Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model.

BACKGROUND: Nearly five percent of Americans suffer from functional constipation, many of whom may benefit from increasing dietary fiber consumption. The annual constipation-related healthcare cost savings associated with increasing intakes may be considerable but have not been examined previously. The objective of the present study was to estimate the economic impact of increased dietary fiber consumption on direct medical costs associated with constipation. METHODS: Literature searches were conducted to identify nationally representative input parameters for the U.S. population, which included prevalence of functional constipation; current dietary fiber intakes; proportion of the population meeting recommended intakes; and the percentage that would be expected to respond, in terms of alleviation of constipation, to a change in dietary fiber consumption. A dose-response analysis of published data was conducted to estimate the percent reduction in constipation prevalence per 1 g/day increase in dietary fiber intake. Annual direct medical costs for constipation were derived from the literature and updated to U.S. $ 2012. Sensitivity analyses explored the impact on adult vs. pediatric populations and the robustness of the model to each input parameter. RESULTS: The base case direct medical cost-savings was $12.7 billion annually among adults. The base case assumed that 3% of men and 6% of women currently met recommended dietary fiber intakes; each 1 g/day increase in dietary fiber intake would lead to a reduction of 1.9% in constipation prevalence; and all adults would increase their dietary fiber intake to recommended levels (mean increase of 9 g/day). Sensitivity analyses, which explored numerous alternatives, found that even if only 50% of the adult population increased dietary fiber intake by 3 g/day, annual medical costs savings exceeded $2 billion. All plausible scenarios resulted in cost savings of at least $1 billion. CONCLUSIONS: Increasing dietary fiber consumption is associated with considerable cost savings, potentially exceeding $12 billion, which is a conservative estimate given the exclusion of lost productivity costs in the model. The finding that $12.7 billion in direct medical costs of constipation could be averted through simple, realistic changes in dietary practices is promising and highlights the need for strategies to increase dietary fiber intakes.

Mortality, cost, and downstream disease of total hip arthroplasty patients in the medicare population.

The purpose of this study is to compare the differences in downstream cost and health outcomes between Medicare hip OA patients who undergo total hip arthroplasty (THA) and those who do not. All OA patients in the Medicare 5% sample (1998-2009) were separated into non-THA and THA groups. Differences in costs and risk ratios for mortality and new disease diagnoses were adjusted using logistic regression for age, sex, race, socioeconomic status, region, and Charlson score. Mortality, heart failure, depression, and diabetes were all reduced in the THA group, though there was an increased risk for atherosclerosis in the short term. The potential for selection bias was investigated with two separate propensity score analyses. This study demonstrates the potential benefit of THA in reducing mortality and improving aspects of overall health in OA patients.

Complications, mortality, and costs for outpatient and short-stay total knee arthroplasty patients in comparison to standard-stay patients.

The purpose of the present study is to determine the differences in cost, complications, and mortality between knee arthroplasty (TKA) patients who stay the standard 3-4 nights in a hospital compared to patients who undergo an outpatient procedure, a shortened stay or an extended stay. TKA patients were identified in the Medicare 5% sample (1997-2009) and separated into the following groups: outpatient, 1-2 days, 3-4 days, or 5+ days inpatient. At two years, costs associated with the outpatient and the 1-2 day stay groups were $8527 and $1967 lower than the 3-4 day stay group, respectively. Out to 2 years, the outpatient and 1-2 day stay groups reported less pain and stiffness, respectively, though the 1-2 day group also had a higher risk for revision.

Understanding healthcare providers' preferred attributes of pediatric pneumococcal conjugate vaccines in the United States.

