Economic impact of Enterosgel® in the hospital treatment of diarrhoeal syndromes associated with different disease conditions

Background: Enterosorbents are orally administered materials which pass through the gut where they bind various substances. In a randomized clinical trial, the efficacy and safety of enterosorbent Enterosgel® in the treatment of non-infectious diseases with diarrhoea have been proved. Objective: To assess the cost impact of Enterosgel® in the treatment of hospitalized patients with non-infectious diseases with diarrhoea adopting a cost/minimization approach. Methods: A cost analysis was conducted considering the hospital’s perspective. The analysis compared the treatment costs (drugs and hospital stays) of Enterosgel® in addition to the standard of care (SoC) to SoC alone. The main analysis focused on the comparison between the two therapeutic strategies regarding the economic valorization of hospital stays, while the secondary analysis estimated the hospital organizational efficiency with regard to the annual bed turnover. Results: Reducing the duration of inpatient admission, compared to SoC alone, Enterosgel® in addition to SoC let the hospital obtain a greater valorization of the hospital stays (range: € 68.54-€ 558.60). The shorter duration of inpatient admission results in an increased number of hospital admissions per year. For example, assuming a 10-bed ward, the total hospital annual gain would be € 82,616. Conclusions: Enterosgel® in addition to SoC is cost saving, allowing the hospital to achieve greater efficiency in managing patients with non-infectious diseases with diarrhoea.

Longitudinal Association of Salaries for Medical Staff With Medical Service Utilization and Expenditure in China, 2007–2016

Objectives: To test the hypothesis that higher salary levels of the medical staff are associated with lower medical service utilization and expenditure.Methods: Using longitudinal data from 31 Chinese provinces for the period 2007-2016, we constructed fixed effects models to analyze the association between the salary of medical staff and medical service utilization, medical expenditure, medication expenditure, and medication proportion.Results: A 10,000 CNY increase in medical staff's salaries was associated with a 0.89% decrease in the average number of annual inpatient admissions per person; 1.88 and 1.59% decreases in average expenditures per outpatient visit and inpatient admission, respectively; 3.05 and 2.66% decreases in drug expenditures per outpatient visit and inpatient admission, respectively; 0.58 percent point and 0.39 percent point decreases in the share of drug expenditure in outpatient and inpatient, respectively. When medical staff's salaries increased by 450,000 CNY, the turning point was reached when the maximum medical expenditure savings offset the medical staff salary increases, yielding a 634 billion CNY surplus from medical expenditure.Conclusions: Our results supported the hypothesis that higher salary levels of the medical staff are associated with lower medical service utilization and expenditure. Further studies are requested to test whether higher medical staff's salaries will attenuate over-treatment and that savings from reduced prescriptions and service charges will offset the increased salaries of medical staff.

The Economic Burden of NIPC and BOS Following allogeneic HSCT in Patients with Commercial Insurance in the United States

Non-infectious pulmonary complications (NIPC) after allogeneic hematopoietic stem cell transplantation (alloHSCT), including bronchiolitis obliterans syndrome (BOS), cause significant morbidity and mortality, but their impact on healthcare resource utilization (HRU) and costs is unknown. This longitudinal retrospective study quantified the economic burden of NIPC and BOS in alloHSCT patients using commercial claims data from the IQVIA PharMetrics Plus™ database. Study patients were aged 0-64 who underwent alloHSCT between 1/1/2006-9/30/2018 and observable 12 months before and up to 5 years after index alloHSCT. NIPC patients were identified using International Classification of Disease (ICD) diagnosis codes. Outcomes were mean per-patient HRU (inpatient admissions, outpatient office, hospital visits, and prescription medications) and costs paid by insurers in each post-transplant year. Among 2,162 alloHSCT patients, 254 developed NIPCs and 155; 147 were propensity score matched to non-NIPC patients. The The mean age was 43yrs and 46% were female. In the first year following transplantation, NIPC patients had significantly higher inpatient admission rates (3.8 ± 3.2 vs. non-NIPC: 2.6 ±2.4; p<0.001) and higher total costs, ($567,870 vs. $412,400; p=0.07), reflecting higher costs for inpatient admissions ($452,475 vs. $300,202; p=.06) and pulmonary function testing ($519 vs. $587; p<0.001). Among those observable for more years, costs remained higher for NIPC patients, reflecting significantly higher inpatient admission rates in the first three years following transplant. Sub-analysis of patients with diagnoses likely reflected of BOS were consistent with these findings. AlloHSCT patients who developed NIPC had higher healthcare resource utilization, and incurred higher costs, compared to alloHSCT patients who did not develop NIPC following transplant.

