Housing Cost Burden and Well-Being in Older Adults Moderated by Neighborhood Cohesion and Disorder

Although aging in the community promotes well-being in older adults, contextual factors (e.g., housing cost burden, neighborhood cohesion, neighborhood disorder) may impact this relationship. Identifying such risk factors represents a first step toward improving older adult well-being. NHATS data (Rounds 5–8) were used to answer two research questions (RQs). RQ1: “Is housing cost burden significantly associated with well-being?” RQ2: “Is this association further moderated by neighborhood cohesion and neighborhood disorder?” Participants were 18,311 adults ≥ 65 years old. Well-being was assessed by summing 11 commonly identified indicators. Two items were merged to assess housing cost burden (categories: “no burden,” “no money for utilities,” “no money for rent,” and “no money for utilities or rent”). Neighborhood cohesion and disorder were combined (categories: “no cohesion, no disorder,” “yes cohesion, no disorder,” “no cohesion, yes disorder,” and “yes cohesion, yes disorder”). Both RQs were assessed through a random coefficient model controlling for established covariates. RQ1 results revealed that, compared to “no burden,” “no money for utilities or rent” (B = −1.22, p = .003) and “no money for rent” (B = −1.50, p = .007) were significantly associated with well-being. RQ2 results revealed that “no cohesion, no disorder” significantly moderated the association between “no money for utilities or rent” and well-being (B = −2.44, p = .011). These results indicate that increased housing cost burden is associated with decreased well-being, especially for those reporting no neighborhood cohesion. Future research should examine neighborhood-level protective factors promoting cohesion for older adults to support well-being.

Estimating the economic impacts of percutaneous coronary intervention in Australia: a registry-based cost burden study

ObjectivesIn this study, we sought to evaluate the costs of percutaneous coronary intervention (PCI) across a variety of indications in Victoria, Australia, using a direct per-person approach, as well as to identify key cost drivers.DesignA cost-burden study of PCI in Victoria was conducted from the Australian healthcare system perspective.SettingA linked dataset of patients admitted to public hospitals for PCI in Victoria was drawn from the Victorian Cardiac Outcomes Registry (VCOR) and the Victorian Admitted Episodes Dataset. Generalised linear regression modelling was used to evaluate key cost drivers. From 2014 to 2017, 20 345 consecutive PCIs undertaken in Victorian public hospitals were captured in VCOR.Primary outcome measuresDirect healthcare costs attributed to PCI, estimated using a casemix funding method.ResultsKey cost drivers identified in the cost model included procedural complexity, patient length of stay and vascular access site. Although the total procedural cost increased from $A55 569 740 in 2014 to $A72 179 656 in 2017, mean procedural costs remained stable over time ($A12 521 in 2014 to $A12 185 in 2017) after adjustment for confounding factors. Mean procedural costs were also stable across patient indications for PCI ($A9872 for unstable angina to $A15 930 for ST-elevation myocardial infarction) after adjustment for confounding factors.ConclusionsThe overall cost burden attributed to PCIs in Victoria is rising over time. However, despite increasing procedural complexity, mean procedural costs remained stable over time which may be, in part, attributed to changes in clinical practice.

671. Initial Impression of Explify Respiratory Testing: Is It an Effective Diagnostic Tool?

Background Respiratory infections are a common cause of hospital admissions resulting in significant morbidity and mortality. Isolating specific pathogens from the respiratory tract is a diagnostic challenge. Traditional testing modalities are prone to contamination, time consuming, and have low sensitivity. Next generation genetic sequencing technology has made possible the development of a number of hypothesis free, fast, and highly accurate genome-based identification tests. In this study, we aim at assessing the initial use and performance of one of these tests, the Explify Respiratory panel, at a large quaternary hospital in west Michigan. Methods We performed retrospective analysis on 16 patients with suspected lower respiratory infections. Subjects were chosen for inclusion in the analysis based on the suspicion of pulmonary infection without an identified pathogen. The patient population included 5 immunocompromised patients, 3 with hematologic malignancy, 4 with solid tumor malignancy, and 2 transplant recipients. Results The test resulted in: lack of identified organism (5 patients), identification of non-pathogenic organisms (6 patients), and identification of organisms that were either identified by other traditional testing or did not impact provider’s therapeutic plan (5 patients). The results of Explify testing in all 16 patients did not have a clinical impact on patient care or treatment plan. Conclusion Explify testing seemed to be an appealing cost-effective tool that could replace other available testing modalities such as culture, other sequencing tests, and serological testing with faster turn-around time and less cost. However, it failed to demonstrate any benefit to clinicians in identifying respiratory pathogens while resulting in added cost burden to the patient. Moreover, it resulted in clinical delays of further investigation while awaiting the results. It remains unclear if the lack of clinical impact results from the extensive interventions and treatments that patients receive prior to Explify testing or from the poor sensitivity and performance of the test.This study emphasizes the importance of continuous evaluation of new diagnostic testing before widespread implementation to improve patient care and minimize cost burden. Disclosures All Authors: No reported disclosures

Intersectoral costs of sexually transmitted infections (STIs) and HIV: a systematic review of cost-of-illness (COI) studies

Background Sexually transmitted infections (STIs) and HIV can generate costs both within and outside the health sector (i.e. intersectoral costs). This systematic review aims (i) to explore the intersectoral costs associated with STIs and HIV considered in cost-of-illness (COI) studies, (ii) to categorise and analyse these costs according to cost sectors, and (iii) to illustrate the impact of intersectoral costs on the total cost burden. Methods Medline (PubMed), EMBASE (Ovid), Web of Science, CINAHL, PsycINFO, EconLit and NHS EED were searched between 2009 and 2019. Key search terms included terms for cost-of-illness, cost analysis and all terms for STIs including specific infections. Studies were included that assessed intersectoral costs. A standardised data extraction form was adopted. A cost component table was established based on pre-defined sector-specific classification schemes. Cost results for intersectoral costs were recorded. The quality of studies was assessed using a modified version of the CHEC-list. Results 75 COI studies were considered for title/abstract screening. Only six studies were available in full-text and eligible for data extraction and narrative synthesis. Intersectoral costs were captured in the following sectors: Patient & family, Informal care and Productivity (Paid Labour). Patient & family costs were addressed in four studies, including patient out-of-pocket payments/co-payments and travel costs. Informal care costs including unpaid (home) care support by family/friends and other caregiver costs were considered in three studies. All six studies estimated productivity costs for paid labour including costs in terms of absenteeism, disability, cease-to-work, presenteeism and premature death. Intersectoral costs largely contributed to the total economic cost burden of STIs and HIV. The quality assessment revealed methodological differences. Conclusions It is evident that intersectoral costs associated with STIs and HIV are substantial. If relevant intersectoral costs are not included in cost analyses the total cost burden of STIs and HIV to society is severely underestimated. Therefore, intersectoral costs need to be addressed in order to ensure the total economic burden of STIs and HIV on society is assessed, and communicated to policy/decision-makers.