As higher-valent pneumococcal conjugate vaccines (PCVs) become available for pediatric populations in the US, it is important to understand healthcare provider (HCP) preferences for and acceptability of PCVs. US HCPs (pediatricians, family medicine physicians and advanced practitioners) completed an online, cross-sectional survey between March and April 2023. HCPs were eligible if they recommended or prescribed vaccines to children age <24 months, spent ≥25% of their time in direct patient care, and had ≥2 y of experience in their profession. The survey included a discrete choice experiment (DCE) in which HCPs selected preferred options from different hypothetical vaccine profiles with systematic variation in the levels of five attributes. Relative attribute importance was quantified. Among 548 HCP respondents, the median age was 43.2 y, and the majority were male (57.9%) and practiced in urban areas (69.7%). DCE results showed that attributes with the greatest impact on HCP decision-making were 1) immune response for the shared serotypes covered by PCV13 (31.4%), 2) percent of invasive pneumococcal disease (IPD) covered by vaccine serotypes (21.3%), 3) acute otitis media (AOM) label indication (20.3%), 4) effectiveness against serotype 3 (17.6%), and 5) number of serotypes in the vaccine (9.5%). Among US HCPs, the most important attribute of PCVs was comparability of immune response for PCV13 shared serotypes, while the number of serotypes was least important. Findings suggest new PCVs eliciting high immune responses for serotypes that contribute substantially to IPD burden and maintaining immunogenicity against serotypes in existing PCVs are preferred by HCPs.

The burden of influenza B: a structured literature review.

We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010. Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B-specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant. The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.

Mortality, cost, and health outcomes of total knee arthroplasty in Medicare patients.

There are little data that quantify the long term costs, mortality, and downstream disease after Total Knee Arthroplasty (TKA). The purpose of this study is to compare differences in cost and health outcomes between Medicare patients with OA who undergo TKA and those who avoid the procedure. The Medicare 5% sample was used to identify patients diagnosed with OA during 1997-2009. All OA patients were separated into non-arthroplasty and arthroplasty groups. Differences in costs, mortality, and new disease diagnoses were adjusted using logistic regression for age, sex, race, buy-in status, region, and Charlson score. The 7-year cumulative average Medicare payments for all treatments were $63,940 for the non-TKA group and $83,783 for the TKA group. The risk adjusted mortality hazard ratio (HR) of the TKA group ranged from 0.48 to 0.54 through seven years (all P<0.001). The risk of heart failure in the TKA group was 40.9% at 7years (HR=0.93, P<0.001). The results demonstrate the patients in the TKA cohort as having a lower probability of heart failure and mortality, at a total incremental cost of $19,843.

Economic burden of periprosthetic joint infection in the United States.

This study characterizes the patient and clinical factors influencing the economic burden of periprosthetic joint infection (PJI) in the United States. The 2001-2009 Nationwide Inpatient Sample was used to identify total hip and knee arthroplasties using International Classification of Diseases, Ninth Revision, procedure codes. The relative incidence of PJI ranged between 2.0% and 2.4% of total hip arthroplasties and total knee arthroplasties and increased over time. The mean cost to treat hip PJIs was $5965 greater than the mean cost for knee PJIs. The annual cost of infected revisions to US hospitals increased from $320 million to $566 million during the study period and was projected to exceed $1.62 billion by 2020. As the demand for joint arthroplasty is expected to increase substantially over the coming decade, so too will the economic burden of prosthetic infections.

Cardiovascular Healthcare Cost Savings Associated with Increased Whole Grains Consumption among Adults in the United States.

Little is known about the potential health economic impact of increasing the proportion of total grains consumed as whole grains to align with Dietary Guidelines for Americans (DGA) recommendations. Health economic analysis estimating difference in costs developed using (1) relative risk (RR) estimates between whole grains consumption and outcomes of cardiovascular disease (CVD) and a selected component (coronary heart disease, CHD); (2) estimates of total and whole grains consumption among US adults; and (3) annual direct and indirect medical costs associated with CVD. Using reported RR estimates and assuming a linear relationship, risk reductions per serving of whole grains were calculated and cost savings were estimated from proportional reductions by health outcome. With a 4% reduction in CVD incidence per serving and a daily increase of 2.24 oz-eq of whole grains, one-year direct medical cost savings were estimated at US$21.9 billion (B) (range, US$5.5B to US$38.4B). With this same increase in whole grains and a 5% reduction in CHD incidence per serving, one-year direct medical cost savings were estimated at US$14.0B (US$8.4B to US$22.4B). A modest increase in whole grains of 0.25 oz-eq per day was associated with one-year CVD-related savings of $2.4B (US$0.6B to US$4.3B) and CHD-related savings of US$1.6B (US$0.9B to US$2.5B). Increasing whole grains consumption among US adults to align more closely with DGA recommendations has the potential for substantial healthcare cost savings.

