scholarly journals Healthcare Resource Utilization and Costs Associated with Switching First-line Antiretroviral Therapy among HIV-infected Patients in the United States

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S435-S436
Author(s):  
Jianbin Mao ◽  
Micheal Johnson ◽  
Jeffrey Mcpheeters ◽  
Girish Prajapati ◽  
Andrew Beyer
Keyword(s):  
Antiretroviral Therapy ◽  
Resource Utilization ◽  
Index Date ◽  
Healthcare Resource ◽  
The United States ◽  
Healthcare Resource Utilization ◽  
Pharmacy Cost ◽  
Charlson Comorbidity Index Score ◽  
Administrative Claims ◽  
First Line

Abstract Background Initial antiretroviral therapy (ART) is modified for non-virologic failure reasons in many patients, and the healthcare resource utilization (HRU) and costs associated with these switches in the real world is not well understood. Methods Administrative claims data from the Optum Research and Impact National Benchmark Databases were utilized. Adult patients (≥18 years) with HIV-1 diagnosis code, and claim for an anchor agent of the protease inhibitor (PI) or non-nucleoside reverse transcriptase inhibitor (NNRTI) class in first-line ART between July 1, 2006 and December 31, 2015 were identified (see Figure 1 for addl. criteria). Patients with a claim for an anchor agent (PI or NNRTI) different from that in first-line ART were defined as switchers, with index date as date of first claim for new anchor agent. Switchers were matched to patients who did not switch (non-switchers) at 1:3 ratio using propensity score matching on patient and first-line ART characteristics. For non-switchers, date following corresponding duration of first-line ART in matched switcher was assigned as index date. Per-patient-per-month (PPPM) all-cause HRU and costs (US$) during switch period (±15 days of index date) were compared descriptively. Results 11,302 patients met study criteria. After matching, switcher (1,204) and non-switcher (3,612) groups were comparable on mean age (41.9 vs. 41.7 years), percent male (85.8% vs. 82.6%), percent commercial enrollee (96.0% vs. 95.8%), mean Quan-Charlson comorbidity index score (both 0.4), and mean ART pill burden (both 2.2) with standard difference less than absolute value of 10%. During switch period, switchers had higher mean PPPM ambulatory visits (2.30 vs. 1.26), emergency room visits (0.12 vs. 0.06), inpatient stays (0.04 vs. 0.01), and pharmacy fills (4.52 vs. 3.01) than non-switchers (all P < 0.001). Switchers also incurred greater mean PPPM costs during switch than non-switchers, with an additional $2,261/month total cost, and $1,031/month pharmacy cost (Figure 2). Conclusion The study gives a more complete view of the burden of switching initial ART with pharmacy costs driving this burden. Assuming some patients will switch regardless of the regimen selected, less expensive initial ART could reduce this burden further. Disclosures M. Johnson, Merk & Co: Research Contractor, research funded by Merk; J. Mcpheeters, Merck & Co.: Research Contractor, Sarary from Optum; G. Prajapati, Merck & Co., Inc.: Employee, Salary; A. Beyer, Merck & Co., Inc: Employee and Shareholder, Salary

Healthcare resource utilization and costs in patients with HIV-1 who switched first-line antiretroviral therapy

2019 ◽  
Vol 35 (11) ◽  
pp. 1945-1953
Author(s):  
Jianbin Mao ◽  
Michael P. Johnson ◽  
Jeffrey T. McPheeters ◽  
Girish Prajapati ◽  
Andrew P. Beyer
Keyword(s):  
Antiretroviral Therapy ◽  
Resource Utilization ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
First Line ◽  
Hiv 1

scholarly journals Real-World Healthcare Resource Utilization in Patients with Indolent Non-Hodgkin's Lymphoma: Differences between Patients Treated First-Line with Ibrutinib or Bendamustine + Rituximab

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3549-3549
Author(s):  
Debra Irwin ◽  
Lu Zhang ◽  
Kathleen Wilson ◽  
Gerard Hoehn ◽  
Erika Szabo ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Healthcare Utilization ◽  
Resource Utilization ◽  
Real World ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Hodgkin's Lymphoma ◽  
First Line

