scholarly journals A Retrospective Chart Review to Assess Burden of Illness Among Patients with Severe Aplastic Anemia with Insufficient Response to Immunosuppressive Therapy

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 678-678
Author(s):  
Regis Peffault De Latour ◽  
Lynn Huynh ◽  
Jasmina I. Ivanova ◽  
Todor Totev ◽  
Mehmet Bilginsoy ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Room ◽  
Research Funding ◽  
Care Utilization ◽  
Emergency Room Visits ◽  
Office Visits ◽  
The Us ◽  
Insufficient Response ◽  
The Mean

Abstract Background: Aplastic anemia (AA) is a rare disease, with an incidence of 1-2 new cases per million per year in Europe and North America. Primary therapies for AA for patients who do not have a sibling or matched unrelated donor or are unfit for allogeneic hematopoietic stem cell transplantation (HSCT) include immunosuppressive therapy (IST) with the combination of antithymocyte globulin (ATG) and calcineurin inhibitors. Therapeutic options beyond IST are limited and include eltrombopag, which was approved by the US FDA for use in patients with severe AA who fail to respond adequately to IST. The health economic burden of this rare and debilitating condition is poorly understood, especially for refractory cases. Objective: To examine health resource utilization associated with severe AA among patients with insufficient response to IST in real-world practice settings in a recent time period. Methods: We conducted a retrospective, longitudinal chart review of patients with severe AA treated at clinical centers in the US (Dana-Farber Cancer Institute [DFCI]) and France (Service d'Hématologie Greffe, Hôpital Saint-Louis [AGRAH]). Severe AA in this study was identified as having bone marrow cellularity <25%, or 25-50% with <30% residual hematopoietic cells; and at least two of the following laboratory findings: neutrophil count <500 cell/µL, platelets <20,000/µL, reticulocyte count <20,000/µL. Eligible patients were ≥18 years old, first diagnosed with severe AA between January 1, 2006 and January 31, 2016, had insufficient response to at least one course of IST following severe AA diagnosis, and had ≥12 months of medical data after first diagnosis with severe AA. Patients with congenital disorders of hematopoiesis were excluded. Kaplan-Meier method was used to analyze time from first IST to time of HSCT. Cumulative incidence and incidence rates were used to summarize frequency of blood transfusions and AA-related health care resource utilization. The study was approved by local IRB. Results: The study included 34 refractory severe AA patients (NDFCI=20; NAGRAH =14). Mean age at severe AA diagnosis was 43.3 (standard deviation [SD]: 16.8) years and 52.9% (18/34) of patients were women. Median follow-up time after severe AA diagnosis was 56.1 (range: 12.0-118.7) months. Thirty-three (97.1%) patients received ATG in combination with calcineurin inhibitor (cyclosporine or tacrolimus) with or without corticosteroid as primary therapy. Among patients treated with ATG, 51.5% (17/33) patients received only one course of ATG and 48.5% (16/33) patients received ≥2 courses of ATG. The most common secondary AA therapy included eltrombopag (17.6%, N=6) and androgens (8.8%, N=3). The median treatment duration for eltrombopag was 6.4 (range: 5.6-53.4) months. The average frequency of transfusions per patient per month was 2.8 (SD: 2.8) red blood cell (RBC) and 3.3 (SD: 3.5) platelet transfusions. The mean AA-related health care utilization rates per patient per year were 0.8 (95% confidence interval [CI]: 0.6, 1.0) for inpatient visits, 0.5 (95% CI: 0.4, 0.8) for emergency room visits, and 19.1 (95% CI: 17.9, 20.5) for office visits prior to undergoing HSCT. Among the subgroup of patients treated with eltrombopag, the mean number of RBC transfusions per patient per month was reduced from 2.4 (SD: 2.0) before to 0.9 (SD: 0.8) after eltrombopag treatment, and from 3.0 (SD: 2.3) to 1.3 (SD: 1.6) for platelet transfusions. Similarly, AA-related health care utilization rates were lower after eltrombopag initiation (∆inpatient visits: -0.3 (95% CI: -1.1, 0.5); ∆emergency room visits: -0.6 (95% CI: -1.5, 0.4); ∆office visits: -11.7 (95% CI: -16.2, -7.1) per patient per year). Thirty (88.2%) patients received HSCT with a median time of 12.9 (95% CI: 7.9, 17.3) months after first IST initiation. During the follow-up period, 29.4% (10/34) patients died; nine patients died after HSCT. Two (5.9%) patients transformed to myelodysplastic syndrome and/or acute myeloid leukemia. Conclusion: This is one of the first studies to quantify the transfusion and health resource burden of refractory severe AA. In a small subgroup of patients receiving eltrombopag, there was a trend toward reduction in blood transfusion frequency, AA-related hospitalization rate, and outpatient office and emergency room visits after eltrombopag initiation. Disclosures Peffault De Latour: Pfizer: Consultancy, Honoraria, Research Funding; Novartis: Consultancy, Honoraria, Research Funding; Alexion Pharmaceuticals, Inc.: Consultancy, Honoraria, Research Funding; Amgen: Research Funding. Huynh: Novartis Pharmaceuticals Corporation: Research Funding. Ivanova: Novartis, GSK, Teva, Lilly: Research Funding. Totev: Novartis Pharmaceuticals Corporation, Shire Pharmaceuticals Inc.: Research Funding. Bilginsoy: Novartis Pharmaceuticals Corporation: Research Funding. Roy: Novartis: Employment, Equity Ownership. Duh: Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Research Funding; Novartis Pharmaceuticals Corporation: Research Funding.