Cost Utility Analysis of Costal Cartilage Autografts and Human Cadaveric Allografts in Rhinoplasty

Background: Human cadaveric allograft (HCA) and costal cartilage autograft (CCA) have been described for reconstruction during rhinoplasty. Neither are ideal due to infection, resorption, and donor site morbidity. The clear superiority of 1 graft over the other has not yet been demonstrated. This study assesses comparative costs associated with current grafting materials to better explore the cost ceiling for a theoretical tissue engineered implant. Materials and methods: A cost utility analysis was performed. Initial procedure costs include physician fees (CPT 30420), hospital outpatient prospective payments, ambulatory surgical center payments, and fees for the following: rib graft (CPT 20910), hospital observation, and DRG (155) for inpatient admission. Additional costs for revision procedure, included the following fees: physician (CPT 30345), rib graft, hospital outpatient prospective payment, and ambulatory surgical center payments. Total costs under each scenario were calculated with and without the revision procedure. Comparison of total costs for each potential outcome to the estimated health utility value allowed for comparison across rhinoplasty subgroups. Results: The mean cost of primary outpatient rhinoplasty using HCA and CCA were $8075 and $8342 respectively. Revision outpatient rhinoplasty averaged $7447 and increased to $8228 if costal cartilage harvest was required. Hospital admission increased the cost of primary rhinoplasty with CCA to $8609 for observational admission and to $13653 for 1 day inpatient admission. Revision CCA rhinoplasty with an inpatient admission complicated by pneumothorax increased costs to $21 099. Conclusion: Cost of rhinoplasty without hospitalization was similar between HCA and CCA and this cost represents the lower limit of a practical cost for an engineered graft. Considering complications such as need for revision or for admission after CCA due to surgical morbidity, the upper limit of cost for an engineered implant would approximately double.

519. Risk Factor Analysis for Hospital Admission Following Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Monoclonal Antibody Treatment

Background The FDA has issued emergency use authorization (EUA) for neutralizing monoclonal antibodies (mAb) for the treatment of mild-moderate coronavirus disease 2019 (COVID-19) in patients who are at high risk of disease progression. The EUA allows for COVID-19 mAb infusion to occur up to 10 days from symptom onset and due to logistics, mAb treatment typically occurs later in this 10 day window. Efficacy of early versus late mAb treatment is unknown Methods In this single center, retrospective case-control study, we performed a risk factor analysis of patients with mild COVID-19 infection treated with mAb on the composite outcome of subsequent evaluation in the Emergency Department (ED) or inpatient admission December 2020 through May 2021. Multivariate analysis of variables found to be significant in univariate analysis was performed using STATA 15 statistical software Results Two-hundred eighty-eight patients who received mAb treatment were included in analysis. The mean age was 58.6 years and 59.7% were female, 64.9% white, and 27.1% African American. Following mAb infusion, 31 (10.8%) had disease progression resulting in an ED encounter or inpatient admission. Patients who received early (days 1-5 of symptoms) mAb infusion were less likely to have progressive disease than patients with late (days 6-12 of symptoms) infusion; (6.1% vs 13.2%; P= 0.048). Zero of 21 patients who received mAb infusion on day 1-3 of symptoms had disease progression. Patients with CHF (7.4% vs 19.4%; P=0.038), cirrhosis (9.3% vs 25.8%; p=0.012), CKD (12.5% vs 35.5%; p=0.001) and hypertension (70.8% vs 90.3%; p=0.021) were more likely to have disease progression. There were no differences in sex, race, BMI, or symptoms between groups. Multivariate analysis revealed cirrhosis (OR 3.0; 95% CI 1.1-7.9) and CKD (OR 2.6; 95% CI 1.0-6.4) increased risk of disease progression while early mAb infusion was protective (OR 0.38; 95% CI 0.14-1.0) Conclusion Infusion of mAb for the treatment of mild to moderate Covid-19 within 5 days of symptom onset reduces rate of disease progression compared to delayed (day 6-12 of symptoms) infusion. This finding was significant when controlling for comorbidities. Efforts should be made to infuse high risk patients with COVID-19 mAb therapy within 5 days of symptom onset Disclosures All Authors: No reported disclosures

