Variations in cost for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18106-e18106
Author(s):  
Jennifer Malin ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
Stephanie Korrer ◽  
Thomas Horstman ◽  
...  
Keyword(s):  
Clinical Data ◽  
Claims Data ◽  
Administrative Claims ◽  
Cancer Type ◽  
Prior Authorization ◽  
Her2 Breast Cancer ◽  
End Of Treatment ◽  
Relative Value ◽  
Time Table ◽  
Care Costs

e18106 Background: We aim to quantify economic outcomes of the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data from a prior authorization program for chemotherapy regimens linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, and biomarkers. Eligible patients were commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including total healthcare cost and cost of chemotherapy were tracked from first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment. Patients were censored at 5/31/2016 or end of enrollment. Results: There were 1612 BC, 237 NSCLC, and 386 CRC non-censored patients who received therapy during the study period. Mean (SD) total and monthly drug costs and total health care costs for the most common regimens by cancer are summarized in the table. Conclusions: The relative value of the most common therapies for BC, NSCLC, and CRC varied significantly depending on the metric used underscoring the importance of comparing total healthcare costs when assessing the value of therapies. Information on these and other regimens will increase as the database grows over time. [Table: see text]

Variations in inpatient stays for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC) in a real world setting.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18099-e18099
Author(s):  
Jennifer Malin ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
Stephanie Korrer ◽  
Thomas Horstman ◽  
...  
Keyword(s):  
Clinical Data ◽  
Claims Data ◽  
Administrative Claims ◽  
Cancer Type ◽  
Prior Authorization ◽  
Inpatient Stay ◽  
Her2 Breast Cancer ◽  
Real World Setting ◽  
End Of Treatment ◽  
The Impact

e18099 Background: We aim to compareprevalence and duration of inpatient stays during the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data obtained from a prior authorization program for chemotherapy linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, relevant biomarkers, and evidence of progression/relapse. Eligible patients included commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including percent of patients experiencing an inpatient stay and number of inpatient days were tracked from the first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment, with remaining patients censored at 5/31/2016 or end of enrollment. Results: There were 1612 HER2- BC, 237 NSCLC, and 386 CRC patients who completed therapy during the study period. Incidence and inpatient stay days per 100 patient months for the most common regimens for each cancer are summarized in the table. Conclusions: The rates and duration of inpatient stays varied substantially across the most commonly used therapies for BC, NSCLC and CRC. These data show the importance of systematically incorporating the impact of hospitalizations alongside other clinical outcomes in treatment choice in routine clinical practice. As the database grows over time, these data will help clinicians and patients better evaluate regimen choices for various cancers. [Table: see text]

scholarly journals A validation of clinical data captured from a novel Cancer Care Quality Program directly integrated with administrative claims data

2017 ◽  
Vol Volume 8 ◽  
pp. 149-155 ◽  
Author(s):  
David M Kern ◽  
John J Barron ◽  
Bingcao Wu ◽  
Alex Ganetsky ◽  
Vincent J Willey ◽  
...  
Keyword(s):  
Clinical Data ◽  
Cancer Care ◽  
Claims Data ◽  
Care Quality ◽  
Administrative Claims ◽  
Administrative Claims Data ◽  
Quality Program

Pattern of utilization of pegfilgrastim in patients with chemotherapy-induced neutropenia: A retrospective analysis of administrative claims data

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 9624-9624
Author(s):  
A. T. Skarin ◽  
F. Vekeman ◽  
F. Laliberté ◽  
O. Afonja ◽  
M. Lafeuille ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Claims Data ◽  
Real Life ◽  
Cytotoxic Chemotherapy ◽  
Administrative Claims ◽  
Cancer Type ◽  
Insurance Claims Data ◽  
Health Insurance Claims Data ◽  
Long Acting ◽  
Practice Methods