An Evaluation of Health Care Utilization, Risk of Infection and Bleeding Among MDS Patients During Periods of Transfusion Dependence or Independence with or without Lenalidomide Therapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3151-3151
Author(s):  
B. Douglas Smith ◽  
Dalia Mahmoud ◽  
Henry J Henk ◽  
Zeba M. Khan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Research Funding ◽  
Index Date ◽  
Care Utilization ◽  
Watch And Wait ◽  
Active Therapy ◽  
Erythroid Response ◽  
Clinically Significant

Abstract Abstract 3151 Introduction A goal of therapy with lenalidomide (LEN) for MDS pts is hematologic improvement, commonly an erythroid response, which results in transfusion independence (TI). However, it is possible that LEN impacts other non-anemia manifestations of MDS, such as significant bleeding (defined as GI, intracranial, hospitalized bleeds, and bleeding deaths), infections. This retrospective claims analysis examined the occurrence of these events as well as health care utilization (ER visits and hospitalizations), for pts with MDS during periods of transfusion dependence (TD) without active therapy compared to periods of TI with or without LEN. Methods: Claims data from a US national commercial health plan were retrospectively reviewed to assess the impact of TD and therapy with LEN on common medical events. Pts ≥ 18 yrs with ≥ 1 claim for MDS (ICD-9-CM diagnosis codes 238.72–238.75) between 01 Jan 07 and 31 Dec 09 were assessed using the 1st MDS diagnosis date as the index date. Continuous enrollment in a commercial or Medicare Advantage plan with a medical and pharmacy benefit for 6 mos before the index date (baseline period) and for a variable period after the index date (follow-up period) was required. Four unique cohorts of pt follow up were identified to analyze pt outcomes. Three groups of TI periods were examined: periods not on any active therapy ‘watch and wait’ (A) periods on any length of LEN therapy (B) and long periods on LEN therapy (> 3 refills) (C) as 90% of responding pts do so after 3 cycles. In addition, TD periods on no active therapy (D) were assessed. The dose of LEN administered varied across pts and time periods analyzed. Common medical events of infection, bleeding, ER visits and hospitalizations were evaluated within each period type. TD was defined as ≥ 2 RBC transfusions in 8 wks and TI as pts on <2 transfusions in 8 weeks. Because length of each time period varied, results are presented as incidence rate per person-year to allow comparison across cohorts adjusting for variable exposure time. Results: A total of 3, 574 pts with MDS were categorized on the basis of transfusions and LEN use resulting in 3, 608 observation periods analyzed. Each pt could account for multiple periods. Average age was 66 yrs and 51% were male. TD periods were associated with the highest incidence of infection and bleeding events compared to any of the TI periods (A, B, or C). In addition hospitalizations and ER visits were highest for TD periods compared to any of the TI periods. Interestingly, the incidence of events during TI periods on longer courses of LEN (≥ 3 LEN cycles) (C) approached that of periods of TI without active therapy (watch and wait) (A). Conclusions: This retrospective database analysis highlights the possible impact of LEN on 2 important clinical manifestations of MDS. As expected, the incidence of infection and clinically significant bleeding was greatest during TD periods. However, the incidence of these events in TI on LEN for > 3 cycles approached that of TI pts not requiring medical therapy (watch and wait) and highlights a potential broader impact of LEN therapy. The effect of LEN in inducing erythroid response in pts with MDS, especially with the 5q- karyotype, is well established; however, these results indicate LEN may also impact the underlying biology of MDS as seen by a lower incidence of infection and clinically significant bleeds during TI periods on LEN (B, C). Furthermore, these data support the concept that effective therapy periods on LEN are not associated with higher rates of medical events and LEN therapy should be considered for eligible TD pts. Disclosures: Smith: Celgene: Consultancy; Genzyme: Consultancy; Incyte: Consultancy; Infinity: Consultancy; Merck-Serono: Research Funding; Synta: Research Funding; Celator: Research Funding; Calistoga: Research Funding; BMS: Research Funding; Novartis: Research Funding. Mahmoud:Celgene: Employment. Khan:Celgene: Employment.

