Economic burden of psoriasis compared to the general population and stratified by disease severity

Abstract

Objective:

To evaluate health care utilization and costs for patients with psoriasis vs. the general population and by psoriasis severity.     

The burden of hepatorenal syndrome among commercially insured and Medicare patients in the United States

Background: This study evaluated the characteristics, healthcare resource utilization (HCRU), and costs, from the payer perspective, of hepatorenal syndrome (HRS) patients covered by commercial and Medicare insurance. Mortality was assessed as a secondary outcome.

Methods: Patients were identified from claims databases of commercially insured patients (OptumHealth Care Solutions Inc.) in 1998–2014 and Medicare beneficiaries in 2009–2013 (5% Standard Analytic Files). At the time of their first inpatient admission (“index date”) with an HRS diagnosis (ICD-9 code 572.4), commercially insured patients must be aged 18–64 and Medicare patients must be aged 65 and older.

Results: A total of 784 commercially insured and 1061 Medicare HRS patients met the sample selection criteria. Patients were disproportionately male (commercial: 63.0%; Medicare: 57.9%) with a mean age of 54.1 among commercially insured and 74.1 among Medicare patients. Within the first 30 days, the average hospital length of stay (LOS) was 12.3 days among commercially insured and 10.8 days among Medicare patients. Based on Kaplan–Meier analyses, 36% of commercially insured and 26% of Medicare patients were readmitted within the next 30 days. During follow-up, many patients received dialysis (commercial: 33.0%; Medicare: 22.1%) or liver transplant (commercial: 10.7%; Medicare: 1.6%). Average costs within the 90?day follow-up were $157,665 for commercially insured and $48,322 for Medicare patients, with 68.3% and 78.3% of the costs incurred within the first 30 days. The primary cost driver was inpatient visits (commercial: 90.3% of costs; Medicare: 83.1% of costs), with differences between the populations consistent with lower mortality, higher dialysis rates, and higher transplant rates (both liver and kidney) among the commercially insured. Using US population and prevalence statistics, these results suggest that HRS imposes an annual total direct medical cost burden of approximately $3.0–$3.8 billion to payers over the period.

Conclusions: HRS imposes a significant economic burden.     

经济篇——慢性病的“家庭账”与“国家账”

会过日子的人心里都有一本账。说到慢性病的危害,除了身心伤害．它还给我们带来了什么？下面就让我们来算算慢性病的一笔经济账。     

Economic burden of psoriatic arthritis

Psoriatic arthritis (PsA) is a chronic autoimmune disease characterized by inflammatory arthritis in association with skin psoriasis (Ps). PsA may show a heterogeneous and variable clinical course, with involvement of peripheral and axial diarthrodial joints, periarticular structures such as entheses, as well as the skin and nails. Evidence is increasing that affected patients can have significant radiographic joint damage, functional impairment, reduced quality of life (QOL) and long-term work disability. The economic burden of PsA can be considerable.There is an increasing interest in pharmacoeconomic evaluations in PsA, driven mostly by the introduction of highly effective but expensive biologic agents, particularly inhibitors of the proinflammatory cytokine tumour necrosis factor (TNF)-alpha. Treatment with TNFalpha inhibitors results in not only substantial improvements in signs and symptoms of arthritis, but also improvements in all distinct sites of the disease, such as axial arthritis, dactylitis, enthesitis and skin disease.There is a dearth of published pharmacoeconomic evaluations in the field of PsA. The notable clinical efficacy of the TNFalpha inhibitors needs to be factored into a comprehensive assessment of their value. Further analyses are needed to optimize the use of the new biologic agents in PsA.     

Cost of subcutaneous immunotherapy in a large insured population in the United States

Objective: Allergic rhinitis (AR) affects up to 40% of the United States population, with approximately $11 billion annual medical costs. Allergy immunotherapy is the best option for long-term symptomatic relief, but treatment compliance can be low. The objective was to describe subcutaneous immunotherapy (SCIT)-related costs for patients overall and those with inconsistent treatment.

