A Web-Based Nutrition Program Reduces Health Care Costs in Employees With Cardiac Risk Factors: Before and After Cost Analysis

Background: Smoking, unhealthy alcohol consumption, poor diet and physical inactivity are leading risk factors for morbidity and mortality, and contribute substantially to overall healthcare costs. The availability of health surveys linked to health care provides population-based estimates of direct healthcare costs. We estimated health behaviour and socioeconomic-attribute healthcare costs, and how these have changed during a period when government policies have aimed to reduce their burden. Methods: The Ontario samples of the Canadian Community Health Surveys (conducted in 2003, 2005, and 2007-2008) were linked at the individual level to all records of health care use of publicly funded healthcare. Generalized linear models were estimated with a negative binomial distribution to ascertain the relationship of health behaviours and socioeconomic risk factors on health care costs. The multivariable cost model was applied to unlinked, Ontario CCHS samples for each year from 2004 to 2013 to examine the evolution of health behaviour and socioeconomic-attributable direct health care expenditures over a 10-year period. Results: We included 80,749 respondents, aged 25 years and older, and 312,952 person-years of follow-up. The cost model was applied to 200,324 respondents aged 25 years and older (CCHS 2004 to 2013). During the 10-year period from 2004 to 2013, smoking, unhealthy alcohol consumption, poor diet and physical inactivity attributed to 22% of Ontario’s direct health care costs. Ontarians in the most disadvantaged socioeconomic position contributed to 15% of the province’s direct health care costs. Combined, these health behaviour and socioeconomic risk factors were associated with 34% ($134 billion) of direct health care costs (2004 to 2013). Over this time period, we estimated a 1.9% reduction in health care expenditure ($5.0 billion) attributable to improvements in some health behaviours, most importantly reduced rates of smoking. Conclusions: Adverse health behaviours and socioeconomic position cause a large direct health care system cost burden.

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467FFR guided acute complete revascularization versus culprit lesion only treatment in patients presenting with STEMI; 3-year cost-analysis data from COMPARE-ACUTE trial

European Heart Journal ◽

10.1093/eurheartj/ehz747.0125 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

P C Smits ◽

M Abdel-Wahab ◽

F J Neumann ◽

B M Boxma-De Klerk ◽

P L Laforgia ◽

...

Keyword(s):

Myocardial Infarction ◽

Health Care ◽

Cost Analysis ◽

Health Care Costs ◽

Average Cost ◽

Long Term Results ◽

Complete Revascularization ◽

Culprit Lesion ◽

Care Costs

Abstract Background Compare-Acute trial showed a 1-year superior outcome of FFR-guided acute complete revascularization (FFR-CR) compared to culprit-lesion-only revascularization (CLO) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Long-term results and financial impact of this strategy are unknown. Purpose To evaluate if FFR-CR strategy is superior to CLO strategy in terms of health care costs at 3 year follow-up. Methods Compare-Acute is a multicenter, investigator-initiated prospective randomized controlled trial that involved 24 sites. Patients with STEMI and MVD were randomized 1:2 after successful primary PCI, towards FFR-CR or CLO treatment strategies (295 vs 590 pts). All stenosis ≥50% by angiography in the non-infarct artery were investigated by FFR in both arms. In the FFR-CR arm, all non-culprit (NC) lesions with a FFR ≤0.80 were treated by PCI. In the CLO arm pts underwent blinded FFR procedure of the NC lesions. Further treatment of these lesions was based on symptoms and/or ischemia testing during follow-up with an allowed treatment window of 45 days. The primary endpoint was defined as a composite of all-cause mortality, non-fatal myocardial infarction, any revascularization and cerebrovascular events (MACCE) at 12 months. The major secondary endpoints are MACCE and health care costs from both strategies up to 3-year follow-up. Cost-analysis is done from an insurance/governmental perspective in countries that use Diagnosis Related Group (DRG) costs: the Netherlands, Germany, Sweden and Poland. Results 1-year results have already been published and showed superior outcome of patients in the FFR-CR arm. According to the Dutch system, at 1 year of follow-up the average cost per patient was 8.150€ in the FFR-CR arm, and 10.319€ in the CLO arm (−21%). The better cost-effectiveness of FFR-CR strategy remained at 3 years of follow-up: average cost per patient was 8.653€ in the FFR-CR arm and 11.100€ in the CLO arm (−22%). Same 3-year data was confirmed using DRG analysis according to the German system (FFR-CR 4.887€ vs CLO 5.200€; −6.0%) and the Swedish system (FFR-CR 6.205€ vs CLO 8.133€; −23.7%). FFR-CR strategy was not more costly according to the Polish system (FFR-CR 3.704€ vs CLO 3.685€; +0.5%). Moreover, the better outcome of the FFR-CR group was mantained at 3 year follow-up (data not shown). Figure 1 Conclusion Our cost-analysis of the Compare Acute Trial shows that the strategy of FFR-guided complete revascularization in patients with STEMI and MVD is not only superior in terms of outcome, but also in terms of health care costs at 1 year. This benefit is maintained at 3 years follow-up.