9624 Background: Pegfilgrastim is a long-acting granulocyte colony-stimulating factor (G-CSF) used to prevent or treat febrile neutropenia associated with myelosuppressive anticancer therapies. According to the prescribing information, pegfilgrastim should not be administered within 14 days before or 24 hours after cytotoxic chemotherapy because of the potential for myeloid toxicity. This study examined use patterns of pegfilgrastim in real-life practice. Methods: Analysis of health insurance claims data in 2000- 2007 from > 35 large health plans across the US was conducted. Patients who had a cancer diagnosis and chemotherapy within 120 days of their first pegfilgrastim injection were identified. The proportion of pegfilgrastim injections that were followed by administration of chemotherapy within 11 and 9 days was calculated. Analysis was also stratified by cancer type [Non-Hodgkin's lymphoma (NHL), lung, breast]. Results: A total of 13,526 cancer patients received 57,118 pegfilgrastim injections. NHL, lung, and breast cohorts comprised 2,722, 2,772, and 4,955 patients, respectively. Mean age (SD) was 55.0 (11.6) and women represented 65.9% of study population. Among all cancer types, 19.2% of pegfilgrastim injections had a chemotherapy claim within the following 11 days. This pattern of use was the highest in NHL (18.9%), followed by lung (17.1%), and breast (16.2%). Similar results were observed in the 9-day sensitivity analysis (see Table ). Conclusions: Based on the retrospective analysis of this administrative claims database, the use of pegfilgrastim within 11 days of an administration of chemotherapy was observed in 15–20% of cases which is inconsistent with the recommended guidelines. Pegfilgrastim use in these situations may have the potential to increase sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy. Further research is being conducted to assess the related clinical and economic impact of this pattern of usage. [Table: see text] [Table: see text]

scholarly journals 1659. Variation in Identifying Sepsis and Organ Dysfunction Using Administrative Versus Clinical Data and Impact on Hospital Outcome Comparisons

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S49-S50 ◽  
Author(s):  
Chanu Rhee ◽  
Maximilian Jentzsch ◽  
Sameer S Kadri ◽  
Christopher Seymour ◽  
Derek Angus ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Organ Dysfunction ◽  
Clinical Data ◽  
Hepatic Injury ◽  
Claims Data ◽  
Kidney Injury ◽  
Mortality Rates ◽  
Administrative Claims ◽  
Sepsis Mortality ◽  
Incidence And Mortality

Abstract Background Administrative claims data are commonly used for sepsis surveillance, research, and quality improvement. However, variations in diagnosis, documentation, and coding practices may confound efforts to benchmark hospital sepsis outcomes using claims data. Methods We evaluated the sensitivity of claims data for sepsis and organ dysfunction relative to clinical data from the electronic health records of 193 US hospitals. Sepsis was defined clinically using markers of presumed infection (blood cultures and antibiotic administrations) and concurrent organ dysfunction. Organ dysfunction was measured using laboratory data (acute kidney injury, thrombocytopenia, hepatic injury), vasopressor administrations (shock), or mechanical ventilation (respiratory failure). Correlations between hospitals’ sepsis incidence and mortality rates by claims (using “explicit” ICD-9-CM codes for severe sepsis or septic shock) versus clinical data were measured by the Pearson correlation coefficient (r) and relative hospital rankings using either data source were compared. All estimates were reliability-adjusted to account for random variation using hierarchical logistic regression modeling. Results The study cohort included 4.3 million adult hospitalizations in 2013 or 2014. The sensitivity of hospitals’ claims data for sepsis and organ dysfunction was low and variable: median sensitivity 30% (range 5–54%) for sepsis, 66% (range 26–84%) for acute kidney injury, 39% (range 16–60%) for thrombocytopenia, 36% (range 29–44%) for hepatic injury, and 66% (range 29–84%) for shock (Figure 1). There was only moderate correlation between claims and clinical data for hospitals’ sepsis incidence (r = 0.64) and mortality rates (r = 0.61), and relative hospital rankings for sepsis mortality differed substantially using either method (Figure 2). Of 48 (46%) hospitals, 22 ranked in the lowest sepsis mortality quartile by claims shifted to higher mortality quartiles using clinical data. Conclusion Variation in the completeness and accuracy of claims data for identifying sepsis and organ dysfunction limits their use for comparing hospital sepsis rates and outcomes. Sepsis surveillance using objective clinical data may facilitate more meaningful hospital comparisons. Disclosures All authors: No reported disclosures.