Methods: This study observed commercial and Medicare Advantage with Part D health plan enrollees. Included subjects had claims with AR diagnostic codes during 1 January 2011–31 December 2015 and ≥1 SCIT claim during 1 January 2013–31 December 2015 (index date?=?first SCIT claim date). A control sample was chosen randomly at a 1:3 ratio of SCIT to controls. Inconsistent use was defined as a ≥90?day gap after ≥1 SCIT. Patient characteristics were compared between SCIT patients and controls. Costs were calculated for all SCIT patients and the inconsistent subgroup.

Results: Compared with controls (n?=?394,479), SCIT (n?=?131,493) patients were younger (39.3 vs. 41.4 years), more likely female (56.4% vs. 50.7%) and more likely in a commercial plan (91.6% vs. 83.6%); all p?<?.001. Among SCIT patients, 15.1% had inconsistent use. Among all SCIT patients, the 3 year total plan-paid SCIT-related costs were $205,741,125 (18% was for inconsistent subgroup) and patient-paid costs were $47,560,450 (15% for inconsistent). Per-member-per-month costs were $0.48 plan-paid and $0.11 patient-paid, with $0.09 plan-paid and $0.02 patient-paid for inconsistent use.

Conclusions: This study showed 15% of patients may have costly inconsistent SCIT treatment. Greater understanding is needed regarding the reasons for inconsistent use of subcutaneous allergy immunotherapy.     

Economic burden in direct costs of concomitant chronic obstructive pulmonary disease and asthma in a Medicare Advantage population

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease whose sufferers consume a large amount of resources. Among community-dwelling Medicare beneficiaries, 12% reported that they had COPD in 2002. For clinicians, differentiating COPD from asthma may be difficult, but among patients with COPD and asthma, approximately 20% have both conditions. The economic impact of concomitant asthma and COPD is potentially large but has not been studied. OBJECTIVE: To assess the cost burden of asthma in patients with COPD in a Medicare Advantage population. METHODS: We reviewed the database of a large health plan that contained information from more than 30 distinct plans covering approximately 25 million members. We identified Medicare beneficiaries aged 40 years or older with medical and pharmacy benefits and medical claims with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes for COPD or asthma over a 1-year identification period (calendar year 2004). We assigned patients to 2 cohorts based on diagnoses on medical claims (any diagnosis field) during 2004; the COPD cohort had at least 1 medical claim for COPD, and the COPD + asthma cohort had at least 1 claim for COPD and at least 1 claim for asthma. A patient's index date was the first date during 2004 in which there was a medical claim with a diagnosis code for COPD or asthma. To confirm diagnosis, each patient was required to have at least 1 additional claim for COPD (COPD cohort) or at least 1 claim for COPD and at least 1 claim for asthma (COPD + asthma cohort) during the 24-month period from 12 months before through 12 months after the index date. We excluded patients who (1) were not continuously enrolled during the 12 months before and after the index date and (2) did not have at least 1 pharmacy claim for a drug of any type (to verify pharmacy benefits). Outcome measures included the use of emergency room (ER) and hospital services, and cost (net provider payment after subtraction of member cost share), categorized as all-cause, non-respiratory, and respiratory-related. ER use and inpatient hospital stays were identified using place-of-service codes. A minimum of 2 consecutive dates of service (length of stay [LOS] of at least 1 day) was required to indicate an inpatient hospitalization. An LOS of at least 1 day was required to distinguish inpatient services from other services (e.g., procedures or tests) reported on claims with an inpatient place of service. Multivariate analyses adjusted for age, gender, census region, and Charlson Comorbidity Index (CCI). Ordinary least squares regression was used to predict respiratory-related total health care costs, and logistic regression was used to predict the occurrence of at least 1 acute event, defined as use of either an ER or an inpatient hospital. All 2-way interactions were considered, and only those with significant results were included in the models. All reported P values were 2-sided with a 0.05 significance level. RESULTS: During 2004, 68,532 individuals within the database were enrolled in a Medicare Advantage plan. After application of the other inclusion criteria, we excluded approximately 11% of the patients who did not have 1 pharmacy claim of any type. There were 8,086 patients (11.8%) who had at least 1 medical claim with diagnosis codes for COPD and at least 1 other medical claim for either COPD or asthma and were continuously enrolled for at least 24 months. The COPD + asthma cohort numbered 1,843 patients (22.8%), and the COPD cohort numbered 6,243 patients (77.2%). Compared with COPD patients without asthma, patients with COPD + asthma were slightly younger, and a higher proportion was female. There were differences between the 2 cohorts in geographic distribution, and the COPD + asthma cohort had a higher disease severity with a mean CCI score of 2.6 (standard deviation [SD], 2.1) compared with the COPD cohort (2.3 [2.3], P < 0.001). Respiratory-related pharmacy costs were a relatively small part of total respiratory-related health care costs: approximately 5.7% for the COPD cohort and 8.8% for the COPD + asthma cohort. Respiratory-related costs accounted for 22.0% of total all-cause health care costs for the COPD cohort and 28.7% for the COPD + asthma cohort. Mean ([SD], median) unadjusted respiratory-related health care costs were $7,240 ([$15,057], $1,957) for the COPD + asthma cohort and $5,158 ([$11,881], $808) in the COPD cohort. After adjusting for covariates, patients in the COPD + asthma cohort were more likely to have at least 1 acute event (e.g., ER visits and hospitalizations) than patients in the COPD cohort (adjusted odds ratio, 1.6; 95% CI, 1.4-1.7) and had $1,931 (37.1%) greater adjusted respiratory-related health care costs--$7,135 versus $5,204 for the COPD cohort (P < 0.001). CONCLUSION: Medicare beneficiaries with COPD and asthma incur higher health care costs and use more health care services than those with COPD without asthma.     

