Health Care Utilization and Costs Associated With Systemic First-Line Metastatic Melanoma Therapies in the United States

2021 ◽  
pp. OP.21.00140
Author(s):  
Sascha van Boemmel-Wegmann ◽  
Joshua D. Brown ◽  
Vakaramoko Diaby ◽  
Jinhai Huo ◽  
Natalie Silver ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Metastatic Melanoma ◽  
Resource Utilization ◽  
The United States ◽  
Health Care Resource ◽  
Care Utilization ◽  
First Line ◽  
Health Care Resource Utilization ◽  
Outpatient Visits

PURPOSE: US Food and Drug Administration approvals of immune checkpoint inhibitors and targeted therapies revolutionized the treatment of metastatic melanoma. Our aim was to assess health care resource utilization and costs for patients with metastatic melanoma treated with systemic therapies in first line between January 2012 and December 2017. METHODS: We conducted a retrospective cohort study of patients with metastatic melanoma using MarketScan data. We included patients diagnosed with melanoma and secondary malignant neoplasm who used pembrolizumab, nivolumab, ipilimumab, ipilimumab plus nivolumab, BRAF-inhibitor (BRAF-i) plus MEK inhibitor (MEK-i), BRAF-i or MEK-i monotherapy, or chemotherapy in first line. We compared health care utilization and costs per patient per month (PPPM) using two-part and generalized linear models. RESULTS: We identified 1,870 patients, including 185 pembrolizumab, 103 nivolumab, 689 ipilimumab, 185 nivolumab plus ipilimumab, 214 BRAF-i plus MEK-i, 240 BRAF-i or MEK-i monotherapy, and 254 chemotherapy users. Highest PPPM rates of hospitalizations, emergency room visits, and outpatient visits were observed in patients with ipilimumab plus nivolumab therapy (adjusted difference v pembrolizumab [aDiff], 0.18, 0.12, and 0.88, respectively; all P < .001). Ipilimumab monotherapy users (aDiff, 0.07 and 0.93; all P < .001) and chemotherapy users (aDiff, 0.10 and 2.63; all P < .001) showed higher PPPM rates of hospitalizations and outpatient visits compared with pembrolizumab users, respectively. Utilization rates in nivolumab, BRAF-i plus MEK-i, and BRAF-i or MEK-i groups were similar to the pembrolizumab group. Highest PPPM total costs and drug-related costs were observed in the ipilimumab group ($80,139 US dollars [USD] and $70,051 USD; all P < .001), followed by the ipilimumab plus nivolumab ($71,689 USD and $56,217 USD; all P < .001) and the BRAF-i plus MEK-i group ($31,184 USD and $19,648 USD; all P < .001). PPPM costs in the nivolumab group were similar to the pembrolizumab group. CONCLUSION: Significant differences in health care resource utilization and costs were found across first-line metastatic melanoma regimens. Utilization rates were highest in patients using ipilimumab-containing therapies. High drug costs constituted a major fraction of total PPPM health care costs.

scholarly journals Health Status and Health Care Utilization of Multiple Sclerosis in Canada

2007 ◽  
Vol 34 (2) ◽  
pp. 167-174 ◽  
Author(s):  
Sheri L. Pohar ◽  
C. Allyson Jones ◽  
Sharon Warren ◽  
Karen V.L. Turpin ◽  
Kenneth Warren
Keyword(s):  
Multiple Sclerosis ◽  
Health Care ◽  
Health Status ◽  
General Population ◽  
Health Care Utilization ◽  
Resource Utilization ◽  
Health Behaviours ◽  
Health Care Resource ◽  
Care Utilization ◽  
Health Care Resource Utilization

Background:Persons with multiple sclerosis (MS) represent a small segment of the population, but given the progression of the disease, they experience substantial physical, psychosocial and economic burdens.Objective:The primary aim was to compare demographic characteristics, health status, health behaviours, health care resource utilization and access to health care of the community dwelling populations with and without MS.Methods:Cross-sectional survey using data from the Canadian Community Health Survey (CCHS 1.1). Adjusted analyses were performed to assess differences between persons with MS and the general population, after controlling for age and sex. Normalized sampling weights and bootstrap variance estimates were used.Results:Respondents with MS were 7.6 times (95% CI: 5.4, 10.7) more likely to have health-related quality of life scores that reflected severe impairment than respondents without MS. Respondents with MS were 12.2 times (95% CI: 8.6, 17.2) to rate their health as ‘poor’ or ‘fair’ than the general population. Urinary incontinence and chronic fatigue syndrome were 18.7 times (95% CI: 12.5, 28.2) and 21.9 times (95% CI: 11.9, 40.3), more likely to be reported by respondents with MS than those without. Differences between the two populations also existed in terms of health care resource utilization and access and health behaviours.Conclusion:Large discrepancies in health status and health care utilization existed between persons with MS who reside in the community and the general population according to all indicators used. Health care needs of persons with MS were also not met.

