scholarly journals Primary Care in Supplementary Health: impact on care costs of elderly patients with heart disease

2020 ◽  
Author(s):  
Geórgia Silva Marques ◽  
Alessandra Maciel Almeida ◽  
Isabel Cristina Gomes ◽  
Michele Renata Barbosa da Silva ◽  
Bruno Almeida Rezende
Keyword(s):  
Health Care ◽  
Heart Disease ◽  
Elderly Patients ◽  
Population Aging ◽  
Health Spending ◽  
Vulnerability Index ◽  
Cost Of Care ◽  
Sample Mean ◽  
One Year ◽  
Care Costs

Abstract Introduction: Population aging has been changing the epidemiological profile in the World. Cardiovascular diseases are the leading cause of death in many countries and have an impact on health spending. Objectives: To identify factors that influence health care costs in elderly patients with heart disease treated at a Supplementary Primary Health Care (PHC) unit in Brazil. Methods: Retrospective cohort of 223 patients with heart disease aged ≥ 60 years from one year before and one year after PHC implantation. Data were obtained from electronic medical records and the costs in the total cost of care database (hospital, outpatient and home). Patients were classified according to the Clinical-Functional Vulnerability Index (CFVI-20). Results: There was no reduction in total costs, but it occurred in hospitalization expenses after the implementation of PHC for the whole sample (mean ± SD, US$ 698.43 ± US$ 3,500.76, p=0.011), with a significant reduction among (p=0.023), pre-diagnosis of acute myocardial infarction (AMI) (p=0.023), eutrophic BMI (p=0.027), non-smokers (p=0.020), and robust according to the CFVI-20 (p=0.013). There was a decrease in the frequency of hospitalization for the whole sample (p=0.006), among males (p=0.014), age between 71 and 80 years (p=0.001), robust (p=0.025) and AMI (p= 0.027). There was a reduction in the frequency of consultations in the Emergency Department among fragile elderly (p=0.011). Conclusions: There was a reduction in the frequency and cost of hospitalization in elderly patients with heart disease in follow-up at PHC, in addition to reducing the frequency of consultation in PHC in the fragile elderly.

scholarly journals Institutionalization-Free Survival and Health Care Costs among Quebec Community-Dwelling Elderly Patients with Dementia

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Sarah-Gabrielle Beland ◽  
Antoine Pariente ◽  
Yola Moride
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Costs ◽  
Reference Population ◽  
Community Dwelling ◽  
Third Party ◽  
Published Data ◽  
Administrative Claims ◽  
Free Survival ◽  
Care Costs

Background. Published data on burden of dementia mainly include patients of third-care facilities. Economic consequences in an outpatient setting remain poorly examined. Objectives. To evaluate institutionalization-free survival and direct health care costs of dementia in the Quebec community-dwelling elderly population. Methods. A retrospective cohort study was conducted using the Quebec administrative claims databases. The cohort included a random sample of patients with treated dementia between January 1, 2000, and December 31, 2009 (n=37,138). The reference population included elderly patients without dementia matched in age group, gender, and index date. Using a third-party payer perspective, direct costs over 5 years were assessed. Results. Institutionalization-free survival at 5 years was lower in patients with dementia than in elderly without dementia (38.9% and 72.2%, resp.). Over 5 years, difference in mean total direct health care costs per patient was CAD$19,159, distributed into institutionalizations (CAD$13,598), hospitalizations (CAD$3,312), and prescribed medications (CAD$2,320). Costs of medical services were similar (−CAD$96). In the first year of followup, cost differentials were mainly attributable to hospitalizations, while in the last year (year 5) they were due to institutionalizations. Conclusion. This study confirms that dementia is an important socioeconomic burden in the community, the nature of which depends on disease progression.

