Cost savings to hospital of rituximab use in severe autoimmune acquired thrombotic thrombocytopenic purpura

Abstract Patients with severe autoimmune thrombotic thrombocytopenic purpura (TTP) experience acute hematologic emergencies during disease flares and a lifelong threat for relapse. Rituximab, in addition to steroids and therapeutic plasma exchange (TPE), has been shown to mitigate relapse risk. A barrier to care in initiating rituximab in the inpatient setting has been the presumed excessive cost of medication to the hospital. Retrospectively reviewing TTP admissions from 2004 to 2018 at our academic center, we calculated the actual inpatient cost of care. We then calculated the theoretical cost to the hospital of initiating rituximab in the inpatient setting for both initial TTP and relapse TTP cohorts, with the hypothesis that preventing sufficient future TTP admissions offsets the cost of initiating rituximab in all patients with TTP. At a median follow-up of 55 months in the initial TTP cohort, rituximab use produced a projected cost savings of $905 906 and would have prevented 185 inpatient admission days and saved 137 TPE procedures. In the relapse TTP setting, rituximab use produced a projected cost savings of $425 736 and would have prevented 86 inpatient admission days and saved 64 TPE procedures. From a hospital cost standpoint, cost of rituximab should no longer be a barrier to initiating inpatient rituximab in both initial and relapse TTP settings.

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Oral Antibiotic Management of Acute Osteomyelitis of the Hand: Outcomes and Cost Comparison to Standard Intravenous Regimen

Hand ◽

10.1177/1558944719873145 ◽

2019 ◽

pp. 155894471987314

Author(s):

Mark Henry ◽

Forrest H. Lundy

Keyword(s):

Bone Loss ◽

Direct Cost ◽

Cost Model ◽

Cost Savings ◽

Cost Of Care ◽

Cost Comparison ◽

Study Cohort ◽

Oral Antibiotic ◽

Direct Inoculation ◽

The Cost

Background: Acute, direct inoculation osteomyelitis of the hand has traditionally been managed by intravenous antibiotics. With proven high levels of bone and joint penetration, specific oral antimicrobials may deliver clinical efficacy but at substantially lower cost. Methods: Sixty-nine adult patients with surgically proven acute, direct inoculation osteomyelitis of the hand were evaluated for clinical response on a 6-week postdebridement regimen of susceptibility-matched oral antibiotics. Inclusion required gross purulence and bone loss demonstrated at the initial debridement and radiographic evidence of bone loss. Excluded were 2 patients with extreme medical comorbidities. There were 53 men and 16 women with a mean age of 46 years. Mean follow-up was 16 weeks (±10). The cost model for the outpatient oral antibiotic treatment was intentionally maximized using Walgreen’s undiscounted cash price. The cost model for the traditional intravenous treatment regimen was intentionally minimized using the fully discounted Medicare fee schedule. Results: All patients achieved resolution of osteomyelitis by clinical and radiographic criteria. In addition, 7 patients underwent successful subsequent osteosynthesis procedures at the previously affected site without reactivation. The mean postdebridement direct cost of care per patient in the study cohort was $482.85, the cost of the antibiotic alone. The postdebridement direct cost of care per patient on a regimen of vancomycin 1.5 g every 12 hours via peripherally inserted central catheter line was $21 646.90. Conclusions: Acute, direct inoculation osteomyelitis of the hand can be successfully managed on oral antibiotic agents with substantial direct and indirect cost savings.

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Higher Incidence of TTP in African Americans and Females: An Analysis of Demographics, Cost and Length of Stay in Teaching and Nonteaching Hospitals for Thrombotic Thrombocytopenic Purpura Between 1999 and 2013

Blood ◽

10.1182/blood.v128.22.4735.4735 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4735-4735

Author(s):

William Lee ◽

Stuthi Perimbeti ◽

Mariola Vazquez Martinez ◽

Nausheen Hakim ◽

Daniel Kyung ◽

...