Abstract 185: Health Care Resource Utilization of Acute Coronary Syndrome (ACS) in a Geographically Distributed US Population 2006-2011

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Mark Cziraky ◽  
Rakesh Luthra ◽  
Maxine D Fisher ◽  
Yaping Xu ◽  
Kenneth Wilhelm ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Resource Utilization ◽  
Health Care Resource ◽  
Care Utilization ◽  
Research Database ◽  
Health Care Resource Utilization ◽  
Coronary Syndrome

Background: Cardiovascular (CV) disease is the leading cause of mortality in both men and women in the US, resulting in substantial health care utilization and costs. There are limited data quantifying long-term resource utilization following an ACS event. Objectives: Evaluate overall and CV-related health care utilization following an ACS event in patients with/without recurrent CV events (CVEs) post-discharge. Methods: Patients with ≥1 ICD-9 CM code for acute myocardial infarction MI) (410.xx) or unstable angina (411.1x) during ACS hospitalization were identified from the HealthCore Integrated Research Database 01/01/2006-09/30/2011. Index date was defined as the first ACS event. Patients with <12 months’ pre-/post-index plan eligibility or age <18 years were excluded. Recurrent CVEs were defined as any occurrence of MI, non-fatal stroke or coronary heart disease-related mortality after the index ACS event. Overall and CV-related health care resource utilization following the index ACS event were evaluated in patients with/without recurrent CVEs. Results: Of 140,903 patients, 22.0% had ≥1 subsequent CVE during follow-up. Patients with/without recurrent CVEs were older (mean 72.4 vs. 65.2 years) and had more comorbidities (mean baseline Deyo-Charlson Index scores 2.4 vs. 1.6). Mean (median) follow up was 2.0 (1.6) and 1.9 (1.5) years in patients with/without recurrent CVEs, respectively. Mean (median) number of 1-year post-index overall and CV-related hospitalizations in the recurrent CVE cohort was higher than the non-recurrent cohort (2.81 [1.98] and 2.40 [1.54] vs. 1.56 [1.23] and 1.30 [0.82], respectively). Mean number of 1-year post-index overall outpatient and office visits were higher in the recurrent versus non-recurrent cohort (31.82 [36.63] and 14.72 [11.15] vs. 21.65 [25.68] and 11.89 [9.67]). Mean annual 3-year utilization post-index showed the same trend (Table). Conclusion: Patients with recurrent CVEs had higher 1- and 3-year post-index overall and CV-related utilization as compared with patients without recurrent CVEs. More aggressive strategies to manage this increased long-term utilization is warranted. This study underscores the need to prevent subsequent adverse CVEs, ultimately to improve patient outcomes and help reduce overall health care utilization.

scholarly journals The impact of high-risk and chronic opioid use among commercially insured endometriosis patients on health care resource utilization and costs in the United States

2020 ◽  
Vol 16 ◽  
pp. 174550652096589
Author(s):  
Stephanie J Estes ◽  
Ahmed M Soliman ◽  
Marko Zivkovic ◽  
Divyan Chopra ◽  
Xuelian Zhu
Keyword(s):  
Health Care ◽  
High Risk ◽  
Resource Utilization ◽  
Health Care Resource ◽  
Low Risk ◽  
Opioid Use ◽  
Health Care Resource Utilization ◽  
Outpatient Visits ◽  
Chronic Opioid Use ◽  
Opioid Users