scholarly journals Treatment Patterns, Adverse Events, and Economic Burden in a Privately Insured Population of Newly Diagnosed Patients with Chronic Lymphocytic Leukemia in the United States

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3557-3557 ◽  
Author(s):  
Shaum Kabadi ◽  
Ravi K Goyal ◽  
Saurabh P Nagar ◽  
James A Kaye ◽  
Keith L Davis ◽  
...  
Keyword(s):  
Health Care ◽  
Adverse Events ◽  
Systemic Therapy ◽  
Research Funding ◽  
The United States ◽  
Treatment Patterns ◽  
Newly Diagnosed ◽  
The Us ◽  
Privately Insured

Abstract Introduction: Contemporary data describing treatment patterns, adverse events (AEs) and outcomes in CLL patients in clinical practice is lacking. We conducted a retrospective cohort study and assessed treatment patterns, AEs, health care resource use (HCRU), and costs in patients with newly diagnosed CLL. Methods: Using a nationally representative population of privately insured patients in the US, adult patients with CLL were selected if they had continuous health plan enrollment for ≥12 months before the first CLL diagnosis without any evidence of any CLL-directed treatment. Treatment patterns up to 4 lines of therapy (LOT) and occurrence of AEs during CLL therapies were assessed. Mean per-patient monthly HCRU and costs were assessed overall and by number of unique AEs. Results: Of all patients meeting the selection criteria (n=7,639; median age, 66 years), 18% (n=1,379) received a systemic therapy during study follow-up. The most common systemic therapy regimens, regardless of therapy line, were bendamustine/rituximab (BR) (32%), rituximab monotherapy (24% [including maintenance]), ibrutinib monotherapy (15%), and fludarabine/cyclophosphamide/ rituximab (FCR) (14%). Of these, BR was the most common LOT-1 regimen (28.1%), while ibrutinib was the most common regimen in LOT-2 (20.8%) and in LOT-3 (25.5%). Use of idelalisib was limited to 1.6% of all patients receiving systemic therapy; however, an increasing trend was observed as patients moved from first to fourth LOT (<1% in LOT-1, 3.1% in LOT-2, 4.7% in LOT-3, and 8.6% in LOT-4). AEs identified during the most common treatments for CLL are presented by treatment regimen in Table 1. The mean monthly all-cause and CLL-related costs, among patients treated with a systemic therapy, were $7,943 (SD=$15,757) and $5,185 (SD=$9,935), respectively. Figure 1 depicts mean monthly costs by care setting and number of AEs, among all patients. Mean (SD) monthly all-cause costs during the post-index date follow-up were $905 ($1,865) among those with no AEs, $1,655 ($5,364) among those with 1-2 AEs, $2,883 ($8,483) among those with 3-5 AEs, and $6,032 ($13,290) among those with ≥6 AEs. Conclusions: This population-based study yielded recent real-world evidence on treatment patterns, AEs, HCRU, and costs in patients enrolled in health plans in the US. Immunochemotherapy, particularly BR, remained the preferred frontline therapy for CLL, whereas ibrutinib was the preferred therapy in LOT-2 and LOT-3, during the study period. This study demonstrates that the AE burden associated with current treatment alternatives for CLL is substantial, and the management of AEs occurring during treatments may have a significant impact on the overall health care costs. Disclosures Kabadi: AstraZeneca: Employment. Goyal:RTI Health Solutions: Employment, Research Funding. Nagar:RTI Health Solutions: Employment, Research Funding. Kaye:RTI Health Solutions: Employment, Research Funding. Davis:RTI Health Solutions: Employment, Research Funding. Mato:Celgene: Consultancy; AstraZeneca: Consultancy; Pharmacyclics: Consultancy, Honoraria, Research Funding; Abbvie: Consultancy; Sunesis: Honoraria, Research Funding; TG Therapeutics: Research Funding; Janssen: Consultancy, Honoraria; Acerta: Research Funding; Prime Oncology: Speakers Bureau; Regeneron: Research Funding.

scholarly journals Health Care Utilization in Transplanted Versus Non-Transplanted Sickle Cell Disease Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 313-313 ◽  
Author(s):  
Santosh L. Saraf ◽  
Krishna Ghimire ◽  
Pritesh Patel ◽  
Karen Sweiss ◽  
John G. Quigley ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Emergency Room ◽  
Care Utilization ◽  
Emergency Room Visits ◽  
Eligibility Criteria ◽  
Utilization Patterns ◽  
Related Donor ◽  
Second Year ◽  
Hospital Days

