Treatment adherence, healthcare resource utilization, and costs in patients with gastrointestinal neuroendocrine tumors (GI NETs).

337 Background: This study aimed to assess treatment adherence, healthcare resource utilization and costs in patients with GI NETs who initiated pharmacologic treatments. Methods: In 2 US commercial claims databases, patients ≥18 years with ≥1 inpatient or ≥2 outpatient claims for GI NETs were identified. The first claim for pharmacologic treatments (e.g. somatostatin analogues [SSAs], cytotoxic chemotherapy [CC], targeted therapy) following diagnosis and between 7/1/2009 and 12/31/2013 was defined as the index date. A 6-month clean period before index date and a 6-month pre- and a ≥1-year post-index enrollment were required. Proportion of days covered (PDC) was calculated during the follow up period. Outcomes were reported separately for patients with 1 and 2 years of post-index enrollment. Descriptive statistics including means, standard deviations, and frequencies and percentages for continuous and categorical data, respectively, were reported. Results: Of 1,322 patients with 1-year of follow-up, 847 initiated SSAs, 397 CC, 35 targeted therapies, 2 interferon, and 41 various combinations. Due to sample sizes, remaining results focus only on SSAs and CC. Mean PDC (SD) was 0.669 (0.331) for SSAs and 0.466 (0.236) for CC; SSA users had 20.5 (13.5) office visits and 0.59 (1.03) hospitalizations, CC users had 30.5 (19.8) and 0.89 (1.45) office visits and hospitalizations respectively; total annual cost for SSA-treated patients during the 1st year was $99,691 (82,423) and $134,912 (116,078) for CC. Among 685 patients with 2 years of follow-up, the annual mean costs in the second year were $8,071 and $58,944 lower than the first year for SSAs and CC, respectively. Conclusions: In this descriptive non-comparative study, we reported the resource utilization and costs associated with different treatment therapies. Overall, costs were higher in the first year than in the second year. This 2-database study offers new information on the magnitude and trends in the cost of pharmacologically treated GI NETs. Additional research with a larger sample size would be needed to better understand real-world utilization and costs for GI NET patients treated with different pharmacological therapies.

Download Full-text

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

Blood ◽

10.1182/blood-2018-99-113093 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3549-3549

Author(s):

Debra Irwin ◽

Lu Zhang ◽

Kathleen Wilson ◽

Gerard Hoehn ◽

Erika Szabo ◽

...

Keyword(s):

Combination Therapy ◽

Healthcare Utilization ◽

Resource Utilization ◽

Real World ◽

Index Date ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Hodgkin's Lymphoma ◽

First Line

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

Download Full-text

Real-World Healthcare Resource Utilization in Patients with Chronic Lymphocytic Lymphoma: Differences between Patients Treated with Ibrutinib or Bendamustine + Rituximab

Blood ◽

10.1182/blood-2018-99-112626 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 3548-3548

Author(s):

Debra Irwin ◽

Lu Zhang ◽

Kathleen Wilson ◽

Gerard Hoehn ◽

Erika Szabo ◽

...

Keyword(s):

Healthcare Utilization ◽

Resource Utilization ◽

Real World ◽

Index Date ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Similar Proportion ◽

