Cost of Cleft Team Care at an Academic Children’s Hospital

Background The financial burden of cleft-craniofacial team care is substantial, and high costs can hinder successful completion of team care. Solution Collaboration with multiple stakeholders including providers, insurers, and patient guardians, as well as hospital administrators, is critical to increase patient retention and improve final clinical outcomes. What We Do That is New At our cleft and craniofacial center, charges for a team care visit fall into one of three categories—hospital fees, professional fees, or external fees. There are four types of hospital fees depending on (1) whether the patient is new or returning, and (2) whether the patient saw ≤4 or ≥5 providers. To further elucidate the financial burden (out-of-pocket costs) directly borne by families of children with cleft lip and/or palate, we conducted a retrospective review of billing records of team care visits made between September 2019 and March 2020. Out-of-pocket costs for a single team care visit (on a commercial insurance plan) ranged from $4 to approximately $1220 and had a median (IQR) of $445 ($118, $749).

Actuarial Modelling for Patients with Acute Lymphoblastic Leukaemia (ALL) based on CNS1 Status

Introduction: Worldwide, Acute Lymphoblastic Leukaemia (ALL) is the most frequent cancer in children. One of the major clinical challenges is adequate diagnosis and treatment of Central Nervous System (CNS) involvement in this disease. CNS relapse has been a barrier to the successful treatment of ALL for many years. Recent studies have shown encouraging results in the survival of these patients for a long time. However, their long-term survival depends upon the cost of therapy toxicity and financial distress. The primitive aim of the paper is to propose a yearly insurance plan to assist these patients financially during the diagnosis period. Method: Based on the CNS status 110 patients are categorised to estimate their long-term survival. Survival times of CNS1 status and for all the patients cumulatively are estimated by Kaplan-Meier and Cox-PH model in presence of the prognostic factors. The survival estimates are used to estimate the premium cost. The premium cost is estimated using a deterministic model which is advantageous for the patient and serviceable for the insurance provider. Result: Both the methods Kaplan-Meier and Cox-PH gave higher survival estimates for ALL patients cumulatively as compared to CNS1. Survival estimate from Cox-PH is 0.998 and 0.997 of first year of follow-up for patients taken cumulatively and in CNS1 respectively. For the fifth year the survival estimates are 0.802 and 0.783 respectively. The estimated premium cost for a 100 rupees of sum insured is rupees 4.7 for the first year and rupees 26.69 for the fifth year for patients taken cumulatively. Same for CNS1, it is rupees 6.24 and 29.42. Conclusion: Cox-PH model for estimating the survival is recommended since it includes the prognostic factors. The insurance plan suggests to opt for the premium as early as possibly since it costs less and increases later.

Prior Authorization, Copayments, and Utilization of Sacubitril/Valsartan in Medicare and Commercial Plans in Patients With Heart Failure With Reduced Ejection Fraction

Background: Slow uptake of sacubitril/valsartan in patients with heart failure with reduced ejection fraction has been reported, which may negatively impact clinical outcomes. We characterized prior authorization (PA) burden, prescription copayment, and utilization of sacubitril/valsartan by insurance plan type to identify potential barriers to its use. Methods: We conducted a national population-level, cross-sectional study using PA data from an insurance coverage website accessed in March 2019 and IQVIA National Prescription Audit data from August 2018 to July 2019. Primary outcomes were proportion of plans requiring PA, frequency of specific PA criteria, number of sacubitril/valsartan prescriptions, and copayments per insurance plan type. Results: Overall, 48.1% (1394/2896) of insurance plans required PA for sacubitril/valsartan. Fewer Medicare (27.7%) than commercial (57.2%) plans required PA ( P <0.001). For both plan types, the most frequently required PA criteria were ejection fraction (71.6%, 90.9%) and New York Heart Association class (60.4%, 90.8%) for Medicare and commercial plans, respectively. Copayment amounts varied by plan type, with more sacubitril/valsartan prescriptions for commercial plans not requiring a patient copayment (32.4%) compared with Medicare plans (19.3%; P <0.001). There were 814 437 sacubitril/valsartan prescriptions for Medicare and 822 292 for commercial plans dispensed from August 2018 to July 2019. Based on estimated heart failure with reduced ejection fraction populations for each plan type, 4-fold more sacubitril/valsartan prescriptions were dispensed in commercial than in Medicare plans (820 versus 215 prescriptions/1000 individuals in the heart failure with reduced ejection fraction population). The estimated proportion of heart failure with reduced ejection fraction patients prescribed sacubitril/valsartan was 3.6% (1.5%–6.8%) for Medicare and 13.7% (4.9%–31.8%) for commercial plan populations. Conclusions: Despite commercial plans having greater PA requirements than Medicare, population-adjusted use of sacubitril/valsartan was higher in commercial plans. Given that commercial plans had more prescriptions with low copayments than Medicare, copayment policies may be more influential on sacubitril/valsartan use than its PA policies. Low sacubitril/valsartan use in both plan types highlights the multifactorial nature of medication underutilization that includes factors beyond the drug policies that we evaluated.

Multicriteria Based Recommender System for Enhancing Customer Centric Business

A multi-criteria-based recommender system makes precise decisions by probing customers multiple criteria’s on-hand and gives recommendations by modelling a user’s utility for the alternatives along several criteria. This paper collects user preferences of criteria over alternatives in the form of linguistic variables. Alternatives includes 6 policies namely term plan, endowment plan, child plan, life insurance plan, criteria include income tax benefit, sum assured, benefits on death and riders option. To rank such alternatives, fuzzy vikor expanded form of MCDM (MCDM) technique is used. MCDM ranks policies based on expand S (S) and expand R (R) value. Sensitivity analysis is used to determine the stability in the alternatives ranking, with the varying parameter value V. The proposed approach is compared with fuzzy topsis approach which ranks alternatives based on closeness coefficient value obtained. After ordering the alternatives using the MCDM techniques, it is inferred that, Both the approach almost provides the closest ranking order. The proposed fuzzy vikor provides best and optimal solution preserving the consistency compared to fuzzy topsis.