Abstract OBJECTIVES: The purpose of this study was to examine real-world differences in healthcare resource utilization of indolent non-Hodgkin's Lymphoma (iNHL) patients treated with first-line ibrutinib monotherapy (IM) or first-line bendamustine + rituximab (BR) combination therapy using U.S. administrative claims data. METHODS: The MarketScan® Research Databases were used to identify patients aged 18 years or older with commercial or Medicare supplemental insurance plans based on their first prescription (index date) of either IM or BR therapy between 02/01/2014 and 08/30/2017. Patients were required to be diagnosed with iNHL and be treatment naïve, as well as be continuously enrolled (CE) for 6 months prior to and at least 30 days following the index date. All-cause and iNHL-related healthcare resource utilization (e.g., inpatient admission (IP) and emergency room (ER) visits) were evaluated during a 12-month follow-up period from the index date among the subset of patients with 12 months of continuous enrollment and reported per-patient per-month (PPPM). Statistical differences in the distribution of IP and ER visits between the IM versus BR therapy groups were estimated using chi-squared test for categorical variables and t-test for continuous variables. RESULTS: A total of 1,544 iNHL patients were identified, with 207 patients in the IM cohort and 1,337 patients in the BR cohort. The IM cohort was significantly older (mean = 68.3 years; SD = 11.8) then the BR cohort (mean age = 62.1 years; SD = 11.1). The proportion of females was significantly (p<.05) lower in the IM cohort (36%) relative to the BR cohort (49%). The two cohorts did not differ in comorbidity as assessed by National Cancer Institute Comorbidity Index score (IM=0.7 vs. BR=0.8, p=0.40). The results of the comparisons between the two groups with 12 months of follow-up (IM = 110; BR = 745) are provided in Table 1. For all-cause healthcare utilization, the proportion of IM patients experiencing at least one IP admission was significantly higher than the BR cohort as were the PPPM number of admissions. The proportion of patients with at least one ER visit was similar in the IM and BR cohorts. However, the average PPPM number of ER visits was significantly higher in the IM cohort relative to the BR cohort. A similar pattern was found for the iNHL-related healthcare utilization variables with one exception. The proportion of patients with at least one iNHL-related ER visit was significantly higher in the IM relative to the BR cohort. Conclusions: The current study examined differences in healthcare utilization among iNHL-patients treated in a front-line setting with either ibrutinib or BR combination therapy. Results indicated that not only did more ibrutinib patients experience an IP admission and ER visits, including both all-cause and iNHL-related, but they also experienced more repeat admissions and ER visits. These real-world findings highlight the importance of considering the healthcare resource utilization of iNHL patients which may be associated with their first-line therapy. Disclosures Irwin: Teva: Consultancy. Zhang:Teva: Consultancy. Wilson:Teva: Consultancy. Hoehn:Teva: Employment. Szabo:Teva: Employment. Tang:Teva: Employment.

scholarly journals Real-World Healthcare Resource Utilization in Patients with Chronic Lymphocytic Lymphoma: Differences between Patients Treated with Ibrutinib or Bendamustine + Rituximab

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3548-3548
Author(s):  
Debra Irwin ◽  
Lu Zhang ◽  
Kathleen Wilson ◽  
Gerard Hoehn ◽  
Erika Szabo ◽  
...  
Keyword(s):  
Healthcare Utilization ◽  
Resource Utilization ◽  
Real World ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Similar Proportion ◽  
First Line ◽  
The Difference

Abstract OBJECTIVES: The purpose of this study was to examine the real-world differences in healthcare resource utilization in chronic lymphocytic lymphoma (CLL) patients treated with either first-line ibrutinib monotherapy (IM) or first-line bendamustine + rituximab (BR) therapy using U.S. administrative claims data. METHODS: The MarketScan® Research Databases were used to identify patients aged 18 years or older with commercial or Medicare supplemental insurance plans based on their first prescription (index date) of either IM or BR therapy between 02/01/2014 and 08/30/2017. Patients were required to be diagnosed with CLL and be treatment naïve, as well as be continuously enrolled (CE) for 6 months prior to and at least 30 days following the index date. All-cause and CLL-related healthcare resource utilization (e.g., inpatient admission (IP) and emergency room (ER) visits) were evaluated during a 12-month follow-up period from the index date among the subset of patients with 12 months of continuous enrollment and were reported per-patient per-month (PPPM). Statistical differences in the distribution of IP and ER visits between the IM versus BR therapy groups were estimated using chi-squared test for categorical variables and t-test for continuous variables. RESULTS: A total of 1,886 CLL patients were identified, with 1,157 patients in the IM cohort and 729 patients in the BR cohort. The IM cohort was significantly older (mean = 69.3 years; SD = 11.6) then the BR cohort (mean age = 66.4 years; SD = 9.8). There was a similar proportion of females (IM = 36%; BR = 32%), and no significant difference in the National Cancer Institute Comorbidity Index score was observed between the two cohorts (IM=0.9 vs BR=0.8, p=0.34). The results of the comparisons between the two groups with 12 months of follow-up (IM = 589; BR = 436) are provided in Table 1. For all-cause healthcare utilization, the proportion of patients experiencing at least one IP admission and the PPPM number of admissions was significantly higher in the IM cohort compared to the BR cohort. The proportion of patients with at least one ER visit was higher in the IM than in the BR cohort, but the difference was not statistically significant. However, the PPPM number of ER visits was significantly higher in the IM cohort. A similar pattern was found for the CLL-related healthcare utilization variables with two exceptions. First, the average length of stay (ALOS) per CLL-related IP admission was significantly longer for the IM than BR cohort; whereas, ALOS per all-cause IP admission was longer for the IM cohort, but the difference was not significantly different. Second, while patients in the IM cohort experienced more CLL-related ER visits, they were not significantly higher in the IM cohort than in the BR cohort. Conclusions: The current study examined differences in healthcare utilization during a 12 month period among CLL-patients initially treated in a front-line setting with either ibrutinib or BR combination therapy. Results indicated that not only did more ibrutinib patients experience an IP admission and ER visits, both all-cause and CLL-related, but they also experienced more repeat admissions and ER visits. These real-world findings highlight the importance of considering the healthcare resource utilization of CLL patients which may be associated with their first-line therapy. Disclosures Irwin: Teva: Consultancy. Zhang:Teva: Consultancy. Wilson:Teva: Consultancy. Hoehn:Teva: Employment. Szabo:Teva: Employment. Tang:Teva: Employment.

