scholarly journals The Relationship between Antimicrobial Resistance and Patient Outcomes: Mortality, Length of Hospital Stay, and Health Care Costs

2006 ◽  
Vol 42 (Supplement_2) ◽  
pp. S82-S89 ◽  
Author(s):  
Sara E. Cosgrove
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Hospital Stay ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Length Of Hospital Stay ◽  
The Relationship ◽  
Care Costs

Persistence to Lenalidomide Improves Patient Outcomes While Remaining Cost-Neutral for the Treatment of Multiple Myeloma

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4688-4688
Author(s):  
Henry J Henk ◽  
Satyin Kaura ◽  
Zeba M. Khan ◽  
April Teitelbaum
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Disease Control ◽  
Disease Progression ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Medicare Advantage ◽  
Pharmacy Benefit ◽  
The Relationship ◽  
Care Costs

Abstract Abstract 4688 Background: While persistence to drug therapy is essential to achieve optimal patient benefits, poorly controlled MM results in more rapid disease progression, disease-related complications, impact on quality of life, and premature death. Additionally, the cost of delivering medical care for myeloma patients is also an important consideration for society and payers. Aim: To evaluate the real-world persistence with lenalidomide treatment in MM patients, and assess the relationship between treatment persistence and (1) indicators of poor disease control and disease-related complications and (2) the total health care costs for patients with MM. Methods: Commercial and Medicare Advantage enrollees initiating LEN for treatment of MM with pharmacy and medical benefits in the 6 months prior and 1 year following initiation of LEN were identified in a US health plan claims database (7/1/2007–6/30/2011). MM was identified by at least 2 medical claims at least 7 days apart with a MM diagnosis code (ICD-9: 203.0x). Treatment discontinuation was defined as the first appearance of a gap greater than 30 days between runout date (prescription fill date + days supply) and next lenalidomide prescription fill. Persistence was defined as days from the first LEN treatment to the earlier of either the date of discontinuation or end of the follow-up period (i.e., 6/30/2011). Disease-related complications included sepsis, indictors of relapse or disease progression (defined as the addition of bortezomib (BORT) to a LEN regimen, a switch to BORT from a LEN regimen, or discontinuation of LEN followed by restarting LEN), sepsis, and evidence of skeletal-related events (SREs) defined as fracture, spinal cord compression, surgery and/or radiation to the bone. Total health care costs include combined payer and patient paid amounts under the medical benefit (e.g., hospital, office, ER) and retail pharmacy benefit (inclusive of specialty pharmacy). Multivariate regression-based models were used to examine the relationship between persistence and measures of disease control and complications, as well as the relationship between persistence and first-year health care costs controlling for age, gender, comorbidity score, prior stem cell transplant, prior SREs, and insurance type (commercial or Medicare Advantage). Results: Among the 605 patients meeting the inclusion criteria, persistency with lenalidomide averaged 6.0 months (median = 4.9) with 57.9% of patients being persistent for the entire year. A one month increase in persistence was associated with a lower probability of SREs (OR=0.96; p=0.078), sepsis (OR=0.86; p<0.001), and relapse or disease progression (OR=0.78; p<0.001). The probability of an inpatient hospitalization (OR=0.68; p-value<0.001) and additional ER visits (OR=0.83; p=0.002) were both lower with longer duration. When examining the relationship between persistence and health care costs, a one-month increase in persistence was found to be associated with, on average, a 8% decrease in medical care costs (p=0.007) and an 8% increase in pharmacy costs (p<0.001). Conclusions: Improved persistence with lenalidomide therapy was associated with improved patient outcomes as demonstrated by fewer SREs and lower likelihood of developing sepsis, consequently leading to cost saving due to fewer hospitalizations and ER visits. The reduction in medical costs offsets the expected increase in pharmacy costs as lenalidomide is covered under the pharmacy benefit. This analysis demonstrates that continuous treatment with lenalidomide can not only improve disease control in MM patients, but in addition also reduces health care utilization and related costs as indicated by the lower risk of a hospitalization and number of ER visits, and could therefore be budget neutral in terms of overall societal burden of health care costs associated with MM. * p<0.001; ** p=0.078. Disclosures: Henk: OptumInsight: Consultancy. Kaura:Celgene: Employment. Khan:Celgene: Employment.