Abstract Sickle cell disease (SCD) is an inherited red blood cell disorder that leads to substantial morbidity and a heavy burden on the health care system. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) regimens using HLA-matched related donors have recently demonstrated high rates of engraftment and a favorable safety profile in adults with SCD. The long term effects of these HSCT regimens on health care utilization, particularly in SCD adults who have had a high burden of SCD-related acute and chronic complications, has not been previously reported. Between 8/2011 and 4/2016, 86 SCD patients who received their routine care at our institution were referred to the Blood & Marrow Transplant Clinic. Sixteen patients received a HSCT from an HLA-match related donor during this time period. Reasons for not proceeding to transplantation in the 70 patients included lack of an HLA-matched related donor in 36 (51%), patient/family declining in 21 (30%), insurance denial in 11 (16%), and the presence of RBC antibodies to potential donors in 2 (3%) patients. We compared health care utilization patterns between 1) 1-year pre-HSCT vs. 1- and 2-years post-HSCT in 16 transplanted SCD adults and 2) 16 transplanted vs. 70 non-transplanted SCD patients at 1- and 2-years from the time of HSCT or referral. Comparisons of linear variables and categorical variables were performed using the Kruskal-Wallis and Chi-square test, respectively. In the 16 SCD patients who met standard transplant eligibility criteria and underwent HSCT, the median age at the time of HSCT was 33 years (interquartile range [IQR], 24 - 34 years), 56% were male, and 94% were HbSS genotype. Treatment prior to HSCT was hydroxyurea in 10 (63%), chronic red blood cell (RBC) transfusion therapy in 5 (31%), and no disease modifying therapy in 1 (6%) patient. Thirteen of 16 (81%) transplanted SCD patients maintained a stable graft. Emergency room (ER) visits were lower 1-year and 2-year post-HSCT compared to 1-year pre-HSCT (P=0.03) (Table 1). In the 2nd year post-HSCT, ER visits, hospital length of stay, RBC transfusion requirements, and rates of documented infections were all lower compared to 1-year pre-HSCT (P<0.03). We then compared health care utilization patterns between the 16 SCD patients that underwent HSCT vs. the 70 SCD patients that were not transplanted. The HSCT and non-HSCT patients were similar with respect to median age (33 vs. 31 years old; P=0.2), gender (35% vs. 56% male, P=0.1), number of eligibility criteria met for HSCT (PMID: 24319206) (2 for each group; P=0.4) and SCD genotype (80% vs. 94% HbSS genotype, P=0.4), respectively. During the first year after transplant or of observation, we observed lower rates of emergency room visits but a greater number of inpatient hospital days in the HSCT vs. no HSCT groups (Figure 1). During the second year, both the number of emergency room visits and the number of inpatient hospital days were lower in the HSCT vs. the no HSCT patients (Figure 1). In conclusion, we demonstrate that allogeneic HSCT leads to lower health care utilization by the second year post-HSCT in adults with SCD. These results support the role for HSCT to lower the morbidity, health care burden and costs associated with SCD and should encourage universal insurance coverage for HSCT in adults with SCD. Disclosures Patel: Celgene: Consultancy, Honoraria; Amgen: Consultancy, Honoraria; Janssen: Honoraria. Khan:Teva: Speakers Bureau.

A Longitudinal Population Level Analysis of Healthcare Resource Utilization, Comorbidity, and Survival in Idiopathic Multicentric Castleman Disease Patients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 11-11
Author(s):  
Sudipto Mukherjee ◽  
Rabecka Martin ◽  
Brenda Sande ◽  
Chad Glen ◽  
Jeremy Paige ◽  
...  
Keyword(s):  
Emergency Room ◽  
Research Funding ◽  
Hematologic Malignancies ◽  
Healthcare Resource Utilization ◽  
Castleman Disease ◽  
Emergency Room Visits ◽  
Advisory Committees ◽  
Multicentric Castleman Disease ◽  
Average Survival