Keyword(s):

African Americans ◽

Length Of Stay ◽

Thrombotic Thrombocytopenic Purpura ◽

Teaching Hospitals ◽

Short Term ◽

Thrombocytopenic Purpura ◽

Total Cost ◽

Chi Square Analysis ◽

The Cost ◽

The U.S

Abstract Background: Limited studies compare the differences in care for Thrombotic Thrombocytopenic Purpura (TTP) patients in teaching versus nonteaching hospitals. TTP is a rare, life-threatening disease marked by widespread aggregation of platelets throughout the body, resulting in multi-organ sequelae including neurological dysfunction and renal insufficiency: a timely diagnosis is imperative for successful treatment. Academic centers generally have more individuals involved in each patient's care. This was considered in the evaluation of demographics, cost, length of stay, and disposition at discharge in the different settings. Methods: Adult admissions with a primary diagnosis of TTP for a 15-year period between 1999 and 2013 were extracted from the National Inpatient Sample database using the ICD-9 code 446.2 during a 15 year period between 1999 and 2013 (N=6,292, for a weighted N=30,011). The sample was weighted to approximate the full inpatient population of the U.S. over the time period. Teaching and nonteaching hospitals were compared within the parameters of gender, race, total cost, insurance, length of stay, mortality, and disposition. Chi square analysis was performed to examine differences in the categorical variables. Total cost was adjusted for inflation using data from the U.S. Bureau of Labor Statistics. Results: The total number of admission for TTP was weighted N=28,058, divided between 20,426 for teaching and 8,082 for nonteaching hospitals. 67.6% of TTP admissions were female in both categories but a greater percentage of African Americans with TTP were admitted to teaching (N=6,842; 33.50%) than nonteaching hospitals (N=1,962; 24.28%) (p < 0.0001). More Caucasians with TTP were admitted to non-teaching (N=2,707; 33.50%) than teaching hospitals (N=6,834; 32.46%) (p <0.0001). The overall length of stay for TTP hospitalizations was 12.30 days +/- 0.16, with teaching hospitals being found to have a shorter length of stay at 11.26 +/- 0.28 days compared to nonteaching hospitals with 13.15 +/- 0.20 days (p < 0.0001). There was a slightly higher mortality rate in nonteaching hospitals: 8.92% in teaching hospitals versus 9.32% in nonteaching hospitals (p <0.6232). Overall hospital mortality decreased from 12.1% in 1999 to 6.0% in 2013. At discharge, more patients from nonteaching hospitals were transferred to short term facilities than those from teaching: 1,877 (23.23%) non-teaching patients versus 2,038 (9.98%) teaching patients (p = 0.0001). The overall cost of a TTP hospitalization was $106,184.94 +/- $1,762.57. Nonteaching hospitals had more costly hospitalizations at $113,437.87 +/- $2247.78 than teaching hospitals, which cost $99,481.35 +/- $3093.53 (p <0.0001). Medicare paid 26.23% of TTP hospitalizations in nonteaching hospitals and 22.91% in teaching hospitals (p <0.0006). Medicaid paid for 18.12% of TTP hospitalizations in teaching hospitals and 12.89% in nonteaching hospitals (p <0.0006). An increase in the cost for admissions for TTP was noted from 1999 to 2013. While the total charge of TTP admission was $58,437 in 1999, it was found to be $153,643 in 2013, or $109,878 when adjusted for inflation. This amounted to an adjusted 88% increase despite an essentially unchanged average length of stay, 12.5 days in 1999 and 12.6 days in 2013. Conclusion: In comparing TTP hospitalizations, teaching hospitals had a shorter length of stay, lesser cost of stay, and sent fewer patients to short term facilities upon discharge. However, these factors did not play a statistically significant role in decreasing mortality. Additionally, a trend of increasing total charges was noted from 1999 to 2013 despite an unchanged length of hospitalization and a decrease in mortality. Advanced age is associated with worse outcome in TTP and this is reflected by the higher mortality and higher percentage of Medicare payment in nonteaching hospitals. Medicaid was responsible for a higher percentage of payment in teaching hospitals and correlated with an improved mortality. Both African Americans and females were found to have more admissions regardless of hospital type, with African Americans being admitted more often to teaching than nonteaching hospitals. Further studies are necessary to determine the etiology of this significant rise in the cost of TTP treatment and to investigate the disproportionately higher incidence of TTP in African Americans and females. Disclosures No relevant conflicts of interest to declare.