Objectives: Evaluate all-cause and endometriosis-related health care resource utilization and costs among newly diagnosed endometriosis patients with high-risk versus low-risk opioid use or patients with chronic versus non-chronic opioid use. Methods: A retrospective analysis of IBM MarketScan® Commercial Claims data from 2009 to 2018 was performed for females aged 18 to 49 with newly diagnosed endometriosis (International Classification of Diseases, Ninth Edition code: 617.xx; International Classification of Diseases, Tenth Edition code: N80.xx). Two sub-cohorts were identified: high-risk (⩾1 day with ⩾90 morphine milligram equivalents per day or ⩾1-day concomitant benzodiazepine use) or chronic opioid utilization (⩾90-day supply prescribed or ⩾10 opioid prescriptions). High-risk or chronic utilization was evaluated during the 12-month assessment period after the index date. Index date was the first opioid prescription within 12 months following endometriosis diagnosis. All outcomes were assessed over 12-month post-assessment period while adjusting for demographic and clinical characteristics. Results: Out of 61,019 patients identified, 18,239 had high-risk opioid use and 5001 chronic opioid use. Health care resource utilization drivers were outpatient visits and pharmacy fills, which were higher among high-risk versus low-risk patients (outpatient visits: 17.49 vs 15.51; pharmacy fills: 19.58 vs 16.88, p < 0.0001). Chronic opioid users had a higher number of outpatient visits (19.53 vs 15.00, p < 0.0001) and pharmacy fills (23.18 vs 16.43, p < 0.0001) compared to non-chronic opioid users. High-risk opioid users had significantly higher all-cause health care costs compared to low-risk opioid users (US$16,377 vs US$13,153; p < 0.0001). Chronic opioid users also had significantly higher all-cause health care costs compared to non-chronic opioid users (US$20,930 vs US$12,272; p < 0.0001). Similar patterns were observed among endometriosis-related HCRU, except pharmacy fills among high-risk and chronic sub-cohorts. Conclusion: This analysis demonstrates significantly higher all-cause and endometriosis-related health care resource utilization and total costs for high-risk opioid users compared to low-risk opioid users among newly diagnosed endometriosis patients over 1 year. Similar trends were observed for comparing chronic opioid users with non-chronic opioid users, except for endometriosis-related pharmacy fills and associated costs.

Health-care resource utilization associated with peanut allergy management under allergen avoidance among commercially insured individuals

2021 ◽  
Vol 42 (4) ◽  
pp. 333-342 ◽  
Author(s):  
J. Allen Meadows ◽  
Shengsheng Yu ◽  
Steve L. Hass ◽  
Annie Guerin ◽  
Dominick Latremouille-Viau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Resource Utilization ◽  
Peanut Allergy ◽  
Health Care Resource ◽  
Allergen Avoidance ◽  
Health Care Resource Utilization ◽  
Factors Associated ◽  
Outpatient Visits ◽  
Ed Visits

Background: Until recently, the standard approach to care for individuals with peanut allergy (PA) was limited to allergen avoidance and treatment of reactions with emergency medicines. Objectives: To assess health-care resource utilization (HRU) and costs associated with PA management under allergen avoidance and to identify risk factors associated with peanut reactions that resulted in inpatient (IP) and/or emergency department (ED) visits. Methods: Privately insured individuals with PA diagnosis codes were identified from a large U.S. administrative claims data base (January 1, 1999, to March 31, 2017). PA-related HRU, indicated by a PA diagnosis and/or diagnostic procedure codes and by epinephrine autoinjectors (EAI) prescription fills in medical and pharmacy claims, respectively, and all-cause costs were described per patient-year (PPY). Risk factors associated with peanut reactions in an IP and/or ED setting were identified by using a multivariable logistic regression model. Results: A total of 86,483 patient-years from 14,136 individuals with PA were included. At the patient-year level, 28.1% were ages 0‐3 years, 43.6% were ages 4‐11 years, 13.7% were ages 12‐17 years, and 14.5% were ages ≥ 18 years; 35.6% had PA-related outpatient visits; 50.6% had EAI fills; and 2.4% had PA-related IP and/or ED visits PPY. Younger individuals had more PA-related outpatient visits and EAI fills, with peak intensive use at ages 4‐11 years. The proportion of individuals with PA-related IP and/or ED visits was highest among those aged ≥ 18 years. Mean all-cause costs were $3084 PPY; individuals with PA-related IP and/or ED visits incurred $8902 PPY ($17,451 for those with one or more IP visits). Risk factors associated with peanut reactions that resulted in IP and/or ED visits included young adults (odds ratio [OR] 3.19 [95% confidence interval {CI}, 2.66‐3.83]), previous peanut reaction(s) (OR 1.66 [95% CI, 1.23‐2.24]), asthma (OR 1.33 [95% CI, 1.18‐1.51]), and male sex (OR 1.14 [95% CI, 1.01‐1.28]). Conclusion: Individuals with PA and under allergen avoidance had significant HRU that varied across all age groups, with more PA-related outpatient visits during preschool and/or school age and PA-related urgent care among adults. Individuals with previous peanut reaction(s), asthma, and males had a higher risk of peanut reactions that resulted in IP and/or ED visits.

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