Comparison of Stroke- and Bleed-Specific Healthcare Resource Utilization and Costs Among Patients with Non-Valvular Atrial Fibrillation, Newly Treated with Dabigatran or Warfarin

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 532-532 ◽  
Author(s):  
Xue Song ◽  
Pranav Gandhi ◽  
Adrienne M Gilligan ◽  
Prachi Arora ◽  
Caroline Henriques ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Resource Utilization ◽  
Real World ◽  
Index Date ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Administrative Claims ◽  
Newly Diagnosed ◽  
Outpatient Visits ◽  
Hospitalization Costs

Abstract INTRODUCTION: In the pivotal Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) clinical trial, dabigatran was associated with lower rates of stroke and systemic embolism compared to adjusted-dose warfarin. However, real-world evidence comparing stroke- and bleed-specific healthcare resource utilization (HCRU), costs, length of stay (LOS) per hospitalization and readmissions in non-valvular atrial fibrillation (NVAF) patients newly treated with dabigatran or warfarin is limited. METHODS: Using a nationwide administrative claims database in the US, a retrospective matched-cohort of newly diagnosed NVAF patients aged ≥18 years treated with dabigatran or warfarin in 01/01/2011-12/31/2013 was evaluated. Index date was the first dabigatran or warfarin claim date. All patients had data for 12 months before the index date and a maximum follow-up of 12 months or until discontinuation or switch, disenrollment, end of study period, or inpatient death. Propensity scores were used to match dabigatran and warfarin users 1:1. Stroke or bleed-specific HCRU and costs were defined as hospitalizations with stroke or bleed as the primary discharge diagnosis and outpatient claims with stroke or bleed diagnosis in any position. Percentage and incidence rate (IR) of first stroke or bleed per 100 person-years and associated 95% confidence interval (CI) were reported. Stroke- and bleed-specific per-patient-per-year (PPPY) HCRU and costs were analyzed for all patients. Among those with a hospitalization for stroke or bleed, LOS and readmissions of patients who were admitted and discharged home were reported. Cox regression examined the risk of stroke or bleed and logistic regression assessed the impact on stroke- and bleed-specific readmission between dabigatran and warfarin users. RESULTS: A total of 18,980 dabigatran patients were matched to corresponding warfarin patients. Of these, the percentage of dabigatran patients with stroke (0.5%, n=87 vs 0.8%, n=142; P<0.001) or bleed (1.2%, n=227 vs 1.6%, n=294; P=0.003) was significantly lower than warfarin patients. The IR (95% CI) of stroke [0.65 (0.51-0.78) vs. 1.06 (0.89-1.24)] and bleed [1.69 (1.47-1.91) vs. 2.20 (1.95-2.46)] was also lower in dabigatran patients compared to warfarin patients. After adjustment, compared to warfarin patients, the hazard ratio (HR) of having a first stroke or bleed was significantly lower in dabigatran patients [(HR = 0.60 (95% CI = 0.46-0.79)) and (HR = 0.76 (95% CI = 0.64-0.91)), respectively]. Among all NVAF patients, dabigatran users had a significantly lower number of stroke-specific hospitalizations (0.007 vs 0.013, P<0.001) and outpatient visits (0.304 vs 0.450, P<0.001) compared to warfarin patients. Similarly, dabigatran users had significantly lower bleed-specific hospitalizations (0.024 vs 0.035, P=0.008) and outpatient visits (0.820 vs 0.920, P=0.018). Dabigatran users had significantly lower stroke-specific outpatient visit costs ($84 vs $144, P=0.01) and bleed-specific hospitalization costs ($360 vs $612, P=0.007). There was no significant difference observed in stroke-specific hospitalization costs and bleed-specific outpatient costs between the two groups. Among dabigatran patients with a stroke or bleed, average LOS was significantly lower compared to warfarin patients [(4.74 days vs 5.70 days) and (4.30 days vs 4.60 days), both P<0.001]. Stroke-related 30-day readmissions did not significantly differ between dabigatran and warfarin patients (0.4%, n=14 vs 0.6%, n=25, P=0.078). However, the odds of stroke-related readmission were significantly lower in dabigatran compared to warfarin users [Odds Ratio (OR) = 0.59 (95% CI = 0.51-0.69)]. Bleed-related 30-day readmissions were significantly lower for dabigatran than warfarin users (0.8%, n=30 vs. 1.5%, n=59, P=0.002); similar results were found after adjustment [OR=0.54 (95% CI = 0.47-0.63)]. CONCLUSION: Using real-world data of newly diagnosed NVAF patients, dabigatran users had a lower risk of stroke or bleed than warfarin users. Dabigatran users had lower stroke- and bleed-specific HCRU (including LOS per hospitalization), and lower odds of stroke- and bleed-specific readmissions compared to warfarin users. Also, costs associated with bleed-specific hospitalizations and stroke-specific outpatient visits were significantly lower for dabigatran users compared to warfarin users. Disclosures Song: Truven Health Analytics: Employment; Amgen: Other: This study was funded by Amgen.. Gilligan:Truven Health Analytics, an IBM Company: Employment. Sander:Boehringer Ingelheim: Employment. Smith:Truven Health Analytics: Employment.