Health Care Costs and Savings Associated with Increased Dairy Consumption among Adults in the United States.

BACKGROUND: The purpose of this study is to estimate the impact on health care costs if United States (US) adults increased their dairy consumption to meet Dietary Guidelines for Americans (DGA) recommendations. METHODS: Risk estimates from recent meta-analyses quantifying the association between dairy consumption and health outcomes were combined with the increase in dairy consumption under two scenarios where population mean dairy intakes from the 2015-2016 What We Eat in America were increased to meet the DGA recommendations: (1) according to proportions by type as specified in US Department of Agriculture Food Intake Patterns and (2) assuming the consumption of a single dairy type. The resulting change in risk was combined with published data on annual health care costs to estimate impact on costs. Health care costs were adjusted to account for potential double counting due to overlapping comorbidities of the health outcomes included. RESULTS: Total dairy consumption among adults in the US was 1.49 cup-equivalents per day (c-eq/day), requiring an increase of 1.51 c-eq/day to meet the DGA recommendation. Annual cost savings of $12.5 billion (B) (range of $2.0B to $25.6B) were estimated based on total dairy consumption resulting from a reduction in stroke, hypertension, type 2 diabetes, and colorectal cancer and an increased risk of Parkinson's disease and prostate cancer. Similar annual cost savings were estimated for an increase in low-fat dairy consumption ($14.1B; range of $0.8B to $27.9B). Among dairy sub-types, an increase of approximately 0.5 c-eq/day of yogurt consumption alone to help meet the DGA recommendations resulted in the highest annual cost savings of $32.5B (range of $16.5B to $52.8B), mostly driven by a reduction in type 2 diabetes. CONCLUSIONS: Adoption of a dietary pattern with increased dairy consumption among adults in the US to meet DGA recommendations has the potential to provide billions of dollars in savings.

Single food focus dietary guidance: lessons learned from an economic analysis of egg consumption.

BACKGROUND: There is a large body of literature evaluating the impact of various nutrients of eggs and their dietary cholesterol content on health conditions. There is also literature on the costs of each condition associated with egg consumption. The goal of the present study is to synthesize what is known about the risks and benefits of eggs and the associated costs from a societal perspective. METHODS: A risk apportionment model estimated the increased risk for coronary heart disease (CHD) attributable to egg cholesterol content, the decreased risk for other conditions (age-related macular degeneration (AMD), cataract, neural tube defects, and sarcopenia) associated with egg consumption, and a literature search identified the cost of illness of each condition. The base 795 case scenario calculated the costs or savings of each condition attributable to egg cholesterol or nutrient content. RESULTS: Given the costs associated with CHD and the benefits associated with the other conditions, the most likely scenario associated with eating an egg a day is savings of $2.82 billion annually with uncertainty ranging from a net cost of $756 million to net savings up to $8.50 billion. CONCLUSION: This study evaluating the economic impact of egg consumption suggests that public health campaigns promoting limiting egg consumption as a means to reduce CHD risk would not be cost-effective from a societal perspective when other benefits are considered. Public health intervention that focuses on a single dietary constituent, and foods that are high in that constituent, may lead to unintended consequences of removing other beneficial constituents and the net effect may not be in its totality a desirable public health outcome. As newer data become available, the model should be updated.

Medicare expenditures associated with diabetes and diabetic retinopathy.