Economic burden of heart failure in the elderly

Heart failure (HF) ranks among the most costly chronic diseases in developed countries. At present these countries devote 1-2% of all healthcare expenditures towards HF. In the US, these costs are estimated at $US30.2 billion for 2007. The burden of HF is greatest among the elderly, with 80% of HF hospitalizations and 90% of HF-related deaths in this cohort. As a result, approximately three-quarters of the resources for HF care are consumed by elderly patients. As demographic shifts increase the number of elderly individuals in both developed and developing nations, the resources devoted to HF care will likely further increase.Hospitalization accounts for roughly two-thirds of HF costs, but procedures, outpatient visits and medications also consume significant financial resources. HF also adversely impacts patient quality of life, and these relevant effects may not be captured in pure cost analyses. The cost effectiveness of several pharmacological interventions has been explored. In general, neurohormonal antagonists used for outpatient treatment of chronic HF are relatively cost effective, in part by reducing hospitalizations.Because HF poses such an enormous financial burden, efficient resource allocation for its management is a major societal and governmental challenge. In order to make informed decisions and allocate resources for HF care rationally, detailed data regarding costs and resource use will be essential. Further studies are needed to examine the impact of pharmacological and non-pharmacological interventions on costs and resource use in elderly individuals with HF.     

Validation of a claims-based diagnostic code for Stevens-Johnson syndrome in a commercially insured population

PURPOSE: To validate the administrative claims identification of a diagnosis of Stevens-Johnson syndrome (SJS) using medical records as the "gold standard" in a large, commercially insured US population. METHODS: Patients with >1 medical claim with the International Classification of Diseases, Ninth Revision, Clinical Modification code 695.1x between 1 July 2000 and 31 May 2007 were queried in the HealthCore Integrated Research Database(SM) , which contains administrative claims data for 14 commercial health insurance plans. Trained nurses and pharmacists abstracted pertinent information from the identified patients' medical records, which were then reviewed by two independent dermatologists to identify criteria to determine SJS diagnosis. Positive predictive values (PPVs) based on the claims and chart data were computed for all the cases. RESULTS: Medical charts for 200 claims-identified cases, with the International Classification of Diseases, Ninth Revision, Clinical Modification code 695.1x, were abstracted and reviewed by the dermatologists. A total of five cases (PPV?=?2.50%, 95%CI = 0.8%-5.7%) were determined to be SJS with clinical certainty. PPVs varied with data stratification: PPV for inpatient claims only (PPV?=?2.00%, 95%CI = 0.24%-7.04%), inpatient claims with 695.1x in first diagnosis field (PPV?=?4.11%, 95%CI?=?0.86%-11.54%), and final decisions of either clinical certainty or probable cases of SJS (PPV?=?6.00%, 95%CI?=?3.14%-10.25%). CONCLUSION: These findings demonstrate the difficulties associated with identifying rare disorders, which lack specific diagnostic criteria, within administrative claims databases. They underscore the challenges of using claims data to monitor ill-defined clinical conditions as well as the need to validate claims-identified cases with information from other sources, such as medical charts. Copyright ? 2012 John Wiley & Sons, Ltd.     