Evaluation of treatment patterns and outcomes in patients diagnosed with genitourinary (GU) cancers with linked claims plus prior authorization data.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 284-284
Author(s):  
Lincy S. Lal ◽  
Caitlin Elliott ◽  
Stephanie Korrer ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
...  
Keyword(s):  
Resource Utilization ◽  
Median Duration ◽  
Real World ◽  
Claims Data ◽  
Clinical Information ◽  
Treatment Patterns ◽  
Cancer Type ◽  
Research Database ◽  
Prior Authorization ◽  
Line Of Therapy

284 Background: Integration of clinical and claims data allows for the examination of outcomes and characteristics which is essential for real world evidence generation and clinical decision making. We describe utilization of clinical data collected from an oncology Prior Authorization (PA) program integrated with claims data to evaluate treatment patterns, resource utilization, and total costs of care during therapy for patients with newly diagnosed metastatic and non-metastatic renal (R), bladder (B), and testicular (T) cancers. Methods: Commercially insured patients with a GU cancer diagnosis, from 2/2016 to 12/2019 with both clinical information from a PA tool (based on NCCN guidelines) and claims from the Optum Research Database were identified. Demographics, clinical information (metastatic status and line of therapy), treatment duration, resource utilization, and all-cause costs were collected, and uploaded to a dynamic web-based Tableau dashboard. Analysis was conducted for non-metastatic and metastatic settings based on the first observed treatment episode. Drug additions or switches incremented line of therapy; single drug discontinuations did not. All cost data were adjusted to 2019 values. Results: A total of 3,736 patients were included; 13% were censored (i.e. on treatment at the end of the study period). 916 patients (25%) were metastatic and 2,820 (75%) were in their adjuvant/neoadjuvant (A/N) line. 60% of the population was ≥55 years old and 85% were male. The top regimen in A/N line for each cancer type were: nivolumab (R), BCG(B), bleomycin + carboplatin/cisplatin+ etoposide (T). The top regimen in metastatic cancer were: nivolumab (R), carboplatin/cisplatin + gemcitabine (B), bleomycin + carboplatin/cisplatin + etoposide (T). The median duration of A/N line ranged from 50(B) to 119(R) days while the median duration for metastatic line range from 71(T) to 82(R) days. The highest rate of inpatient admissions was observed in patients with R (31%). Of the three cancers, R was the most expensive in the A/N and metastatic settings with mean (standard deviation) costs of $192,308 ($269,358) and $136,293 ($146,632), respectively. Conclusions: Combination of clinical and claims data provide valuable information on real world outcomes in routine clinical care and may support treatment selection decisions at the point of care.

scholarly journals Paradigm Shift of Healthcare Cost for Patients with Inflammatory Bowel Diseases: A Claims Data-Based Analysis in Japan

2018 ◽  
Vol 1 (1) ◽  
pp. 120-128 ◽  
Author(s):  
Shota Saito ◽  
Kyoko Nakazawa ◽  
Kenji Suzuki ◽  
Takashi Ishikawa ◽  
Kouhei Akazawa
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Inflammatory Bowel Diseases ◽  
Claims Data ◽  
Cost Driver ◽  
Medication Cost ◽  
Administrative Claims ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
Care Costs

Anti-tumor necrosis factor-α (anti-TNFα) agents are used for induction and maintenance of remission in patients with inflammatory bowel diseases (IBD). However, biologic drugs present a large economic burden on health insurance systems. We aimed to estimate the mean annual health care cost per patient with IBD and cost contribution of anti-TNFα agents. We performed an analysis of patients with Crohn’s disease (CD) and ulcerative colitis (UC) based on a large-scale administrative claims database constructed by Japan Medical Data Center (JMDC) Co. Ltd., comprising inpatient, outpatient, and pharmacy claims data. We evaluated all claims from 1 April 2013 through 31 March 2016. Descriptive statistics were used to measure median health care costs paid per member per year (PMPY) and the relative cost contribution of anti-TNFα agents. A total 1405 patients with CD and 5771 with UC were included. Median costs PMPY were approximately six times higher for CD than UC (JPY 1,957,320 and JPY 278,760, respectively). Medication cost for anti-TNFα agents was the main cost driver, accounting for 59.9% and 17.8% of the total costs for CD and UC, respectively. In Japan, costs for anti-TNFα agents have resulted in drug costs exceeding inpatient costs for IBD. Optimized use of anti-TNFα agents and introduction of biosimilars for anti-TNFα agents can be expected to substantially reduce the health care costs of IBD.