First Line ◽

The Difference

Abstract OBJECTIVES: The purpose of this study was to examine the real-world differences in healthcare resource utilization in chronic lymphocytic lymphoma (CLL) patients treated with either first-line ibrutinib monotherapy (IM) or first-line bendamustine + rituximab (BR) therapy using U.S. administrative claims data. METHODS: The MarketScan® Research Databases were used to identify patients aged 18 years or older with commercial or Medicare supplemental insurance plans based on their first prescription (index date) of either IM or BR therapy between 02/01/2014 and 08/30/2017. Patients were required to be diagnosed with CLL and be treatment naïve, as well as be continuously enrolled (CE) for 6 months prior to and at least 30 days following the index date. All-cause and CLL-related healthcare resource utilization (e.g., inpatient admission (IP) and emergency room (ER) visits) were evaluated during a 12-month follow-up period from the index date among the subset of patients with 12 months of continuous enrollment and were reported per-patient per-month (PPPM). Statistical differences in the distribution of IP and ER visits between the IM versus BR therapy groups were estimated using chi-squared test for categorical variables and t-test for continuous variables. RESULTS: A total of 1,886 CLL patients were identified, with 1,157 patients in the IM cohort and 729 patients in the BR cohort. The IM cohort was significantly older (mean = 69.3 years; SD = 11.6) then the BR cohort (mean age = 66.4 years; SD = 9.8). There was a similar proportion of females (IM = 36%; BR = 32%), and no significant difference in the National Cancer Institute Comorbidity Index score was observed between the two cohorts (IM=0.9 vs BR=0.8, p=0.34). The results of the comparisons between the two groups with 12 months of follow-up (IM = 589; BR = 436) are provided in Table 1. For all-cause healthcare utilization, the proportion of patients experiencing at least one IP admission and the PPPM number of admissions was significantly higher in the IM cohort compared to the BR cohort. The proportion of patients with at least one ER visit was higher in the IM than in the BR cohort, but the difference was not statistically significant. However, the PPPM number of ER visits was significantly higher in the IM cohort. A similar pattern was found for the CLL-related healthcare utilization variables with two exceptions. First, the average length of stay (ALOS) per CLL-related IP admission was significantly longer for the IM than BR cohort; whereas, ALOS per all-cause IP admission was longer for the IM cohort, but the difference was not significantly different. Second, while patients in the IM cohort experienced more CLL-related ER visits, they were not significantly higher in the IM cohort than in the BR cohort. Conclusions: The current study examined differences in healthcare utilization during a 12 month period among CLL-patients initially treated in a front-line setting with either ibrutinib or BR combination therapy. Results indicated that not only did more ibrutinib patients experience an IP admission and ER visits, both all-cause and CLL-related, but they also experienced more repeat admissions and ER visits. These real-world findings highlight the importance of considering the healthcare resource utilization of CLL patients which may be associated with their first-line therapy. Disclosures Irwin: Teva: Consultancy. Zhang:Teva: Consultancy. Wilson:Teva: Consultancy. Hoehn:Teva: Employment. Szabo:Teva: Employment. Tang:Teva: Employment.

Download Full-text

Evaluation of Healthcare Resource Utilization and Costs Among Patients with Chronic Myeloid Leukemia after Disease Progression

Blood ◽

10.1182/blood.v128.22.3573.3573 ◽

2016 ◽

Vol 128 (22) ◽

pp. 3573-3573

Author(s):

Elias Jabbour ◽

Jay Lin ◽

Lisa R Siegartel ◽

Melissa Lingohr-Smith ◽

Brandy Menges ◽

...

Keyword(s):