scholarly journals Healthcare resource utilization and costs associated with hyperkalemia in a large managed care population

2021 ◽  
Author(s):  
Ajay Sharma ◽  
Paula J Alvarez ◽  
Steven D Woods ◽  
Jeanene Fogli ◽  
Dingwei Dai
Keyword(s):  
Resource Utilization ◽  
Health Plan ◽  
Healthcare Resource ◽  
Healthcare Resource Utilization ◽  
Care Physician ◽  
Study Cohort ◽  
Administrative Claims ◽  
Improvement Program ◽  
Renin Angiotensin ◽  
Ckd Stage

Abstract Background Hyperkalemia is a serious metabolic condition and can lead to life-threatening cardiac arrhythmias and sudden death. Guideline-directed medications that affect the renin-angiotensin-aldosterone axis can increase serum potassium and may limit their use. Hyperkalemia has been shown to drive healthcare resource utilization (HRU) and costs for patients with cardiorenal conditions. Objectives To describe hyperkalemic patient characteristics and quantify patient HRU and costs relative to normokalemic patients from a large US health plan. Methods A retrospective cohort study that identified and evaluated a hyperkalemic patient population from a large administrative claims database. The observation period was 1 January 2015 to 31 May 2018, with a 1-year follow-up period after the index date (the earliest service/claim with evidence of hyperkalemia). Primary patient outcomes included inpatient admissions, emergency department (ED) visits, primary care physician (PCP)/specialist visits, length of stay (LOS) and associated medical and pharmacy costs. This hyperkalemic cohort was stratified by renin-angiotensin-aldosterone system inhibitor (RAASi) utilization and chronic kidney disease (CKD) stage for the economic analysis. Key findings 86,129 adult patients with hyperkalemia were evaluated in the study cohort (median age: 69 years). There were more males [45,155 (52%)], with the majority of patients located in the Southern United States [45,541 (51%)] and a 70/30 split of Medicare to a commercial health plan. Most patients had CKD, hypertension and hyperlipidemia; ≥80% of the patients had ≥4 comorbidities. Over 40% of patients were not receiving RAASi therapy, and potassium binder use was low (&lt;5%). Patients using optimal-dose RAASi with proportion of days covered ≥80% were observed to have the lowest HRU for inpatient admissions, ED and PCP visits and LOS days. Conclusions Hyperkalemia is associated with substantial HRU and costs. The development of a quality improvement program structured around the management of hyperkalemia in individuals with heart failure, diabetes and/or CKD may be necessary.

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