Consumer Cost-Sharing as a Means to Reduce Health Care Costs

PEDIATRICS ◽  
1980 ◽  
Vol 65 (1) ◽  
pp. 168-170
Author(s):  
Stephen M. Davidson ◽  
John P. Connelly ◽  
R. Don Blim ◽  
James E. Strain ◽  
H. Doyl Taylor
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Cost Sharing ◽  
Cost Of Care ◽  
National Commission ◽  
Insurance Policies ◽  
National Medical ◽  
Use Of Services ◽  
The Cost ◽  
Care Costs

The National Commission on the Cost of Medical Care1 states in part (Recommendation 2) that "insurance policies should include provisions through which the consumer shares in the cost of care received, at the time of service, for selected benefits and for selected groups...." These cost-sharing provisions are expected to reduce national medical care expenditures by encouraging consumers to reduce their use of services in order to avoid paying additional money out of their own pockets. They will thus moderate the demand-inducing tendency of insurance, leading the rational consumer to seek only necessary services and to forego those services contributing to what is believed to be over-utilization. As the Commission states in its supporting statement:

All-cause and disease-related health care costs associated with recurrent venous thromboembolism

2013 ◽  
Vol 110 (12) ◽  
pp. 1288-1297 ◽  
Author(s):  
Patrick Lefebvre ◽  
Edith A. Nutescu ◽  
Mei Duh ◽  
Joyce LaMori ◽  
Brahim K. Bookhart ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Propensity Scores ◽  
Venous Ulcer ◽  
P Value ◽  
Cost Difference ◽  
Recurrent Venous Thromboembolism ◽  
Recurrent Vte ◽  
One Year ◽  
Care Costs

SummaryIt was the objective of this study to quantify the risk of complications and the incremental health care costs associated with recurrent VTE events. Health care insurance claims from the Ingenix IMPACT database from 01/2004−09/2008 were analysed. Subjects aged ≥18 years on the date of first recurrent VTE diagnosis with ≥12 months of baseline observation prior to the index recurrent VTE were matched 1:1 with no-recurrent VTE patients based on propensity scores. The risk of developing post-thrombotic syndrome (PTS) and other disease-related diagnoses (thrombocytopenia, superficial venous thrombosis, venous ulcer, pulmonary hypertension, stasis dermatitis, and venous insufficiency) was compared between the recurrent and no-recurrent VTE groups for up to one year. All-cause and disease-related costs per patient per year (PPPY) were calculated. The recurrent VTE and no-recurrent VTE cohorts (8,001 subjects in each group) were matched with respect to age, gender, and comorbidities. The risk ratios (RRs) indicated that the risk of developing post-event complications was significantly higher for the recurrent VTE group compared to the no-recurrent VTE group (RR [95% CI]: PTS: 2.7 [2.4 − 2.9], p-value <0.01). Patients with recurrent VTE had significantly higher average PPPY all-cause costs compared to no-recurrent VTE patients ($86,744 versus $37,525, cost difference: $49,219 [€33,617]; 95% CI= 46,253−51,989). Corresponding disease-related health care costs PPPY were also significantly higher for the recurrent VTE group ($11,120 vs $1,262, cost difference: $9,858 [€6,733]; 95% CI= $9,081-$10,476). In conclusion, in this large matched-cohort study, recurrent VTE patients had significantly higher risk of complications and health care costs compared to no-recurrent VTE patients.Note: Parts of this manuscript were presented at the American College of Clinical Pharmacy (ACCP) Annual Meeting 2012, October 21–24, Hollywood, Florida and at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 18th Annual International Meeting 2013, May 18–22, New Orleans, LA, USA.

Cost analysis of a randomized trial of early palliative care (PC) in patients with metastatic non-small cell lung cancer (NSCLC).

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 4-4 ◽  
Author(s):  
Joseph A. Greer ◽  
Angela Tramontano ◽  
Pamela M McMahon ◽  
Areej El-Jawahri ◽  
Ravi Bharat Parikh ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Health Care Costs ◽  
Standard Care ◽  
Secondary Analysis ◽  
Cost Of Care ◽  
Average Total Cost ◽  
Total Cost ◽  
Metastatic Nsclc ◽  
Care Costs

