Assessing direct healthcare costs when restricted to self-reported data: a scoping review

Abstract Background In the absence of electronic health records, analysis of direct healthcare costs often relies on resource utilisation data collected from patient-reported surveys. This scoping review explored the availability, use and methodological details of self-reported healthcare service utilisation and cost data to assess healthcare costs in Ireland. Methods Population health surveys were identified from Irish data repositories and details were collated in an inventory to inform the literature search. Irish cost studies published in peer-reviewed and grey sources from 2009 to 2019 were included if they used self-reported data on healthcare utilisation or cost. Two independent researchers extracted studies’ details and the PRISMA-ScR guidelines were used for reporting. Results In total, 27 surveys were identified containing varying details of healthcare utilisation/cost, health status, demographic characteristics and health-related risk and behaviour. Of those surveys, 21 were general population surveys and six were study-specific ad-hoc surveys. Furthermore, 14 cost studies were identified which used retrospective self-reported data on healthcare utilisation or cost from ten of the identified surveys. Nine of these cost studies used ad-hoc surveys and five used data from pre-existing population surveys. Compared to population surveys, ad-hoc surveys contained more detailed information on resource use, albeit with smaller sample sizes. Recall periods ranged from 1 week for frequently used services to 1 year for rarer service use, or longer for once-off costs. A range of perspectives (societal, healthcare and public sector) and costing approaches (bottom-up costing and a mix of top-down and bottom-up) were used. The majority of studies (n = 11) determined unit prices using multiple sources, including national healthcare tariffs, literature and expert views. Moreover, most studies (n = 13) reported limitations concerning data availability, risk of bias and generalisability. Various sampling, data collection and analysis strategies were employed to minimise these. Conclusion Population surveys can aid cost assessments in jurisdictions that lack electronic health records, unique patient identifiers and data interoperability. To increase utilisation, researchers wanting to conduct cost analyses need to be aware of and have access to existing data sources. Future population surveys should be designed to address reported limitations and capture comprehensive health-related, demographic and resource use data.

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Direct costs of overdiagnosed asthma: a longitudinal, population-based cohort study in British Columbia, Canada

BMJ Open ◽

10.1136/bmjopen-2019-031306 ◽

2019 ◽

Vol 9 (11) ◽

pp. e031306 ◽

Cited By ~ 1

Author(s):

Bryan Ng ◽

Mohsen Sadatsafavi ◽

Abdollah Safari ◽

J Mark FitzGerald ◽

Kate M Johnson

Keyword(s):

Cohort Study ◽

Resource Use ◽

Healthcare Costs ◽

Challenge Test ◽

Medication Use ◽

Population Based ◽

Methacholine Challenge ◽

Physician Visits ◽

Direct Healthcare Costs ◽

Physician Diagnosis

ObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and to evaluate strategies to reduce this burden. We assessed differences in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out.DesignPopulation-based, prospective cohort study.SettingParticipants were recruited through random-digit dialling of both landlines and mobile phones in the province of British Columbia, Canada.ParticipantsWe included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma. The diagnosis of asthma was reassessed at the end of 12 months of follow-up using a structured algorithm, which included a bronchodilator reversibility test, methacholine challenge test, and if necessary medication tapering and a second methacholine challenge test.Primary and secondary outcome measuresSelf-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits and medication use from the perspective of the Canadian healthcare system.ResultsAsthma was ruled out in 86 (24.9%) participants. The average annual asthma-related direct healthcare costs for participants with confirmed asthma were $C497.9 (SD $C677.9) and for participants with asthma ruled out, $C307.7 (SD $C424.1). In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (relative ratio (RR)=1.60, 95% CI 1.14 to 2.22), increased rate of specialist visits (RR=2.41, 95% CI 1.05 to 5.40) and reliever medication use (RR=1.62, 95% CI 1.09 to 2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11).ConclusionsA quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.

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The direct costs of overdiagnosed asthma in a longitudinal population-based study

10.1101/409870 ◽

2018 ◽

Author(s):

Bryan C. Ng ◽

Mohsen Sadatsafavi ◽

Abdollah Safari ◽

J. Mark FitzGerald ◽

Kate M. Johnson

Keyword(s):