10 Years History of Cost-Effectiveness for 209 Newly Diagnosed Multiple Myeloma Patients at a Single-Institute in Japan

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5620-5620
Author(s):  
Kenshi Suzuki ◽  
Tomofumi Yamamoto ◽  
Masahiro Ikeda ◽  
Tomomi Takei ◽  
Nobuhiro Tsukada ◽  
...  
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Hospital Stay ◽  
Median Survival ◽  
Health Care Costs ◽  
Length Of Hospital Stay ◽  
Novel Agents ◽  
Newly Diagnosed ◽  
The Cost ◽  
Care Costs

Abstract Background & Objective The therapy of multiple myeloma (MM) has improved greatly over the last decade. However, the rise in health care costs has become a big problem. Therefore, it is necessary to consider the cost-effectiveness including Quality of Life (QoL). In this study, we assessed the real-world cost-effectiveness of MM treatment. Methods & Patients A total of 209 MM patients who were newly diagnosed and treated only at Japanese Red Cross Medical Center (JRC-MC) from January 2006 to December 2015 were registered for this retrospective research. Those patients who were treated at other institute than JRC-MC were excluded. All of the costs for MM treatment in hematology department were analyzed. The costs were calculated based on the health care costs spent in hematology department. Overall survival was evaluated by the Kaplan-Meier method. All of the costs were calculated in US dollars based on average value from 2006 to 2015 (1USD = 100.294 Japanese yen). Result First, the cost paid for treatment of 84 patients who died from symptom onset to death was about 0.14 million USD. We also calculated the total annual health care cost for their patients from 2006 to 2015. Annual cost of all MM patients at 2006 was 0.454 million USD, and the cost at 2015 was 7.505 million USD. The cost/patient-year of 2006, when novel agents were not obtainable was 21,656 USD, and that cost of 2015, when three new agents were available was 55,608 USD. These results showed that the costs of MM treatment became 2.56 times higher in the past 10 years. Individual costs for bortezomib, thalidomide, and lenalidomide is shown in Fig.1. Since 2011 to 2014, the ratio of cost of novel agents exceeded 50%. Secondly, overall survival was evaluated by statistical analysis. The median survival from diagnosis was 56 (range, 0-117) months 95% CI (45.12-66.88). We divided patients into 5 subgroups, according to the time of diagnosis. (1)2006: 21 patients, (2)2007-2008: 26 patients, (3)2009-2010: 38 patients, (4)2011-2012: 42 patients, (5)2013-2015: 82 patients. In Japan, the novel agents such as bortezomib, thalidomide, lenalidomide were approved the year 2006, 2008, 2010 respectively. Median survival of subgroup (1), (2), and (3) were 56 months 95% CI (42.66-69.33), 55 months 95% CI (19.12-90.87) and 54 months 95% CI (36.42-71.57) respectively. Median survival of subgroup (4) and (5) have not been reached. Then we investigated the treatment costs in these groups. In each subgroup the average annual cost was 332, 518, 507, 588 and 631 USD respectively. Compared to subgroup (1), the cost of other groups were significantly high. These results showed that the impact of three novel agents on medical cost were significant. We also investigated the relationship between health care costs and the length of hospital stay or autologous stem cell transplantation. There were no statistically significant differences among them, however, there was tendency that the length of hospital stay shortened by time; Average length of total hospital stay the subgroup (1), (2), and (3) were 205, 125 and 56 days respectively. Subgroup (4) and (5) showed also shortened length of hospital stays, although observation years subgroup (4) and (5) were short (date was not shown). Among 5 subgroups the cases of received autologous stem cell transplantation were not stastically differences (total 56 patients). Conclusion We revealed the real-world costs of MM treatment in a single-institute, by following up individual patients sequentially. Health care costs for treatment of MM increased drastically, by introduction of three novel agents. We also showed that the introduction of three novel agents shorten hospital stay, which leads to improve QoL. Therefore, bortezomib, thalidomide and lenalidomide had the significant impact of QoL. After the further approval of novel agents in Japan, health care costs will be even higher but on the other hand, they might bring positive impacts on OS and QoL. Our study clearly indicated the importance of considering the balance of cost and effectiveness for the MM treatment is important. Character count: 3477(excluding spaces) Disclosures No relevant conflicts of interest to declare.

Integration of Podiatric Medicine Within the Fracture Liaison Services Model

2020 ◽  
Vol 110 (1) ◽  
Author(s):  
Tyler MacRae ◽  
David W. Shofler
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Health Care Costs ◽  
Metabolic Disorders ◽  
Models Of Care ◽  
Treatment Of Osteoporosis ◽  
Fracture Liaison Services ◽  
Fracture Management ◽  
Care Costs ◽  
Fracture Liaison

Underlying bone metabolic disorders are often neglected when managing acute fractures. The term fracture liaison services (FLS) refers to models of care with the designated responsibility of comprehensive fracture management, including the diagnosis and treatment of osteoporosis. Although there is evidence of the effectiveness of FLS in reducing health-care costs and improving patient outcomes, podiatric practitioners are notably absent from described FLS models. The integration of podiatric practitioners into FLS programs may lead to improved patient care and further reduce associated health-care costs.