Describing the value of the most common first line NSCLC regimens in a real world setting.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9046-9046
Author(s):  
Lee N. Newcomer ◽  
Stacey DaCosta Byfield ◽  
Benjamin Chastek ◽  
Stephanie Korrer ◽  
Thomas Horstman ◽  
...  
Keyword(s):  
Clinical Data ◽  
Real World ◽  
Significant Risk ◽  
Cost Of Care ◽  
Administrative Claims ◽  
Cancer Type ◽  
Care Organization ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy

9046 Background: We aim to describe clinical and economic outcomes of common chemotherapy regimens for first line therapy of metastatic non-small cell lung cancer (mNSCLC).The data are intended to help clinicians and patients understand the real world results for patients like themselves. Methods: This retrospective analysis used clinical data obtained from a prior authorization (PA) program for chemotherapy linked with administrative claims data from 6/1/2015 to 5/31/2016 from a large national managed care organization. Clinical data included cancer type, stage at diagnosis, biomarkers, treatment line and evidence of progression/relapse. Eligible patients were commercially insured members with a PA request for commonly used NCCN recommended regimens for first line therapy of mNSCLC. Outcomes, including duration of therapy, % of patients hospitalized and total cost of care were tracked from first claim for chemotherapy until end of treatment due to discontinuation, death or start of a second line, with remaining patients censored at 5/31/2016 or end of enrollment. Results: Of 830 mNSCLC patients, 498 (60%) completed first line therapy during the study period. 345 initiated one of the following: Carbo/cisplatin + pemetrexed (CA), Carbo/cisplatin + paclitaxel (CP), Carbo/cisplatin + bevacizumab + pemetrexed (CBA), nivolumab (N), and docetaxal (D). Outcomes are summarized in the Table. Conclusions: Patients treated with the five most commonly prescribed first line therapies for mNSCLC have much shorter duration of therapies (52-76 days) than reported in published clinical trials with a significant risk of hospitalization (18% -30%) and at substantial cost ($34,971 - $108,100). These data are an important consideration for the patient and clinician making treatment decisions in routine clinical practice and will become more valuable as the database grows over time. [Table: see text]

Administrative claims data to support pragmatic clinical trial outcome ascertainment on cardiovascular health

2019 ◽  
Vol 16 (4) ◽  
pp. 419-430 ◽  
Author(s):  
Qinli Ma ◽  
Haechung Chung ◽  
Sonali Shambhu ◽  
Matthew Roe ◽  
Mark Cziraky ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Electronic Health Record ◽  
Health Plan ◽  
Clinical Data ◽  
Major Bleeding ◽  
Claims Data ◽  
Administrative Claims ◽  
Health Record ◽  
Research Networks ◽  
Administrative Claims Data