BACKGROUND: Human herpesvirus-8-negative/idiopathic multicentric Castleman disease (iMCD) is a heterogenous group of diseases characterized by proinflammatory hypercytokinemic state with a wide range of systemic manifestations ranging from generalized lymphadenopathy to death in severe cases. Limited data has shown an increased prevalence of organ dysfunction and cancers in iMCD patients either as a result of underlying disease pathophysiology or treatment received. The objective of this study was to assess the healthcare resource utilization, patterns of iMCD-related comorbidities, and survival of iMCD patients in a real-world setting. METHODS: We performed a retrospective analysis of administrative claims data for &gt;30 million United States patients continuously enrolled over a three-year study period from January 1, 2017 and December 31, 2019. Patients were identified as iMCD if they had an ICD-10 diagnosis code for Castleman disease (D47.Z2) and ≥2 diagnostic codes corresponding to the minor criteria from the international evidence-based consensus diagnostic criteria for iMCD. Exclusion criteria included history of HIV, HHV-8, lymphoma, myeloma, lupus, or rheumatoid arthritis within one year of diagnosis of Castleman disease. Index diagnosis date (IDD) was defined as the first time a patient received a diagnosis for Castleman disease using the new ICD-10 code (D47.Z2) or the general code for lymphadenopathy (785.6) in ICD-9 that included Castleman disease, whichever was diagnosed first between 2006 and 2019. Included patients were followed for up to 5 years from IDD and evaluated for post-diagnosis hospitalizations, emergency room visits, hematologic malignancies, non-hematologic malignancies, thromboses, and organ dysfunction. Estimated average survival was calculated based on estimated incidence and prevalence rates for the iMCD patient population, assuming a stable incidence. RESULTS: We identified 191 iMCD patients including 109 women (57%) and 82 men (43%) with a mean age of 51 years (range: 6 - 90). The average post-diagnosis follow up was 3.2 years after IDD (range: 0.3 - 14.1). Within the first year of iMCD diagnosis, 58.9% of patients required inpatient hospitalization and 53.4% had at least one emergency room visit. Among the patients who remained enrolled after the first year, an average of 25.1% were hospitalized and 36.1% visited the emergency room during each subsequent year (Table 1). The annual rate of hospitalizations and emergency room visits for the entire database of &gt;30 million patients was 9.0% and 20.6%, respectively. As shown in Table 2, the annual prevalence of iMCD-related comorbidities in this cohort was 18.2% for non-hematologic malignancies, 6.3% for hematologic malignancies (including lymphomas and myelomas from second year follow up onwards), 5.8% for thromboses, 5.7% for renal failure, and 5.2% for respiratory failure. Based on an average annual incidence of 2.45 (95% CI, 0.85 - 8.60) per million and average prevalence of 6.31 (95% CI, 3.25 - 13.05) per million, we estimated an average survival of 2.57 (95% CI, 1.59 - 4.25) years after diagnosis in this study time period. DISCUSSION: Using a large nationally representative health claims database, we identified a cohort of iMCD patients and found a high rate of hospitalizations and emergency room visits in the first five years following diagnosis. The annual prevalence of iMCD-related organ failure was approximately 5-6% primarily involving renal and respiratory systems. This study provides further evidence to support the previously reported increase in frequency of subsequent hematologic and non-hematologic malignancies in iMCD patients. In the five-year follow up period, the average estimated survival of iMCD patients was 2.57 (95% CI, 1.59 - 4.25) years after diagnosis, which is shorter than previously published average survival durations based on academic medical centers. The worse survival in this cohort may represent iMCD survival outside of academic medical centers or may reflect inaccuracies in estimated incidence and prevalence which were used to estimate average survival. Further studies are needed to compare outcomes to age-matched controls and to determine whether these adverse outcomes are broadly seen across iMCD patients or instead attributable to a smaller subset of more severe cases. Disclosures Mukherjee: Bristol Myers Squib: Honoraria; Partnership for Health Analytic Research, LLC (PHAR, LLC): Honoraria; Celgene: Consultancy, Honoraria, Research Funding; Aplastic Anemia and MDS International Foundation: Honoraria; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; EUSA Pharma: Consultancy; Celgene/Acceleron: Membership on an entity's Board of Directors or advisory committees. Martin:EUSA Pharma: Current Employment. Sande:EUSA Pharma: Current Employment. Glen:HVH Precision Analytics: Current Employment. Paige:HVH Precision Analytics: Consultancy. Yarlagadda:HVH Precision Analytics: Current Employment. Fajgenbaum:EUSA Pharma: Research Funding; Janssen Pharmaceuticals: Research Funding.