Disease Progression ◽

Resource Utilization ◽

Healthcare Costs ◽

Myeloid Leukemia ◽

Index Date ◽

Healthcare Resource ◽

Baseline Period ◽

Healthcare Resource Utilization ◽

Outpatient Prescription

Abstract Introduction: Tyrosine kinase inhibitors (TKIs) have been shown to be efficacious for the treatment of chronic myeloid leukemia (CML). However, resistance, lack of response, or intolerance may occur, resulting in disease progression. There is a paucity of evidence quantifying the real-world healthcare burden of patients with CML progression. Thus, the objective of this study was to evaluate the economic consequences of patients with CML progression using a real-world database analysis. Methods: Patients (≥18 years of age) with at least 1 inpatient or ≥2 outpatient (≥30 days apart) diagnoses of CML were identified from the MarketScan Commercial and Medicare healthcare claims databases between January 1, 2007 and June 30, 2015. CML patients were grouped into 2 study cohorts, those with evidence of disease progression and those without. Patients with CML progression were identified by the presence of claims for acute myeloid leukemia (AML)-like or acute lymphoblastic leukemia (ALL)-like chemotherapy treatments, based on the guidelines of the National Comprehensive Cancer Network (version 1.2016), or a hematopoietic stem cell transplant (HSCT). For patients with progression, the first date of such a claim was defined as the index. For patients without evidence of progression, a random date after the first CML diagnosis was identified as the index date. In order to increase accuracy of detecting progression, patients with other cancers, including AML and ALL, documented prior to the first recorded diagnosis of CML were excluded from the study. Patients were required to have continuous medical and prescription insurance coverage during the 12 months prior to the index date (baseline period). Demographics and clinical characteristics were evaluated during the baseline period. Healthcare resource utilization, including hospitalizations, outpatient medical services, and outpatient prescription drug usage, and the associated costs were captured during the baseline period and a variable follow-up period, lasting ≥1 day and up to 1 year, and compared among study cohorts. All costs were inflation adjusted to 2015 cost level. Generalized linear models (GLMs) were used to further compare the incremental costs of CML patients with vs. without progression while adjusting for various factors. Results: Of the overall identified CML study population, 587 (7%) experienced disease progression and 7,504 did not. A greater percentage of male than female patients had evidence of disease progression and CML patients with progression had more comorbidities, as measured by Charlson Comorbidity Index, than those without progression (Table 1). Approximately 31% of CML patients with progression were treated with HSCT at the index date, while 69% were treated with chemotherapy (Table 1). During the baseline period, mean total healthcare costs, including costs for hospitalizations, outpatient medical service costs, and outpatient prescription costs were significantly greater for CML patients with vs. without progression ($143,778 vs. $53,143, p<0.001). During the follow-up, mean total annual healthcare costs, costs for hospitalizations, and outpatient medical service costs, were substantially greater for patients with vs. without progression; however, costs for outpatient prescription drugs were less (Table 2). When patient characteristics were taken into consideration with a GLM, the incremental costs for CML patients with vs. without progression were $270,925 (CI: $235,290, $311,958, p<0.001); when an additional GLM model was used, in which the baseline healthcare costs of CML patients were added as a covariate, the incremental costs for patients with vs. without progression were $136,308 (CI: $119,223, $155,841, p<0.001). Conclusions: The healthcare burden, in terms of healthcare resource utilization and costs, of patients with CML progression is substantial. Healthcare providers and payers need to consider various strategies to minimize the rate of CML progression. Disclosures Elias: Bristol-Myers Squibb: Consultancy. Lin:Bristol-Myers Squibb: Consultancy; Novosys Health: Employment. Siegartel:Bristol-Myers Squibb: Employment. Lingohr-Smith:Novosys Health: Employment. Menges:Novosys Health: Employment. Makenbaeva:Bristol-Myers Squibb: Employment, Equity Ownership.

Download Full-text

P0788HEALTHCARE RESOURCE UTILIZATION AND COSTS IN A DAPA-CKD-LIKE POPULATION USING A CONTEMPORARY US HEALTHCARE COHORT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0788 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Tope Olufade ◽

Lois Lamerato ◽

Juan Jose Garcia Sanchez ◽

Like Jiang ◽

Joanna Huang ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Health System ◽

Healthcare System ◽

Resource Utilization ◽

Healthcare Costs ◽

Index Date ◽

Healthcare Resource ◽

Healthcare Resource Utilization

Abstract Background and Aims Recent studies have shown an association between Sodium Glucose Co-Transporter 2 inhibitor (SGLT-2i) class of drugs and lower healthcare costs compared with other glucose lowering therapy, in type 2 diabetes (T2D) patients mainly as a result of reduced rates of cardiovascular and other T2D-associated outcomes. The DAPA-CKD Trial (A study to evaluate the effect of dapagliflozin on renal outcomes and CV mortality in patients with CKD) is the first SGLT-2i renal outcomes trial to test the efficacy and safety of an SGLT-2i, dapagliflozin, in patients with CKD with and without T2D. The objective of this study is to assess the healthcare resource utilization and cost in a “DAPA-CKD-like population” (eGFR 25-75ml/min/1.73m2 and UACR 200-5000mg/g) using a contemporary US healthcare system. Method Data from the Henry Ford Health System (HFHS) were used to identify persons with CKD stages 2 through 4 between 2006 and 2016 (based on eGFR labs) and patients were followed through 2018. Persons with no confirmatory eGFR > 90 days from index date, death within 30 days, history of renal transplant, and evidence of renal replacement therapy, or progression to CKD stage 5 during the baseline period (6 months pre or post index date) were excluded. Inpatient admissions, inpatient days, emergency department encounters, and ambulatory care encounters with primary care, specialty care and overall were assessed. Cumulative utilization was evaluated for all patients and evaluation based on the follow-up time. Patients were censored on date of death, last contact with the Health System or at December 31st, 2018. The utilization rates are the total observed utilization divided by follow-up time and reported as an annual rate. Billing records for all care with HFHS were used to estimate costs. Results 6,557 patients (mean age 62.9 years, 46.2% male) met the eligibility criteria and are included in the study cohort. The population was stratified by UACR (0-<30, 30–199, 200–5,000mg/g). The DAPA-CKD-like population (200-5000mg/g) was associated with significantly higher annualized per-patient healthcare costs, $39,222/yr (UACR 200-5000mg/g) vs. $19,547/yr (UACR <30mg/g). This increased healthcare utilization was predominantly driven by increased acute care, including hospital admissions, inpatient days and emergency department visits. Persons in the highest UACR category were almost three times more likely to have a hospital admission compared to the lowest UACR (rates 0.55/year vs. 0.20/year, respectively; see Figure below). Persons in the lowest UACR category had more primary care visits per year compared with those with highest UACR (5.81 vs 5.21). In contrast, the highest number of outpatient specialist visits per year was reported for the DAPA-CKD-like population (7.55 vs. 6.74). Conclusion This analysis of a contemporary US healthcare system demonstrated that there exists a high disease burden in the DAPA-CKD-like population as seen by the substantial increase in healthcare resource utilization and costs compared to other cohorts of patients with a lower UACR. These results highlight the need for innovative therapies to improve patient outcomes in this population.