Criteria of Hospital Inpatient Admission of Pediatric Dental Patient

Some dental conditions that are presented to the pediatric emergency department need hospital inpatient admission to facilitate supportive care, provide dental treatment and monitor the physiologic state of the child. The decision to treat the pediatric dental patient as an outpatient or inpatient is very important to control the overuse of hospital resources and at the same time not placing the child at the risk of rapid deterioration. However, no available guidelines or validated measures for the correct decision to treat the patient in either inpatient or outpatient care settings that can be used specifically for pediatric dental patients presented to the emergency department. Up to date, the decision of admitting pediatric patients is usually based on the severity of illness that can be measured by using The Pediatric Risk of Admission (PRISA II) Score. This review gives an overview of indications and clinical criteria of hospital inpatient admission of pediatric patients subsequent to traumatic and non-traumatic dental conditions.

EP.WE.339The Role of a “Clean Ward” Model in Minimizing COVID-19 Exposure for Elective General Surgical Patients

Aims To assess if a “clean ward” model is effective in preventing peri-operative COVID-19 infection in elective general surgical patients. Methods Elective general surgical cases were audited prospectively in three thirty-day cycles - May–July 2020, September–October 2020 and December 2020–January 2021. Patients isolated for 10 days and required a negative COVID swab prior to admission. Nursing and surgical staff underwent weekly swabbing, operations were carried out in a dedicated “clean theatre” and a no-visiting policy was enforced. Inpatient COVID cases and COVID-19 status at 14 days post discharge were recorded and compared to the community COVID-19 Reproduction (R) number. Results Cycle 1, (May-Jul 20, R number=0.3-1.5) 44 elective patients. One patient was diagnosed with clinical COVID post-operatively and recovered well. Cycle 2, (Sept-Oct 20, R number=0.8-1.8) 57 patients identified. No positive COVID-19 cases during inpatient admission or at 14 days post discharge. Cycle 3, (Dec 20-Jan 21, R number=1.0-1.9) 38 elective patients. One patient tested positive for COVID-19 following transfer to the emergency surgical ward due to COVID-19 related bed pressures. No other positive cases were identified during follow up. Conclusions Despite an ongoing rise in community COVID-19 cases, the “clean ward” model appears to be effective in reducing COVID-19 transmission for elective general surgical patients. When the R number was at its highest, the only COVID positive case developed symptoms after moving from the “clean ward” system. Extrapolation of this model could be considered in re-establishing elective operating lists across the region.

Oncology value based payment models: Where are the savings opportunities?

69 Background: Oncology practices are increasingly participating in value-based payment (VBP) arrangements; however, there is limited information on where practices have the greatest impact on reducing medical costs. Methods: United Healthcare (UHC) conducted a pilot to evaluate a VBP consisting of an episode fee, eliminating drug margin, and shared savings. The pilot was limited to members with breast, lung or colon cancer enrolled in UHC’s commercial plans. We compared total medical cost (TMC) per 120-day episode calculated from paid claims amounts for the pilot practices with a concurrent national cohort for the performance period (9/2015-9/2019) and a baseline period (1/2013-3/2015) using a difference-in-differences technique with a generalized linear regression model, adjusting for age, gender, cancer type and stage (adjuvant vs. metastatic), comorbidities, cancer surgery, radiation therapy, novel therapy, duration of therapy, and region. We categorized claims into 6 categories and estimated the impact of the VBP on costs: chemotherapy/drugs, radiation therapy, cancer surgery, cancer diagnostics, other cancer-related and other non-cancer related. In addition, we evaluated the difference in acute inpatient admission rates. Results: Patient treated in the pilot practices contributed 2,647 episodes of a total of 73,352 episode during the performance period, weighted equally between adjuvant and metastatic disease (Table). The adjusted TMC per 120-day episode was $36,434 for the national cohort and $37,215 for the participating clinics at baseline and $50,773 and $41,416, respectively during the performance period, resulting in an average decrease in TMC of $9,687 or a 20% reduction; although this varied significantly by stage and cancer type. The relative decrease in medical costs by category ranged from 13% for chemotherapy/drugs to 33% for cancer surgery and an increase in costs associated with cancer diagnostics of 7%; however, chemotherapy/drug were still associated with the largest absolute decrease in costs ($2,941). Practices participating in the pilot had a 24.7% decrease in the number of acute inpatient admissions and 12.6% decrease in the number of inpatient admission days; however, this did not reach statistical significance. Conclusions: Overall, practices participating in a VBP pilot with a commercial health plan decreased TMC per episode by 20% with savings across all cost categories except for cancer diagnostics.[Table: see text]