Health Care Utilization, Risk of Infection and Bleeding Among MDS Patients During Periods of Transfusion Dependency or Independency with or without Active Therapy

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 3149-3149
Author(s):  
B. Douglas Smith ◽  
Dalia Mahmoud ◽  
Stacey Dacosta Byfield ◽  
Zeba M. Khan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Disease Activity ◽  
Research Funding ◽  
Index Date ◽  
Care Utilization ◽  
Watch And Wait ◽  
Active Therapy ◽  
Transfusion Dependency

Abstract Abstract 3149 Introduction: Clinical manifestations of MDS include recurrent infections from neutropenia and bleeding from thrombocytopenia. These events often result in increased healthcare resource utilization (ER visits and hospitalizations) and are associated with disease-related deaths. Understanding the interplay between disease activity, transfusion needs, and medical interventions that can initially worsen baseline cytopenias, may help to improve treatment approaches for MDS patients. This retrospective claims review analyzed the occurrence of infection and significant bleeding (defined as GI, intracranial, and hospitalized bleeds as well as bleeding deaths) related to pre-defined follow-up periods which captured the clinical activity of MDS based on transfusion dependency vs. independency and active therapy Rx (defined as use of lenalidomide, 5-azacitidine, or decitabine). Methods: Claims data from a US national commercial health insurer were retrospectively reviewed to assess the impact of RBC transfusion dependency (TD) on bleeding and infection events. Pts ≥ 18 yrs with ≥ 1 claim for MDS (ICD-9-CM codes 238.72–238.75) between 01 Jan 07 and 31 Dec 09 were assessed using the 1st MDS date as the index date. Continuous enrollment in a commercial or Medicare Advantage plan with a medical and pharmacy benefit for 6 mos before the index date (baseline period) and for a variable period after the index date was required. Pt follow-up was divided according to 4 unique treatment periods: transfusion independent (TI) periods without active therapy termed “watch and wait” (A), TI periods on active therapy (B), (TD) periods on no active therapy (C), TD on active therapy (D). Health care utilization focused on infectious complications and significant bleeding events and was captured within each follow-up period. TD was defined as ≥ to 2 RBC transfusions in 8 weeks and TI as < 2 transfusions in 8 weeks. The number (%) of periods with events is reported. Health care utilization was also calculated as “incidence per person-year” to account for the variable length of the pre-defined periods and to compare results across the follow-up period cohorts. Results: A total of 3, 886 pts with MDS with a mean age of 67.1 years (SD=14.9) represented 4, 007 total follow-up periods. Each patient could account for multiple periods. The follow-up periods (A, B, C, D) appear to predict expected disease activity based on the results of incidence per person-year in each period. For example – the TI periods (A and B) had lower incidence per person-year compared to the TD periods (C and D). Furthermore, within the TI periods, those requiring medical treatment (B) had more events compared to the watch and wait periods (A). Interestingly, the TD periods were not differentiated based on medical intervention and the TI periods with therapy (B) had lower events than either TD periods. Conclusion: This retrospective analysis helps to define the health care utilization patterns of MDS pts based on transfusion requirements and treatment interventions. Periods of TD are associated with higher numbers of medical events compared to TI periods. These data also suggest that periods of TI on therapy had fewer events compared to either TD period and may allay concerns that active therapy could worsen baseline cytopenias. In fact, active therapy plays a role in lowering supportive care requirements and resources utilization for many pts and may also reduce the incidence of MDS-related medical events. Results demonstrate that active therapy should be considered in all eligible TD MDS pts. Disclosures: Smith: Celgene: Consultancy; Genzyme: Consultancy; Incyte: Consultancy; Infinity: Consultancy; Merck-Serono: Research Funding; Synta: Research Funding; Celator: Research Funding; Calistoga: Research Funding; BMS: Research Funding; Novartis: Research Funding. Mahmoud:Celgene: Employment. Khan:Celgene: Employment.

Health-care utilization and cost for the treatment of melanoma in the six months following diagnosis

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18005-18005
Author(s):  
D. C. Taylor ◽  
Z. Zhou ◽  
S. Haider ◽  
D. Thompson
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Cost Of Care ◽  
Stage Iii ◽  
Disease Stage ◽  
Care Utilization ◽  
Melanoma Treatment ◽  
The Mean ◽  
Medicare Claims Data