Background/aims Health plan administrative claims data present a cost-effective complement to traditional trial-specific ascertainment of clinical events typically conducted through patient report or a single health system electronic health record. We aim to demonstrate the value of health plan claims data in improving the capture of endpoints in longitudinal pragmatic clinical trials. Methods This retrospective cohort study paralleled the design of the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial designed to compare the effectiveness of two doses of aspirin. We applied the ADAPTABLE identification query in claims data from Anthem, an American health insurance company, and identified health plan members who met the ADAPTABLE trial criteria. Among the ADAPTABLE eligible members, we selected overlapping members with PCORnet Clinical Data Research Networks in the 2 years prior to the index date (1 April 2014). PCORnet Clinical Data Research Networks consist of network partners (or healthcare systems) that store their electronic health record data in the same format to support multi-institutional research. ADAPTABLE outcome events—cardiovascular hospitalizations including admissions for myocardial infarction, stroke, or cardiac procedures; hospitalizations for major bleeding; and in-hospital deaths—were evaluated for a 2-year follow-up period. Events were classified as within or outside PCORnet Clinical Data Research Networks using facility identifiers affiliated with each hospital stay. Patient characteristics were examined with descriptive statistics, and incidence rates were reported for available Clinical Data Research Networks and claims data. Results Among 884,311 ADAPTABLE eligible health plan members, 11,101 patients overlapped with PCORnet Clinical Data Research Networks. Average age was 70 years, 71% were male, and average follow-up was 20.7 months. Patients had 1521 cardiovascular hospitalizations (571 (37.5%) occurred outside PCORnet Clinical Data Research Networks), 710 for major bleeding (296 (41.7%) outside PCORnet Clinical Data Research Networks), and 196 in-hospital deaths (67 (34.2%) outside PCORnet Clinical Data Research Networks). Incidence rates (events per1000 patient-months) differed between available network partners and claims data: cardiovascular hospitalizations, 4.1 (95% confidence interval: 3.9, 4.4) versus 6.6 (95% confidence interval: 6.3, 7.0), major bleeding, 1.8 (95% confidence interval: 1.6, 2.0) versus 3.1 (95% confidence interval: 2.9, 3.3), and in-hospital death, 0.56 (95% confidence interval: 0.47, 0.67) versus 0.85 (95% confidence interval: 0.74, 0.98), respectively. Conclusion This study demonstrated the value of supplementing longitudinal site-based clinical studies with administrative claims data. Our results suggest that claims data together with network partner electronic health record data constitute an effective vehicle to capture patient outcomes since >30% of patients have non-fatal and fatal events outside of enrolling sites.

scholarly journals Trends in antipsychotic prescribing for approved and unapproved indications to Medicaid-enrolled youth in Philadelphia, Pennsylvania between 2014 and 2018

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Molly Candon ◽  
Siyuan Shen ◽  
Oluwatoyin Fadeyibi ◽  
Joseph L Smith ◽  
Aileen Rothbard
Keyword(s):  
Bipolar Disorder ◽  
Foster Care ◽  
Treatment Duration ◽  
Claims Data ◽  
Quality Monitoring ◽  
Administrative Claims ◽  
Prior Authorization ◽  
Policy Initiatives ◽  
Monitoring Programs ◽  
Antipsychotic Prescribing

Abstract Background Antipsychotic prescribing to Medicaid-enrolled youth has been the target of numerous policy initiatives, including prior authorization and quality monitoring programs, which often target specific populations. Whether these efforts have changed the level or composition of antipsychotic prescribing is unclear. Methods Using 2014–2018 administrative claims data for Medicaid enrollees aged 21 years and under in Philadelphia, Pennsylvania, we measured antipsychotic prescription fills overall and for youth without an approved indication (autism, bipolar disorder, or psychosis). We then assessed whether trends differed for populations that have been targeted by policy initiatives, including younger children and foster care-enrolled youth. We also identified the most common approved and unapproved indications and examined whether the treatment duration of antipsychotic prescriptions differed based on whether the youth had an approved or unapproved indication. Results Overall, the number of Medicaid youth with an antipsychotic prescription fill halved between 2014 and 2018. Youth aged 17 years and under and foster care-enrolled youth, who were targeted by prior authorization and quality improvement efforts, experienced larger declines. Roughly half of prescriptions were for unapproved indications in both 2014 and 2018; the most common unapproved indication was ADHD, and the treatment duration was shorter for unapproved indications compared to approved indications. Conclusions Antipsychotic prescribing to Medicaid-enrolled youth is declining, particularly among populations that have been targeted by policy initiatives like prior authorization and quality monitoring programs. Despite the fact that these initiatives often assess diagnostic criteria, half of antipsychotic prescriptions were for unapproved indications in both 2014 and 2018. More research is needed to gauge whether this prescribing is appropriate.

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