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The Impact of Health Information Sharing on Hospital Costs

Healthcare ◽

10.3390/healthcare9070806 ◽

2021 ◽

Vol 9 (7) ◽

pp. 806

Author(s):

Na-Eun Cho

Keyword(s):

Information Sharing ◽

Health Information ◽

Hospital Costs ◽

Cost Savings ◽

Cost Of Care ◽

Health It ◽

Substantial Progress ◽

The Cost ◽

The Impact ◽

Health Information Sharing

Despite substantial progress in the adoption of health information technology (IT), researchers remain uncertain as to whether IT investments benefit hospitals. This study evaluates the effect of health information sharing on the cost of care, and whether the effect varies with context. Our results suggest that information sharing using health IT, specifically the extent (breadth) and level of detail (depth) of information sharing, helps to reduce the cost of care at the hospital level. The results also show that the effects of depth of information sharing on cost savings are salient in poor and less-concentrated regions, but not in wealthier, more-concentrated areas, whereas the the effects of breadth of information sharing on cost savings are equivalent across wealth and concentration. To realize the benefits of using health IT more effectively, policy makers’ strategies for encouraging active use of health IT should be informed by market characteristics.

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Cost of care for adult patients with relapsed acute lymphoblastic leukemia (rALL) in Germany.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e18504 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e18504-e18504

Author(s):

Yun Su ◽

Sarah Schmitter ◽

Ana Navarro ◽

Lukas Mayerhoff ◽

Sigurd Prieur ◽

...

Keyword(s):

Lymphoblastic Leukemia ◽

Cost Of Care ◽

Adult Patients ◽

Inpatient Cost ◽

German Population ◽

Cell Transplant ◽

Term Survival ◽

Number Of Patients ◽

The Cost ◽

The Impact

e18504 Background: Adult ALL is a rare but progressive frequently fatal disease. For those who survive and respond to initial therapy, many experience relapse. For relapse ALL (rALL), stem cell transplant (SCT) is potentially curative. This retrospective observational study investigates the cost of care and the impact of SCT on total cost for rALL. Methods: A representative sample of German claims data covering approximately 7 million of the German population was used to identify patients 18 years and older with a new diagnosis of ALL (ICD-10-GM code: C91.0*) between Jan 2011 and Dec 2015 who had a relapse after remission to initial treatment. Mean health care cost per patient per quarter were determined by whether or not SCT was received after relapse. Costs were from the perspective of German statutory health insurance and included prescription, outpatient and inpatient treatment costs. Results: Of the total 116 incident adult ALL patients identified, 29 (25%) were determined to have had a relapse, 11 underwent SCT after the relapse (38%). Patients with a SCT appear to incur higher cost than those without SCT in each of the quarters after relapse was diagnosed (Table), with the highest in the first quarter, but decreasing in subsequent quarters. Inpatient cost accounted for the majority of the cost for the first three quarters for both SCT and non-SCT patients (64% in Q2 to 86% in Q1). The number of patients in the SCT cohort remained relatively stable, while the non-SCT cohort had only half the patients left by the third quarter post relapse. Conclusions: Current results inform the magnitude of cost in Germany associated with adult patients with rALL with or without a SCT after relapse. It would be important to determine the magnitude of benefit such as long-term survival associated with SCT as well. The cost estimates provide a benchmark against which new treatment options for rALL can be compared. [Table: see text]

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Cost Effectiveness of Rituximab As Adjunctive Therapy in Reducing Apheresis Procedures and Hospital Length of Stay in Relapsed Thrombotic Thrombocytopenic Purpura

Blood ◽

10.1182/blood-2018-99-113621 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3814-3814 ◽

Cited By ~ 2

Author(s):

George Goshua ◽

Amit Gokhale ◽

Jeanne E. Hendrickson ◽

Christopher Tormey ◽

Alfred Ian Lee

Keyword(s):