18005 Background: The objective of this study was to use a 5% sample of Medicare claims data to estimate health-care utilization and cost for the treatment of melanoma. Methods: Data for this study were obtained from national administrative Medicare files. Adult patients were selected for the analysis if they were newly diagnosed with melanoma between July 1, 1999 and June 30, 2001. Patients with diagnoses of other cancers prior to melanoma as well as those who did not have data available for at least six months of continuous follow-up were excluded from the analysis. Patients were identified as having Stage 0-II or Stage III-IV melanoma based on the absence or receipt, respectively, of lymph node dissection, chemotherapy, and/or radiation therapy. Study measures included the type, cost, and duration of melanoma treatment. Results: A total of 1,465 patients were identified for the study, including 1,291 with Stage 0-II melanoma and 174 with Stage III-IV melanoma. The mean age was 73.9 years, 54% were female. Overall, 98.3% of patients underwent a surgical procedure, 3.1% underwent chemotherapy, 2.3% had inpatient treatment, 1.2% received radiation, and 1.5% had home health treatment for melanoma in the first six months after diagnosis. Corresponding percentages by disease stage were 100%, 0%, 1.2%, 0%, and 0.9% for Stage 0-II patients, and 85.6%, 25.9%, 10.9%, 10.3%, and 6.3% for Stage III-IV patients. The average total six-month Medicare cost of care was $2,395 ($2,065 outpatient, $330 inpatient) per patient; the average per-patient cost of care was $1,402 ($1,292 outpatient, $110 inpatient) for Stage 0-II patients and was $9,756 ($7,800 outpatient, $1,956 inpatient) for Stage III-IV patients. Conclusions: Treatment costs for melanoma are substantial in the first six months following diagnosis, especially for those patients with Stage III-IV disease. No significant financial relationships to disclose.

Hospitalizations in elderly glioblastoma patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21529-e21529
Author(s):  
Claire Elizabeth Moroney ◽  
James R. Perry ◽  
Derek S Tsang ◽  
Denise Bilodeau ◽  
Christina Mueller ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Room ◽  
Acute Care ◽  
Health Care Costs ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Emergency Room Visits ◽  
The Mean ◽  
Care Costs

e21529 Background: Elderly glioblastoma (GB) patients are at risk of hospitalizations due to the morbidity of the disease and possible treatment toxicity. Methods: In this observational cohort study, 255 newly diagnosed GB patients age 65 years and older were included. Survival, emergency room visits and admissions to an acute care hospital were determined. Mean and median total health care costs were calculated. Risk factors for Emergency room visits and acute care hospital admissions were determined. Results: Median overall survival was 6 months. The majority of patients (68%) had at least one visit to the emergency department and 77% had at least one admission to acute care. The mean and median length of hospital stay per patient was 20.5 days and 14 days respectively. Forty-three percent of patients spent 0-4% of their survival as an inpatient. Only 3% spent 70% or more of their survival as an acute care inpatient. There was a mean of 79.7 days and a median of 43 days from the last emergency department visit to death. The mean and median total costs (hospital, ambulatory, physician billing, other health care costs) per patient were $162 479.78 (CAN) and $125 511.00 (CAN), respectively. Treatment with radiation or treatment with radio-chemotherapy was associated with a relative risk (RR) of 2.31 (95% CI 1.44, 3.7; p = 0.0005) and 2.19 (95% CI 1.28, 3.74; p = 0.0 04), respectively for emergency department visits as compared to patients who were managed with comfort measures only. Patients with a baseline ECOG 0 had a RR of 1.71 (95% CI 1.06, 2.77; p = 0.0289) and patients with baseline ECOG 1 had a RR of 1.49 (0.98, 2.26; p = 0.0623) for hospital admission as compared to patients with ECOG 4. Conclusions: A large proportion of elderly GB patients (particularly those with good baseline performance status who underwent active treatment) presented to the emergency department and had at least one admission to acute care.

scholarly journals Five-Year Outcomes of Chronic Red Blood Cell Exchange Transfusion Program for Patients with Sickle Cell Disease, the Experience of University of Nebraska Medical Center

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4988-4988
Author(s):  
Omar Abughanimeh ◽  
Steven Ebers ◽  
Mahammed Khan Suheb ◽  
Julie Eclov ◽  
Robin High ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Blood Cell ◽  
Emergency Room ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Research Funding ◽  
Medical Center ◽  
Emergency Room Visits ◽  
Cell Disease ◽  
The Mean

