patients with recurrent VTE recurrence had their index VTE documented during a hospitalization (61.3% vs. 55.4%, p=0.03). Patients with a VTE recurrence had significantly more ER and outpatient visits at baseline compared to those without recurrence, but no statistically significant difference was observed in baseline total healthcare costs ($29,352 vs. $27,955, p=0.44, respectively). The mean follow-up was similar between groups: 9.6 months for patients experiencing a VTE recurrence and 9.3 months for patients without a VTE recurrence (p=0.4059). Patients with a VTE recurrence had higher all-cause resource utilization rates (RRs; 95% CI) compared to patients without a VTE recurrence (hospitalization [2.37; 2.23 - 2.52], hospitalization days [2.64; 2.57 - 2.72], ER visits [1.62; 1.48 - 1.76], and outpatient visits [1.26; 1.24 - 1.28]). The rates of VTE-related hospitalization and VTE-related hospitalization days were close to $30,000 higher in patients with a VTE recurrence (Figure 1). The all-cause healthcare costs were $84,708 PPPY in patients with a VTE recurrence compared to $44,903 in patients without a VTE recurrence. The difference was mainly explained by lower VTE-related hospitalization costs (Figure 2). Conclusion: This real-world claims analysis showed that cancer patients with recurrent VTE consume significantly more healthcare resources. Total healthcare costs were nearly 2-fold higher in cohort with than in cohort without VTE recurrence. Close to 75% of the total cost difference was associated with VTE recurrence. VTE-related costs were ~4-fold higher in cohort with than in cohort without VTE recurrence. Reducing VTE recurrence in patients with cancer could lead to substantial healthcare cost savings. Figure 1 VTE-Related Healthcare Resource Utilization Figure 1. VTE-Related Healthcare Resource Utilization Figure 2 VTE-Related Healthcare Costs, PPPY Figure 2. VTE-Related Healthcare Costs, PPPY Disclosures Khorana: Pfizer: Consultancy, Honoraria; Bayer: Consultancy, Honoraria; Sanofi: Consultancy, Honoraria; Halozyme: Consultancy, Honoraria; Amgen: Consultancy, Honoraria, Research Funding; Janssen Scientific Affairs, LLC: Consultancy, Honoraria, Research Funding; Leo: Consultancy, Honoraria, Research Funding; Roche: Consultancy, Honoraria. McCrae:Janssen: Membership on an entity's Board of Directors or advisory committees. Milentijevic:Janssen Scientific Affairs: Employment, Equity Ownership. Fortier:Janssen Pharmaceuticals: Research Funding. Laliberté:Janssen Scientific Affairs: Research Funding. Crivera:Janssen Scientific Affairs, LLC, Raritan, New Jersey: Employment, Equity Ownership. Lefebvre:Janssen Scientific Affairs: Research Funding. Schein:Johnson & Johnson: Employment, Equity Ownership, Other: Own in excess of $10,000 of J&J stock.

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