Resource Use ◽

Healthcare Costs ◽

Healthcare Resource ◽

Medication Use ◽

Population Based ◽

Healthcare Resource Use ◽

Asthma Diagnosis ◽

Physician Visits ◽

Direct Healthcare Costs ◽

Physician Diagnosis

ABSTRACTObjectivesA current diagnosis of asthma cannot be objectively confirmed in many patients with physician-diagnosed asthma. Estimates of resource use in overdiagnosed cases of asthma are necessary to measure the burden of overdiagnosis and evaluate strategies to reduce this burden. We assessed the difference in asthma-related healthcare resource use between patients with a confirmed asthma diagnosis and those with asthma ruled out.DesignPopulation-based prospective cohort study.SettingParticipants were recruited through random-digit dialling of both landlines and mobile phones in BC, Canada.ParticipantsWe included 345 individuals ≥12 years of age with a self-reported physician diagnosis of asthma which was confirmed by a bronchodilator reversibility or methacholine challenge test at the end of the 12-month follow-up.Primary and secondary outcome measuresSelf-reported annual asthma-related direct healthcare costs (2017 Canadian dollars), outpatient physician visits, and medication use from the Canadian healthcare system perspective.ResultsAsthma was ruled out in 86 (24.9%) participants. Average annual asthma-related direct healthcare costs for participants with confirmed asthma were $497.9 (SD $677.9), and $307.7 (SD $424.1) for participants with asthma ruled out. In the adjusted analyses, a confirmed diagnosis was associated with higher direct healthcare costs (Relative Ratio [RR]=1.60, 95%CI 1.14-2.22), increased rate of specialist visits (RR=2.41, 95%CI 1.05-5.40) and reliever medication use (RR=1.62, 95%CI 1.09-2.35), but not primary care physician visits (p=0.10) or controller medication use (p=0.11).ConclusionsA quarter of individuals with a physician diagnosis of asthma did not have asthma after objective re-evaluation. These participants still consumed a significant amount of asthma-related healthcare resources. The population-level economic burden of asthma overdiagnosis could be substantial.Strengths and limitations of this studyParticipants were recruited through random sampling of the general population in the province of British Columbia.Asthma diagnosis was confirmed or ruled out using sequential guideline-recommended objective airway tests.Healthcare resource use was self-reported, potential recall bias may have led to reduced accuracy.The study was unable to evaluate the indirect costs of overdiagnosis or the cost-savings from correcting the diagnosis.The generalizability of the results may be limited by regional differences in medical costs and practices.

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Cohort study of healthcare use, costs and diagnoses from onset to 6 months after discharge for takotsubo syndrome in Sweden

BMJ Open ◽

10.1136/bmjopen-2018-027814 ◽

2019 ◽

Vol 9 (2) ◽

pp. e027814 ◽

Cited By ~ 2

Author(s):

Sara Wallström ◽

Inger Ekman ◽

Elmir Omerovic ◽

Kerstin Ulin ◽

Hanna Gyllensten

Keyword(s):

Primary Care ◽

Resource Use ◽

Healthcare Costs ◽

Healthcare Resource ◽

Takotsubo Syndrome ◽

Healthcare Resource Use ◽

Direct Healthcare Costs ◽

The Mean ◽

Discharge From Hospital

ObjectiveLittle is known about the economic impact of takotsubo syndrome (TS) for patients and the health system after initial discharge from hospital. Therefore, the aim of this study was to describe the healthcare resource use and calculate direct healthcare costs for TS, from hospitalisation to 6 months after discharge, and explore the distribution of costs between TS and other diagnoses among patients with TS.Method, participants and settingCohort study investigating direct healthcare costs from hospitalisation, open specialised outpatient and primary care. Healthcare resource use during 6 months after diagnosis with TS was collected for 58 consecutive patients from the Regional Patient Register. Incidence-based direct healthcare costs, in 2015 values, were calculated using diagnosis-related group weights and unit costs from national statistics on healthcare costs.ResultsThe mean length of hospital stay was 10.2 days, index 6.4 and re-admissions 3.8 days. The mean number of follow-up encounters per patient was 15.6, of which two-thirds was specialised outpatient and one-third was primary care. This resulted in an average cost of €10 360. Of this, costs of €8026 (77.5%) occurred during encounters for which at least one of the registered conditions was cardiovascular. Costs differed little according to background characteristics.ConclusionThis study shows that patients utilise hospital, specialised outpatient and primary care after discharge for TS. Most direct healthcare costs relate to cardiac diagnoses. Patients with TS would probably benefit from a supportive follow-up programme after discharge from hospital.