Length Of Stay ◽

Low Dose ◽

Standard Dose ◽

Cost Savings ◽

Similar Efficacy ◽

Inpatient Setting ◽

Sustained Remission ◽

Thrombocytopenic Purpura ◽

Average Hospital ◽

Total Cost

Abstract Introduction: Rituximab at standard dosing (375 mg/m2 weekly for 4 weeks) is effective in preventing thrombotic thrombocytopenic purpura (TTP) relapse and is recommended as a therapy of choice along with plasmapheresis (PLEX) in the UK expert-based guidelines on TTP (category IB), although it is not yet universally viewed as standard of care. There is also emerging data for low dose rituximab (100 mg weekly for 4 weeks) in the treatment of relapsing TTP with mixed data on efficacy as compared to standard dose rituximab. With this in mind, we conducted a retrospective chart review to examine the financial cost of treating a patient hospitalized for a TTP relapse with rituximab, PLEX and steroids compared to PLEX and steroids only. The purpose of this study was to determine an average savings per patient of utilizing rituximab as an adjunctive agent in the inpatient setting. Methods: Chart records for patients admitted to a major academic center with a diagnosis of TTP, defined as laboratory and smear evidence of microangiopathy with ADAMTS13 level of 10% or less or evidence of microangiopathy in a patient with a prior established diagnosis of TTP, were reviewed. The clinical course of all patients including treatments received and length of stay (LOS) for each hospitalization was recorded. TTP relapse was defined as hospitalization for TTP more than 30 days after hospital discharge. An average hospital cost per patient with a relapsed episode of TTP was calculated utilizing average costs for LOS and for PLEX during their hospitalization for TTP relapse. The average wholesale price of a fixed dose of rituximab for one cycle (defined as four doses of 375 mg/m2) was utilized to calculate the total cost of rituximab treatment. A cost superiority determination per patient was calculated by comparing the total cost of relapsed TTP hospitalizations versus the cost of rituximab administered in the inpatient setting. All costs are listed in United States Dollar (USD). Results: A total of 28 patients spanning 25 years were hospitalized for a TTP exacerbation. The median age of these patients was 40.7 with ADAMTS13 level of 6.5% at diagnosis and 3.2% at relapse. Of 28 patients, 15 patients had relapsed TTP for a total of 50 hospitalizations. All 15 relapsed patients were treated with PLEX and steroids during every hospitalization. The average number of inpatient PLEX procedures performed on patients admitted for relapsed TTP was 7.1 with an average hospital LOS of 9.6 days. 13 of the 15 relapsed patients received a total of 15 cycles of rituximab while 2 patients did not receive any rituximab. Of the 13 rituximab-treated patients, 10 received one cycle of rituximab, with 9 achieving a sustained remission and the other patient experiencing a relapse of TTP that was not treated with any additional rituximab; 2 received a second cycle, with both achieving a sustained remission, although 1 had an allergic reaction during the second cycle that led to discontinuation of rituximab. In total, 11 of 15 episodes of relapsed TTP were treated with rituximab with 73% achieving a sustained remission over a median follow up time of 36 months. In our study cohort, use of rituximab would have led to a reduction in 182 total hospitalization days and 135 total PLEX procedures, yielding a cost savings of $59,918.40 per relapse of TTP. This would be offset by a cost of $30,894 for each cycle of standard dose rituximab, for a net cost savings of $29,024.40 per occurrence of TTP relapse treated with rituximab. A similar cost analysis utilizing low dose rituximab yielded a net cost savings of $55,582.40 per relapse of TTP, assuming similar efficacy of low and standard dose rituximab. Conclusions: The addition of rituximab to PLEX and steroids in treatment of relapsed TTP is more cost effective than PLEX and steroids alone, owing to the high efficacy of rituximab and the cumulative costs of PLEX and hospital LOS. This cost superiority of rituximab holds both for standard and low dose rituximab, assuming similar efficacy of the latter. Although not calculated in our analysis, administration of rituximab in the outpatient rather than inpatient setting would result in further cost savings. Therefore, from a cost efficiency standpoint, rituximab should be incorporated into treatment paradigms for relapsed TTP. Disclosures No relevant conflicts of interest to declare.