Download Full-text

Analysis of Healthcare Resource Utilization and Costs after the Initiation of Biologic Treatment in Patients with Ulcerative Colitis and Crohn’s Disease

Journal of Health Economics and Outcomes Research ◽

10.36469/9791 ◽

2018 ◽

Vol 6 (1) ◽

pp. 96-112 ◽

Cited By ~ 1

Author(s):

Sue Perera ◽

Shibing Yang ◽

Marni Stott-Miller ◽

Joanne Brady

Keyword(s):

Ulcerative Colitis ◽

Crohn’S Disease ◽

Crohn's Disease ◽

Resource Utilization ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Small Sample ◽

Outpatient Visits ◽

Ed Visits

Background: This retrospective cohort study aimed to describe and quantify healthcare resource utilization and costs for patients with ulcerative colitis (UC) and Crohn’s disease (CD) following initiation of biologic therapy. Methods: Resource utilization and costs were analyzed at baseline and 1- and 2-years after initiating a biologic. Data were extracted from a US administrative health insurance claims database for adults ≥18 years. Eligible patients were continuously enrolled in a health plan with medical and pharmacy benefits for ≥12 months prior to, and 12 months (primary analysis) or 24 months (secondary analysis) after index date (biologic initiation). Results: In total, 4864 and 2692 patients with UC, and 8910 and 5227 patients with CD were identified in the 1- and 2-year follow-up cohorts, respectively. Of 1-year follow-up cohort patients, 45% received the same biologic initiated at index for ≥1 year. Infliximab and adalimumab were the most commonly initiated biologics in patients with UC or CD. The highest proportion of patients who continued with the same biologic after 1-and 2-years had initiated therapy with infliximab for both indications (although at the 1-year follow-up for CD, the highest proportion continued to use natalizumab, but this was a small sample [n=15]). Generally, the proportion of patients having inpatient admissions and emergency department (ED) visits decreased after receiving the same biologic for 1 year compared with baseline, although the proportion having outpatient visits did not change. Mean per patient all-cause costs for inpatient hospitalizations, ED visits and outpatient visits decreased for patients with UC or CD who received the same biologic for 1 year, while mean pharmacy costs per patient increased. Conclusions; This descriptive analysis shows that although biologics effectively reduced inpatient and ED resource utilization and corresponding costs in patients with UC and CD, total management costs increased, driven by increased pharmacy costs.

Download Full-text

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

Circulation ◽

10.1161/circ.129.suppl_1.p147 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Chien-Chia Chuang ◽

Edward Lee ◽

Sharvari Bhurke ◽

Sabyasachi Ghosh ◽

Alie Tawah ◽

...

Keyword(s):

Diabetes Mellitus ◽

Regression Models ◽

Index Date ◽

Healthcare Resource ◽

Baseline Period ◽

Healthcare Resource Utilization ◽

Office Visits ◽

Medical Encounter ◽

Outpatient Visits

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

Download Full-text

2374. Healthcare Resource Use, Costs, and Recurrences in Patients with Clostridioides difficile Infection: A Real-world Data Analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2052 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S819-S819

Author(s):

Winnie Nelson ◽

Laura Stong ◽

Naomi Sacks ◽

Alexandria Portelli ◽

Bridget Healey ◽

...