Abstract Background: Red blood cell exchange (RBCX) is an effective therapy in treatment of acute and chronic complications of sickle cell disease (SCD). It involves exchanging patient's red blood cells (RBCs) with donor RBCs to significantly lower hemoglobin S concentration without subjecting the patient to the risk of iron overload. The University of Nebraska Medical Center (UNMC) established a chronic RBCX program in November 2015, which cared for patients with multiple hemoglobinopathies. In this study, we aim to evaluate some of the outcomes of patients with SCD who joined the program. Methods: This is a retrospective study based on review of medical records of patients with sickle cell disease. We reviewed the health records of patients with SCD who were enrolled in the chronic RBCX program between 11/2015-8/2020 at UNMC. We included patients with SCD, regardless of age, who underwent RBCX in the outpatient setting during the study period. Data were collected to assess if RBCX influenced the frequency of SCD crisis, emergency room visits, hospitalizations, and other sickle cell-related complications. Results: A total of 404 sessions of exchange transfusions were performed between November 2015 and August 2020 for 21 patients with SCD. The study included 9 adults (age ≥ 18 years) and 12 children with a median age of 12 years (2-31 years). During the study period, 3 adults left the program due to relocation out of state, patient's preference, or physician's decision. Table 1 summarizes the population demographic. The most common indication for enrollment in the RBCX program was recurrent sickle cell crisis (Figure 1). The mean number of emergency room visits before enrollment in the RBCX program was 22.5 visits (2-62 visits), which reduced after enrollment to 10.4 visits (0-65 visits), with a difference in mean of 12.1 visits (P=0.0021). The mean number of hospital admissions before enrollment in the RBCX program was 13.2 admissions(0-54 admissions), which also reduced to 6.7 admissions (0-50 admissions), with a significant difference in the means equal to 6. 6 admissions (P=0.0013) (Figure 2). Thirteen patients had a baseline ferritin &gt; 500 ng/ml at enrollment; all of them had a decrease in their baseline ferritin during the study, with 4 of them achieving a new baseline &lt; 500 ng/ml. Six patients had pre-existing antibodies at enrollment due to prior alloimmunization; however, no new alloantibodies were noticed after enrollment. The patients without preexisting antibodies were transfused with Rh and Kell matched blood. The patients with pre-existing antibodies were transfused with phenotypically matched blood. Three patients became pregnant during the study period, and their pregnancies were uncomplicated except for one patient with preeclampsia resulting in early delivery. There was no reportable death, acute chest syndrome, or stroke among the patients during the study period. Conclusion Outpatient chronic RBCX demonstrated safety and feasibility in both adults and children. It also showed promising outcomes in terms of reduction of sickle cell complications, number of emergency room visits and hospitalizations. These results can provide the basis for evaluating RBCX in a prospective study to better understand changes in quality of life and clinical outcomes of patients with SCD and limited therapeutic options. Figure 1 Figure 1. Disclosures Gundabolu: Pfizer: Research Funding; Samus Therapeutics: Research Funding; BioMarin Pharmaceuticals: Consultancy; Bristol-Myers Squibb Company: Consultancy; Blueprint Medicines: Consultancy.

scholarly journals A78 THE IMPACT OFGASTROINTESTINAL FOLLOW UP CARE ON HEALTHCARE UTILIZATION IN PATIENTS WITH ESINOPHILICESOPHAGITID (EOE).

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 45-46
Author(s):  
K Alazemi ◽  
M Alkhattabi ◽  
J C Gregor
Keyword(s):  
Emergency Room ◽  
Healthcare Utilization ◽  
Attrition Rate ◽  
Quality Improvement Initiative ◽  
Food Impaction ◽  
Emergency Room Visits ◽  
True Rate ◽  
Funding Agencies ◽  
The Impact

Abstract Background EOE is an increasingly recognized gastrointestinal condition that causes significant morbidity ranging from dietary limitations to food impactions requiring emergency room visits. There are a variety of dietary, pharmacologic and endoscopic treatments available but most are more practically guided by a subspecialist familiar and experienced with the condition. There is a perception among some physicians that follow up is sporadic and may be related at least in part to patient compliance. Aims To assess the true rate of EOE patients follow up rate at Lodon Health Scince Center Methods We used a retrospective cohort of patients diagnosed with EoE between July 2011 and June 2014 who met the traditional diagnostic criteria. As part of a quality improvement initiative, local follow up over the ensuing 5–7 years was tracked. The impact of follow up on subsequent healthcare utilization was analyzed. Results 123 patients with biopsy confirmed EoE were analyzed. Follow up appointments were made for 114/123 (92%) patients. 55/123 (45%) had repeat elective endoscopy booked. Only 10/114 (8.7%) of initial appointments went unattended but 15/55 (27.2%) of the patients offered ongoing follow up failed to attend. There were no complications (ie. perforation or bleeding) attributable to any of the procedures. 5/123 (4%) patients required repeat emergency room endoscopy for food impaction. Two patients required this on multiple occasions. 4/5 patients requiring repeat emergency room endoscopy for food impaction had received some sort of follow up, although 4/5 of these had at least one missed appointment. 2/5 patients having emergency room endoscopy required overnight admission. There were no perforations in the cohort. Conclusions Patients with a confirmed diagnosis of EOE do have a risk of requiring subsequent emergency endoscopy for food impaction although it is not clear that scheduled follow up significantly reduces that risk. Contrary to the perception of some physicians, patients with EoE are very likely to attend their first follow up visit although the attrition rate for subsequent scheduled visits is not insignificant. Funding Agencies None

Sign in / Sign up

Export Citation Format

Share Document