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Differences in Health Care Costs and Utilization among Adults with Selected Lifestyle-Related Risk Factors

American Journal of Health Promotion ◽

10.4278/0890-1171-16.4.225 ◽

2002 ◽

Vol 16 (4) ◽

pp. 225-233 ◽

Cited By ~ 21

Author(s):

Larry A. Tucker ◽

Alan G. Clegg

Keyword(s):

Risk Factors ◽

Health Care ◽

Health Care Costs ◽

Related Risk ◽

Care Costs

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Exercise Effects on Bone Mineral Density, Falls, Coronary Risk Factors, and Health Care Costs in Older Women

Archives of Internal Medicine ◽

10.1001/archinternmed.2009.499 ◽

2010 ◽

Vol 170 (2) ◽

pp. 179 ◽

Cited By ~ 93

Author(s):

Wolfgang Kemmler

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Health Care ◽

Older Women ◽

Health Care Costs ◽

Bone Mineral ◽

Coronary Risk Factors ◽

Coronary Risk ◽

Mineral Density ◽

Care Costs

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Ten Modifiable Health Risk Factors and Employees’ Medical Costs—An Update

American Journal of Health Promotion ◽

10.1177/0890117120917850 ◽

2020 ◽

Vol 34 (5) ◽

pp. 490-499 ◽

Cited By ~ 3

Author(s):

Ron Z. Goetzel ◽

Rachel Mosher Henke ◽

Michael A. Head ◽

Richele Benevent ◽

Kyu Rhee

Keyword(s):

Risk Factors ◽

Health Care ◽

Health Promotion ◽

Health Risk ◽

Health Care Costs ◽

Health Risks ◽

Modifiable Risk Factors ◽

Full Time ◽

The Relationship ◽

Care Costs

Purpose: To estimate the relationship between employees’ health risks and health-care costs to inform health promotion program design. Design: An observational study of person-level health-care claims and health risk assessment (HRA) data that used regression models to estimate the relationship between 10 modifiable risk factors and subsequent year 1 health-care costs. Setting: United States. Participants: The sample included active, full-time, adult employees continuously enrolled in employer-sponsored health insurance plans contributing to IBM MarketScan Research Databases who completed an HRA. Study criteria were met by 135 219 employees from 11 employers. Measures: Ten modifiable risk factors and individual sociodemographic and health characteristics were included in the models as independent variables. Five settings of health-care costs were outcomes in addition to total expenditures. Analysis: After building the analytic file, we estimated generalized linear models and conducted postestimation bootstrapping. Results: Health-care costs were significantly higher for employees at higher risk for blood glucose, obesity, stress, depression, and physical inactivity (all at P < .0001) than for those at lower risk. Similar cost differentials were found when specific health-care services were examined. Conclusion: Employers may achieve cost savings in the short run by implementing comprehensive health promotion programs that focus on decreasing multiple health risks.

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