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Humanistic burden and economic impact of chronic kidney disease: a systematic literature review

F1000Research ◽

10.12688/f1000research.21374.1 ◽

2019 ◽

Vol 8 ◽

pp. 2142 ◽

Cited By ~ 2

Author(s):

Caroline Freeman ◽

Lucia Giles ◽

Polly Field ◽

Elisabeth Sörstadius ◽

Heleen van Haalen

Keyword(s):

Quality Of Life ◽

Kidney Disease ◽

Resource Use ◽

Healthcare Costs ◽

Symptom Burden ◽

Disease Stage ◽

Life Questionnaire ◽

Quality Of Life Questionnaire ◽

Reported Data

Background: Chronic kidney disease (CKD) is increasing in prevalence worldwide. Progression of CKD to end-stage renal disease (ESRD) can result in the requirement for renal replacement therapy, which incurs considerable healthcare costs and imposes restrictions on patients’ daily living. This systematic review was conducted to inform understanding of the humanistic and economic burden of CKD by collecting quality of life (QoL), symptom burden, and cost and resource use data, with a focus on the impact of disease progression. Methods: Embase, MEDLINE, the Cochrane Library, and conference proceedings were searched in May 2017 according to predefined inclusion criteria. Data were extracted for full publications reporting either QoL or symptom burden (published 2007–2017; reporting data from ≥ 100 patients) or costs and resource use (published 2012–2017). Relevant QoL studies were those that used the 6-dimension or 8-, 12-, or 36-item Short-Form Health Surveys, 5-dimension EuroQol questionnaire, Healthy Days/Health-Related Quality of Life questionnaire, or Kidney Disease Quality of Life Questionnaire. Results: Data were extracted from 95 studies reporting QoL data, 47 studies reporting cost and resource use data, and eight studies reporting descriptions of symptoms; 12 studies (seven QoL; five costs/resource use) reported data for patients with and without CKD, and 15 studies (seven QoL; eight costs/resource use) reported data by disease stage. Patients with CKD, including those with ESRD, had worse QoL than those with normal kidney function, and incurred higher healthcare costs. Disease progression was associated with cost increases, particularly for later stages and in patients receiving dialysis. Increasing CKD severity was also associated with reductions in QoL, although not all studies identified showed a consistent decrease with increasing disease stage. Conclusions: The presence of CKD and CKD progression are associated with reductions in patients’ QoL and increased economic impact. This may be mitigated by interventions that slow progression.

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PCN76 Evaluating Trends In Direct Healthcare Costs In The Last Year Of Life Among Patients With Lung Cancer In Germany

Value in Health ◽

10.1016/j.jval.2020.08.213 ◽

2020 ◽

Vol 23 ◽

pp. S435

Author(s):

R. Knapp ◽

F. Hardtstock ◽

U. Maywald ◽

T. Wilke

Keyword(s):

Lung Cancer ◽

Healthcare Costs ◽

Direct Healthcare Costs

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Frailty Phenotype and Healthcare Costs in Women in Late Life: The SOF study

Innovation in Aging ◽

10.1093/geroni/igaa057.2814 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 778-778

Author(s):

Lisa Langsetmo ◽

Allyson Kats ◽

John Schousboe ◽

Tien Vo ◽

Brent Taylor ◽

...

Keyword(s):

Healthcare Costs ◽

Functional Limitations ◽

Late Life ◽

Cost Ratio ◽

Deficit Accumulation ◽

Frailty Phenotype ◽

Medicare Claims ◽

Accumulation Index ◽

Direct Healthcare Costs ◽

Frailty Indicator

Abstract We used data from 1324 women (mean age 83) at the 2002-2004 exam linked with their Medicare claims to determine the association of the frailty phenotype with healthcare costs. The frailty phenotype was categorized as robust, pre-frail or frail. Multimorbidity and a frailty indicator (approximating the deficit accumulation index) were derived from claims. Functional limitations were assessed by asking about difficulty performing IADL. Total direct healthcare costs were ascertained during 36 months following the exam. Compared with robust, pre-frailty and frailty were associated with higher costs after accounting for demographics, multimorbidity, functional limitations and the frailty indicator (cost ratio 1.37 [1.10-1.71] among pre-frail and 1.63 [1.28-2.08] among frail). Discrimination of high-cost (top decile) women was improved by adding the phenotype and functional limitations to a model containing demographics and the claims-based measures. Findings suggest that assessment of the phenotype may improve identification of individuals at higher risk of costly care.

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Which health-related reasons lead to prehospital emergency care and how does subjective emergency status connect to subsequent care?