Keyword(s):

Resource Utilization ◽

Resource Use ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Healthcare Resource Use ◽

Diagnosis Code ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Ed Visits

Abstract Background Clostridioides difficile infection (CDI), especially recurrent CDI (rCDI), is associated with high morbidity and resource use and imposes a significant burden on the US healthcare system. The objective of this study was to evaluate the burden of rCDI on healthcare resource utilization. Methods A retrospective study analyzed commercial claims data from patients aged 18–64 years old in the IQVIA PharMetrics Plus™ database. CDI episodes required an inpatient stay with CDI diagnosis code (ICD-9-CM 008.45; ICD-10-CM A04.7, A04.71, A04.72), or an outpatient medical claim with CDI diagnosis code plus a CDI treatment, and index episodes occurred from January 1, 2010 to June 30, 2017. Only patients who were observable 6 months before and 12 months after the index CDI episode were included. Each CDI episode was followed by a 14-day claim-free period after the end of treatment. rCDI was defined as another CDI episode within an 8-week window immediately after the claim-free period. Number of CDI and rCDI episodes, healthcare resource use, and costs were calculated over 12-month follow-up and stratified by number of rCDI episodes. Costs were adjusted to 2018 dollars. Results 46,571 patients with an index CDI episode were included, with 3,129 (6.7%) who had 1 rCDI, 472 (1.0%) who had 2 rCDI, and 134 (0.3%) who had 3+ rCDI episodes. Mean age was 47.4 years, and 62.4% were female. In the 12-month follow-up, the mean (SD) numbers of inpatient visits were 1.4 (2.1) for those with no rCDI, 2.7 (3.4) for those with 1 rCDI, 3.7 (3.9) for those with 2 rCDI, and 5.8 (6.0) for those with 3+ rCDI episodes. Emergency department (ED) visits had a similar trend, with mean (SD) number of visits of 1.5 (3.5), 2.5 (6.0), 3.7 (7.0), and 4.6 (13), respectively for the four study groups. All-cause costs after the index CDI were $71,980 for those with no rCDI, $131,953 for those with 1 rCDI, $180,574 for those with 2 rCDI, and $207,733 for those with 3+ rCDI. Conclusion CDI and rCDI are associated with substantial healthcare resource utilization and direct medical costs. During the 12 months after an index CDI episode, the number of inpatient admissions and ED visits increased substantially for patients with an rCDI episode. Direct medical costs for patients with rCDI also increased with number of recurrences. Disclosures All authors: No reported disclosures.

Download Full-text

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

Blood ◽

10.1182/blood.v116.21.3841.3841 ◽

2010 ◽

Vol 116 (21) ◽

pp. 3841-3841

Author(s):

Eric Qiong Wu ◽

Annie Guerin ◽

Vamsi Bollu ◽

Denise Williams ◽

Amy Guo ◽

...

Keyword(s):

Resource Utilization ◽

Medical Cost ◽

Economic Burden ◽

Regression Models ◽

Index Date ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Total Medical Cost ◽

Employment Equity ◽

Equity Ownership

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

Download Full-text

Healthcare Resource Utilization Trends over Time with Continuous Lenalidomide Treatment (Tx) in Patients (Pts) with Newly Diagnosed Multiple Myeloma (NDMM)

Blood ◽

10.1182/blood.v124.21.1326.1326 ◽

2014 ◽

Vol 124 (21) ◽

pp. 1326-1326

Author(s):

Katja Weisel ◽

Dan T. Vogl ◽

Michel Delforge ◽

Kevin Song ◽

Meletios Dimopoulos ◽

...

Keyword(s):