Economic burden of influenza-like illness in long-term-care facilities.

Direct medical costs and medically related transportation costs incurred by patients in long-term-care facilities (LTCFs) as a result of influenza-like illness (ILI) were studied. The study was conducted from the payer's perspective. Charts were reviewed retrospectively for all patients who were residents of four Richmond, Virginia, LTCFs between January 1 and May 31, 1999. Consultant pharmacists gathered data on patient demographics, ILI status, vaccination for influenza and streptococcal pneumonia, diagnosis of asthma or chronic obstructive pulmonary disease, and utilization of health care services related to ILI. Services included the use of antimicrobials, antivirals, and respiratory drugs; emergency room visits; diagnostic tests; hospitalizations; and medically related transportation. Costs were based on average wholesale prices (for drugs) and Medicare or Medicaid reimbursement rates. Data were collected for 551 patients. Of these, 112 patients had been diagnosed with 128 cases of ILI during the study period. Twenty-two patients with ILI had 28 visits to emergency rooms, and 30 patients with ILI had 36 hospitalizations. The mean +/- S.D. cost per case of ILI was $1341 +/- $2063; inpatient hospital costs accounted for 84% of this amount. Centers for Disease Control and Prevention criteria for ILI provided a lower incidence of ILI and, consequently, a lower mean +/- S.D. cost of $968 +/- $1806 per case. ILI in patients in four LTCFs in Richmond, Virginia, generated substantial costs, the bulk of which resulted from hospitalization. A substantial percentage of the patients apparently were not immunized.     

Economic impact and quality-of-life burden of allergic rhinitis

Allergic rhinitis can be a debilitating condition which, if untreated, can result in considerable health-related and economic consequences. A review of the published literature was conducted, with quantitative/qualitative analysis as appropriate, to explore the direct, indirect, and hidden costs of allergic rhinitis, as well as the quality-of-life burdens that the disease presents to patients and to the healthcare system. Lack of treatment, undertreatment, or nonadherence to treatment in allergic rhinitis were seen to increase direct and indirect costs, reinforcing the need for patient education and for physicians to implement existing evidence-based guidelines for prevention and treatment. It was concluded that greater awareness of the total economic burden of allergic rhinitis should encourage appropriate intervention and ultimately ensure clinically favorable and cost-effective outcomes.     

Economic and humanistic burden of external genital warts

External genital warts (EGW) are a sexually transmitted infection caused by various strains of human papillomavirus (HPV). Several studies have described the direct and indirect costs of EGW, while others have reported on the burden of EGW in terms of the impact on the quality of life (QOL) of patients. The arrival of a quadrivalent HPV vaccine that protects against both cervical cancer and EGW requires a proper understanding of the impact of vaccines on costs and QOL. Using pre-defined search terms and inclusion/exclusion criteria, we performed a systematic review of the economic and humanistic burden of EGW. The focus of our review was on literature describing the direct and indirect costs of EGW per episode of care (EoC) or per year, as well as the impact of EGW on disease-specific, generic, or preference-based QOL measures. We also reviewed the literature on the national economic burden of EGW from the perspectives of different countries. Other aspects of EGW management that can inform economic modelling studies, such as length of EoC, number of physician visits and indirect costs, were also explored. Our review sheds light on the high economic and humanistic burden of EGW and important differences in the costs between men and women, as well as the differences in health resource utilization and costs across countries. Our study also highlights the dearth of information on the impact of EGW on the QOL and productivity of patients.