Notfall + Rettungsmedizin ◽

10.1007/s10049-020-00832-2 ◽

2021 ◽

Author(s):

Silke Piedmont ◽

Anna Katharina Reinhold ◽

Jens-Oliver Bock ◽

Enno Swart ◽

Bernt-Peter Robra

Keyword(s):

Health Insurance ◽

Emergency Care ◽

Third Party ◽

Insurance Companies ◽

Prehospital Emergency Care ◽

Health Related ◽

Life Threatening ◽

Prehospital Emergency ◽

Health Insurance Companies ◽

Reported Data

Abstract Objectives/Background In many countries, the use of emergency medical services (EMS) increases steadily each year. At the same time, the percentage of life-threatening complaints decreases. To redesign the system, an assessment and consideration of the patients’ perspectives is helpful. Methods We conducted a paper-based survey of German EMS patients who had at least one case of prehospital emergency care in 2016. Four health insurance companies sent out the questionnaire to 1312 insured persons. We linked the self-reported data of 254 respondents to corresponding claims data provided by their health insurance companies. The analysis focuses a.) how strongly patients tend to call EMS for themselves and others given different health-related scenarios, b.) self-perceived health complaints in their own index case of prehospital emergency care and c.) subjective emergency status in combination with so-called “objective” characteristics of subsequent EMS and inpatient care. We report principal diagnoses of (1) respondents, (2) 57,240 EMS users who are not part of the survey and (3) all 20,063,689 inpatients in German hospitals. Diagnoses for group 1 and 2 only cover the inpatient stay that started on the day of the last EMS use in 2016. Results According to the survey, the threshold to call an ambulance is lower for someone else than for oneself. In 89% of all cases during their own EMS use, a third party called the ambulance. The most common, self-reported complaints were pain (38%), problems with heart and circulation (32%), and loss of consciousness (17%). The majority of respondents indicated that their EMS use was due to an emergency (89%). We could detect no or only weak associations between patients’ subjective urgency and different items for objective care. Conclusion Dispatchers can possibly optimize or reduce the disposition of EMS staff and vehicles if they spoke directly to the patients more often. Nonetheless, there is need for further research on how strongly the patients’ perceived urgency may affect the disposition, rapidness of the service and transport targets.

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Health-related quality of life 1–3 years post-myocardial infarction: its impact on prognosis

Open Heart ◽

10.1136/openhrt-2020-001499 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001499

Author(s):

Stuart Pocock ◽

David B Brieger ◽

Ruth Owen ◽

Jiyan Chen ◽

Mauricio G Cohen ◽

...

Keyword(s):

Quality Of Life ◽

Resource Use ◽

Rate Ratio ◽

Index Score ◽

Health Related Quality ◽

Lower Index ◽

Related Quality ◽

Health Related

ObjectiveTo assess associations of health-related quality of life (HRQoL) with patient profile, resource use, cardiovascular (CV) events and mortality in stable patients post-myocardial infarction (MI).MethodsThe global, prospective, observational TIGRIS Study enrolled 9126 patients 1–3 years post-MI. HRQoL was assessed at enrolment and 6-month intervals using the patient-reported EuroQol-5 dimension (EQ-5D) questionnaire, with scores anchored at 0 (worst possible) and 1 (perfect health). Resource use, CV events and mortality were recorded during 2-years’ follow-up. Regression models estimated the associations of index score at enrolment with patient characteristics, resource use, CV events and mortality over 2-years’ follow-up.ResultsAmong 8978 patients who completed the EQ-5D questionnaire, 52% reported ‘some’ or ‘severe’ problems on one or more health dimensions. Factors associated with a lower index score were: female sex, older age, obesity, smoking, higher heart rate, less formal education, presence of comorbidity (eg, angina, stroke), emergency room visit in the previous 6 months and non-ST-elevation MI as the index event. Compared with an index score of 1 at enrolment, a lower index score was associated with higher risk of all-cause death, with an adjusted rate ratio of 3.09 (95% CI 2.20 to 4.31), and of a CV event, with a rate ratio of 2.31 (95% CI 1.76 to 3.03). Patients with lower index score at enrolment had almost two times as many hospitalisations over 2-years’ follow-up.ConclusionsClinicians managing patients post-acute coronary syndrome should recognise that a poorer HRQoL is clearly linked to risk of hospitalisations, major CV events and death.Trial registration numberClinicalTrials.gov Registry (NCT01866904) (https://clinicaltrials.gov).

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Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers

BMC Emergency Medicine ◽

10.1186/s12873-020-00380-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sofi Varg ◽

Veronica Vicente ◽

Maaret Castren ◽

Peter Lindgren ◽

Clas Rehnberg

Keyword(s):

Emergency Department ◽

Acute Care ◽

Resource Use ◽

Healthcare Providers ◽

Healthcare Utilisation ◽

Direct Care ◽

Care Centre ◽

Decision System ◽

Geriatric Ward ◽

Patient Pathways

Abstract Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.

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