Multiple Myeloma ◽

Resource Utilization ◽

Research Funding ◽

Healthcare Resource ◽

Healthcare Resource Utilization ◽

Medical Utilization ◽

Fixed Duration ◽

Advisory Committees ◽

Over Time

Abstract Introduction: Multiple myeloma (MM) is an incurable hematologic condition that is associated with high Tx costs. Resource consumption is driven by hospitalization and medical utilization, which is highest during periods of uncontrolled disease, such as after diagnosis and during relapses (De Portu 2013). In the pivotal phase 3 FIRST trial, continuous Tx with lenalidomide plus low-dose dexamethasone (Rd) was compared with fixed-duration Rd (Rd18) or fixed-duration combination Tx with melphalan, prednisone, and thalidomide (MPT), each for 18 months (mos), in NDMM pts who were ineligible for stem cell transplantation. Continuous Rd extended progression-free survival (PFS) and overall survival (interim analysis) vs. MPT. However, it is still unclear whether extending Tx duration with Rd adversely affects healthcare resource utilization. This analysis quantifies the rates of hospitalizations and medical utilization with continuous Rd over time based on data collected in the FIRST trial. Methods: The FIRST trial (N = 1,623) was a pivotal multinational, randomized, open-label study with a median follow up of 37 mos. Non-protocol-driven resource-use data was collected until subjects discontinued study Tx. To assess whether continuous Rd increases healthcare resource utilization over time, the rates of resource utilization for subjects treated with continuous Rd (N = 535) were plotted for up to 48 mos. In addition, hospitalization and medical utilization rates during the Tx period (18 mos) were estimated and compared between the 2 fixed-duration Tx arms. Results: Resource utilization amongst pts treated with continuous Rd declined over time (Figure). The annualized hospitalization rate in the first 3 mos was 3.2 times higher than the average rate for the remaining 45 mos of follow-up (2.02 vs. 0.62), and 4.2 times higher for medical utilization (5.66 vs. 1.34). After 4 years (yrs) of continuous Rd Tx, hospitalization and medical utilization rates were estimated to be 83% and 84% lower than those observed in the first 3 mos of Tx, reflecting the long-term disease control observed with continuous Rd in the FIRST trial. The highest hospitalization rates were associated with infections (0.20 per patient year), cardiovascular disorders (0.06), and respiratory and thoracic disorders (0.05). The mean (standard deviation) length of stay per admission was 14.08 (21.19) days. The highest medical utilization rates were associated with blood transfusions (0.76 interventions per patient year), general imaging procedures (0.21), respiratory and thoracic imaging procedures (0.20), and therapeutic interventions (0.09).The hospitalization rates for the fixed dose Tx arms were 0.91 (Rd18) and 0.79 (MPT) per patient year of follow-up during the Tx period of 18 mos, resulting in a rate ratio (RR) of 1.15 (1.01–1.30). The equivalent rates for medical utilization were 3.00 (Rd18) and 2.86 (MPT) medical interventions per patient year (RR = 1.05 [0.98–1.12]). Conclusions: The rates of resource utilization among pts treated with continuous Rd dropped substantially after the first 3 mos of Tx, and then gradually declined as Tx duration increased. The findings suggest that continuous Tx with Rd does not further increase resource utilization in hospitalizations and medical utilization compared to fixed-duration Tx. A comparison between the 2 fixed arms showed a 15% increase in hospitalization with Rd18 vs. MPT, and no differences in medical utilization between the 2 arms. A limitation of this analysis is that the resources were collected only while pts were receiving their respective Txs. Future analysis should include all costs generated by healthcare resources throughout pts Tx, including Tx-free intervals, and the costs associated with relapses. Figure 1: Hospitalization and medical utilization rates per patient year for patients treated with continuous Rd Figure 1:. Hospitalization and medical utilization rates per patient year for patients treated with continuous Rd Disclosures Weisel: BMS: Consultancy; Onyx: Consultancy, Honoraria; Janssen: Consultancy, Honoraria; Celgene Corporation: Consultancy, Honoraria; Noxxon: Consultancy. Off Label Use: Lenalidomide used in newly diagnosed multiple myeloma patients. Vogl:Amgen: Consultancy; Millennium/Takeda: Research Funding; GSK: Research Funding; Acetylon: Research Funding; Celgene Corporation: Consultancy. Delforge:Janssen: Honoraria; Celgene Corporation: Honoraria. Song:Celgene Corporation: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees. Dimopoulos:Celgene Corporation: Consultancy, Honoraria. Cavenagh:Celgene Corporation: Honoraria. Hulin:Celgene Corporation: Honoraria. Foá:Celgene Corporation: Consultancy. Oriol:Janssen: Consultancy, Speakers Bureau; Celgene Corporation: Consultancy, Speakers Bureau. Guo:Celgene Corporation: Consultancy. Monzini:Celgene Corporation: Employment, Equity Ownership. Van Oostendorp:Celgene: Employment. Ervin-Haynes:Celgene: Employment. Facon:Celgene Corporation: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.

Download Full-text