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Pancreatic cancer cost-of-care in inpatient setting.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.28 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 28-28

Author(s):

Dhruv Bansal ◽

Pranshu Bansal ◽

Vidit Kapoor

Keyword(s):

Pancreatic Cancer ◽

Cancer Care ◽

Cost Of Care ◽

Inpatient Cost ◽

Inpatient Setting ◽

Modest Improvement ◽

Time Period ◽

The Mean ◽

Improvement In Survival ◽

Mean Cost

28 Background: Pancreatic cancer continues to carry bad prognosis with modest improvement in survival in the last decade. SEER analysis from 2006-2012 shows a 5-year survival of 7.7% for pancreatic cancer and number of new diagnoses were 11.3 per 100,000 U.S. population in 2003 and 12.7 in 2013. The mortality rate was 10.5 and 10.8 per 100,000 during the same time period. In spite of modest improvement in survival, the cancer care costs including pancreatic cancer continue to rise and inpatient costs contribute a major chunk to cancer care which is often ignored. Methods: We used National Inpatient Sample (NIS) to extract data for patients hospitalized with primary diagnosis of pancreatic cancer using clinical classification software code 17, and corresponding ICD9 codes for the years 2004-2013. NIS is a nationally representative survey of hospitalizations conducted by the Healthcare Cost and Utilization Project. It represents 20% of all hospital data in the US. Trend of rate of hospitalization, mean length of stay (LOS), and mean cost of hospitalization were analyzed. Results: The rate of hospitalization for pancreatic cancer were 11.0 +/-0.5 in 2004 and 11.0 +/-0.3 per 100,00 hospitalizations in 2013. Mean LOS declined from 8.978 +/-0.141 to 7.616 +/-0.105 days between 2004-2013. In the same time period the mean cost of hospital stay increased from $39,533 +/-1,514 to $74,216 +/- 2,408. Conclusions: In the years 2004-2013 the rate of hospitalization for pancreatic cancer remained stable (z test p = 1.0), LOS decreased significantly by approximately 15% (z test p < 0.001), but the mean cost of hospitalization showed the most significant increase throughout the decade with a mean increase of approximately 47% (p < 0.001) in hospital costs. National inflation rate was 23.3% during this time. The gains made in decreasing the LOS has not lead to a decrease in inpatient cost of care. Pancreatic cancer treatment lags behind other cancers with dismal survival rates, and combination chemotherapies are increasingly being used which may add to inpatient cost in future as well although results at this time remain modest. Further research efforts to better identify the factors contributing to inpatient cost should be undertaken.

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Exploration-Stage Implementation Variation

Zeitschrift für Psychologie ◽

10.1027/2151-2604/a000164 ◽

2014 ◽

Vol 222 (1) ◽

pp. 37-48 ◽

Cited By ~ 12

Author(s):

Stephanie Romney ◽

Nathaniel Israel ◽

Danijela Zlatevski

Keyword(s):

Parent Training ◽

Average Cost ◽

Cost Savings ◽

Training Group ◽

Group Differences ◽

Triple P ◽

Community Based ◽

Parent Training Program ◽

A Site ◽

The Cost

The present study examines the effect of agency-level implementation variation on the cost-effectiveness of an evidence-based parent training program (Positive Parenting Program: “Triple P”). Staff from six community-based agencies participated in a five-day training to prepare them to deliver a 12-week Triple P parent training group to caregivers. Prior to the training, administrators and staff from four of the agencies completed a site readiness process intended to prepare them for the implementation demands of successfully delivering the group, while the other two agencies did not complete the process. Following the delivery of each agency’s first Triple P group, the graduation rate and average cost per class graduate were calculated. The average cost-per-graduate was over seven times higher for the two agencies that had not completed the readiness process than for the four completing agencies ($7,811 vs. $1,052). The contrast in costs was due to high participant attrition in the Triple P groups delivered by the two agencies that did not complete the readiness process. The odds of Triple P participants graduating were 12.2 times greater for those in groups run by sites that had completed the readiness process. This differential attrition was not accounted for by between-group differences in participant characteristics at pretest. While the natural design of this study limits the ability to empirically test all alternative explanations, these findings indicate a striking cost savings for sites completing the readiness process and support the thoughtful application of readiness procedures in the early stages of an implementation initiative.

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