4 Background: Several randomized, controlled trials have shown that early, integrated palliative and oncology care improves quality of life, mood, and symptom burden in patients with advanced cancers. However, the degree to which early involvement of specialty PC in the ambulatory care setting impacts the cost of care remains unknown. We investigated the health care costs for patients with metastatic NSCLC enrolled in a clinical trial of early PC. Methods: For this secondary analysis, we examined data from a randomized trial of 151 patients with newly-diagnosed metastatic NSCLC from 06/2006 to 07/2009. Patients received either early PC integrated with standard care or standard care (SC) alone. We abstracted costs for emergency and inpatient care, outpatient visits, intravenous chemotherapy, and physician services from the hospital’s accounting system. Oral chemotherapy costs were estimated based on actual drug charges for patients. To estimate hospice costs, we used Medicare reimbursement rates. For each participant, we calculated the average total cost of care per day for the entire study period as well as the total cost of care for the final 30 days prior to death. Costs differences between groups were examined with the Wilcoxon Rank-Sum Test. Results: We analyzed health care costs of the 138 patients who died by 07/15/2013 (early PC N=68; SC N=70). The mean number of days on study was longer for patients assigned to early PC (M=397, SD=360) versus SC (M=299, SD=266). Over the study period, early PC was associated with a lower average total cost per day of $117 (SD=$436) compared to SC (p=.09). In the final 30 days of life, patients in the early PC group incurred higher total costs for hospice care (Mean difference=$1,053, SD=$3,162, p=.11), while expenses for chemotherapy were less (Mean difference=$757, SD=$2,143, p=.06). No cost differences between groups met the threshold for statistical significance. Conclusions: Although this secondary analysis was inconclusive due to the lack of statistical power to examine differences in cost outcomes, the delivery of early PC for patients with metastatic NSCLC does not appear to increase health care expenses over the course of disease or at the end of life. Clinical trial information: NCT01038271.

Factors influencing 2-year health care costs in patients undergoing revision lumbar fusion procedures

2012 ◽  
Vol 16 (4) ◽  
pp. 323-328 ◽  
Author(s):  
Scott L. Parker ◽  
David N. Shau ◽  
Stephen K. Mendenhall ◽  
Matthew J. McGirt
Keyword(s):  
Health Care ◽  
Global Health ◽  
Resource Utilization ◽  
Health Care Costs ◽  
Lumbar Fusion ◽  
Perioperative Complications ◽  
Fold Increase ◽  
Cost Of Care ◽  
Site Infection ◽  
Care Costs

Object Revision lumbar fusion procedures are technically challenging and can be associated with tremendous health care resource utilization and cost. There is a paucity of data regarding specific factors that significantly contribute to increased cost of care. In light of this, the authors set out to identify independent risk factors predictive of increasing 2-year direct health care costs after revision lumbar fusion. Methods One hundred fifty patients undergoing revision instrument-assisted fusion for adjacent-segment disease (50 cases), pseudarthrosis (47 cases), or same-level stenosis (53 cases) were included in this study. Patient demographics, comorbidities, preoperative health states as assessed by patient-reported outcome questionnaires and perioperative complications were collected and analyzed. Two-year back-related medical resource utilization and direct health care costs were assessed. The independent association of all variables to increasing cost was assessed using multivariate linear regression analysis. Results There was a wide range ($24,935–$63,769) in overall 2-year direct costs for patients undergoing revision lumbar fusion (mean $32,915 ± $8344 [± SD]). Preoperative variables independently associated with 2-year direct health care costs included diagnosis of congestive heart failure, more severe leg pain (visual analog scale), greater back-related disability (Oswestry Disability Index), and worse mental health (12-Item Short Form Health Survey Mental Component Summary score). There was a 1.1- to 1.2-fold increase in cost for patients in the greatest quartiles compared with those in the lowest quartiles for these variables. Surgical site infection, return to the operating room, and spine-related hospital readmission during the 90-day global health period were postoperative variables independently associated with 2-year cost. Patients in the greatest versus lowest quartiles had a 1.7- to 1.9-fold increase in cost for these variables. Conclusions Revision lumbar fusion can be associated with considerable 2-year health care costs. These costs can also vary widely among patients, as evidenced by the 2.6-fold overall cost range in this series. Although comorbidities and preoperative severity of disease states contribute to cost of care, the primary drivers of increased cost include perioperative complications such as surgical site infection, return to the operating room, and readmission during the global health period. Measures focused on health service improvement will be most successful in reducing the cost of care for patients undergoing revision lumbar fusion.

Health Care Costs for Adults With Congenital Heart Disease in the United States 2002 to 2012

2016 ◽  
Vol 118 (4) ◽  
pp. 590-596 ◽  
Author(s):  
David A. Briston ◽  
Elisa A. Bradley ◽  
Aarthi Sabanayagam ◽  
Ali N. Zaidi
Keyword(s):  
United States ◽  
Health Care ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Health Care Costs ◽  
Congenital Heart ◽  
The United States ◽  
Care Costs
Sign in / Sign up

Export Citation Format

Share Document