Treatment Persistence with Azacitdine (Vidaza) Is Associated with Lower Inpatient Hospitalization Costs Over Time

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4231-4231
Author(s):  
B. Douglas Smith ◽  
Dalia Mahmoud ◽  
Stacey Dacosta Byfield ◽  
Henry J Henk
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Medical Costs ◽  
Sensitivity Analyses ◽  
Bleeding Complications ◽  
Inpatient Hospitalization ◽  
Treatment Persistence ◽  
Hospitalization Costs ◽  
The Relationship ◽  
Care Costs

Abstract Abstract 4231 Background: In the US, understanding the costs associated with Myelodysplastic Syndromes (MDS) is challenging given that multiple channels including pharmacy, ambulatory, and inpatient hospitalization (IPH) settings make up the total expenses to manage patients. Recent studies suggest that MDS patients under active medical management experience fewer cytopenia-related medical problems compared to untreated, transfusion dependent (TD) patients who require more medical treatments, often for recurrent infections and bleeding complications. It is clear that persistence of drug therapy is essential to achieve optimal clinical responses for MDS patients and we sought to determine if continued therapy also optimized costs related to the disease. Aim: To evaluate the relationship between treatment persistence with AZA and health care costs encountered for patients with MDS. Methods: Commercial and Medicare Advantage enrollees with a diagnosis of high grade MDS (ICD-9, 238.73) who initiated AZA with pharmacy and medical benefits in the prior 6 months and who had a variable follow up period from initiation of AZA to disenrollment or end of study were identified in a US health plan claims database (1/1/2007-6/30/2010). The number of AZA “cycles” was calculated by dividing the total number of AZA administrations by 7 days, with a sensitivity analysis for 5 day administration, - commonly utilized in the “real-world”. Persistence was defined as the number of cycles of AZA. Eligible patientshad to have at least 2 AZA cycles. An independent analysis identified health care costs for the same patients during periods of transfusion-dependence (TD) - defined as periods in which they received 2 transfusions in an 8 week period and did not receive erythropoietin-stimulating agents (ESAs) or AZA. Average Per Patient Per Month (PPPM) costs were examined among patients with various lengths of TD periods, up to 1 year. Linear models were used to examine the relationship between persistence on AZA and PPPM health care costs. Healthcare costs included both payer and patient paid amounts under the medical and pharmacy benefit. Medical costs were further broken out into IPHs, ambulatory, and other costs captured. Several sensitivity analyses were performed to confirm the robustness of the results such as excluding patients with IPH prior to AZA initiation, and including patients with <2 cycles of AZA. Results: The baseline cost breakdown for MDS patients (n=225) who were transfusion dependent and not receiving treatment are outlined in Figure 1. Interestingly, the largest proportion of the medical costs for TD patients comes from IPHs. In fact, the PPPM IPH costs among TD periods account for approximately 65–75% of total health care costs - even at one year of their diagnosis. A similar analysis was done for patients completing at least 2 cycles of AZA (n = 100) which suggested that the proportion of cost related to IPHs was closer to 40%. This cohort averaged 6.3 cycles (median = 5) with 24% of patients completing at least 8 cycles. Importantly, completion of every additional AZA cycle (baseline 7day analysis) was found to be associated with, on average, a 6% decrease in medical care costs (p=0.005) driven largely by an 18% decrease in IPH costs (p<0.001; Figure 2) due to fewer medical events. Even a single additional AZA cycle was found to be associated with 5% lower total health care cost (p=0.006). These results also hold in the sensitivity analyses. As expected, an examination of medical needs of both TD and AZA treated patients led infections as a frequent driver of IPHs. Conclusions: Patients who persist with AZA therapy have lower PPPM medical costs, driven by decreased expenditures on IPHs. This is consistent with results identified in the AZA-001 clinical trial in which patients receiving AZA experienced reduced IPHs driven by less transfusions and need for IV antibiotics, antifungals, and antivirals. These lower overall costs offset the expected increase in continuing therapy based on the cost of drug alone. Improving duration of therapy of AZA may not only optimize clinical outcomes but may decrease cumulative costs of care among high risk MDS patients. Disclosures: Smith: Celgene: Consultancy. Mahmoud:celgene: Employment. Dacosta Byfield:Celgene: Consultancy. Henk:Celgene: Consultancy.

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