BACKGROUND: To estimate the expenditures for diabetic retinopathy in the United States by Medicare. METHODS: Retrospective data analysis using the 1997 through 2004 5% Medicare claims data. A case control design was used; eligible beneficiaries were 65 or older and without major ophthalmic conditions (cataract, cataract surgery, and macular degeneration) during the study period. Controls had diabetes but no evidence of diabetic retinopathy. There were two diabetic retinopathy case groups: beneficiaries with nonproliferative diabetic retinopathy (NPDR) and beneficiaries with proliferative diabetic retinopathy (PDR). Analyses quantified annual Medicare payments for case and control groups. RESULTS: A total of 178,383 controls, 33,735 NPDR cases, and 6,138 PDR cases were identified. After adjusting for age, sex, and race, annual average Medicare payments for all care were significantly higher for case groups compared to the control group, as were average payments for ophthalmic care only (all P < 0.0001). In addition, average payments for all care and for ophthalmic care were substantially higher for PDR cases compared to NPDR cases. CONCLUSION: These findings demonstrate substantial expenditures associated with diabetic retinopathy, and with PDR in particular, only part of which is due to ophthalmic care. Delaying progression may be associated with decreased Medicare expenditures.

Impact of visual impairment on service and device use by individuals with diabetic retinopathy.

PURPOSE: This study was performed to assess the use of devices and caregiving among individuals with diabetic retinopathy and to evaluate the impact of visual acuity on use. METHODS: Data were collected using a questionnaire that included items on demographic and clinical characteristics and on the use of services, assistive devices, and caregiving. The study was approved by an institutional review board. Two ophthalmologists identified and invited patients with diabetic retinopathy and provided best corrected visual acuity (BCVA). Patients provided informed consent. De-identified data were analysed in SAS(R). RESULTS: Of the 806 respondents, 55% were women; mean age was 65 years. Respondents were classified into five categories based on BCVA. Few respondents used services such as transportation and counseling, but there was wide use of assistive devices. More than 20% of respondents used a cane, a hand-held magnifier, and/or special glasses. The mean number of devices used increased significantly as BCVA deteriorated, as did hours of caregiving. Annual costs for services, devices, and caregiving increased as BCVA deteriorated. CONCLUSIONS: There are substantial differences in the use and costs of assistive devices and caregiving among individuals with diabetic retinopathy with varying BCVA.

A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges.

BACKGROUND: Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies. OBJECTIVE: The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF. METHODS: We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements. RESULTS: A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving. CONCLUSIONS: No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions.

Health Economic Evaluation Modeling Shows Potential Health Care Cost Savings with Increased Conformance with Healthy Dietary Patterns among Adults in the United States.

BACKGROUND: Many American adults have one or more chronic diseases related to a poor diet, resulting in significant direct and indirect economic impacts. The 2015-2020 Dietary Guidelines for Americans (DGA) recognized that dietary patterns may be more relevant for predicting health outcomes compared with individual diet elements and recommended three healthy patterns based on evidence of favorable associations with many chronic disease risk factors and outcomes. Health economic assessments provide a model to estimate the potential influence on costs associated with changes in chronic disease risk resulting from improved diet quality in the US adult population. OBJECTIVE: To estimate the impact on health care costs associated with increased conformance with the three healthy patterns recommended in the 2015-2020 DGA, including the Healthy US-Style, the Healthy Mediterranean-Style, and the Healthy Vegetarian eating patterns. METHODS: Recent moderate- to high-quality meta-analyses of health outcomes associated with increased conformance with the Healthy US-Style eating pattern as measured by the Healthy Eating Index (HEI) or the Healthy Mediterranean-Style eating pattern measured by a Mediterranean diet score (MED) were identified. Given the lack of quantification of the association between an increased conformance with a vegetarian pattern and health outcomes, the analysis was limited to studies that evaluated Healthy US-style and Healthy Mediterranean-style eating patterns. The 2013-2014 What We Eat in America data provided estimates of conformance with these two eating patterns using the HEI-2015 and the 9-point MED among the US adult population. Risk estimates quantifying the association between eating patterns and health outcomes were combined with the eating pattern score increase under two conformance scenarios: increasing the average HEI-2015 and MED by 20% and increasing the average HEI-2015 and MED to achieve 80% of complete conformance. The resulting change in risk was combined with published data on annual health care and indirect costs, inflated to 2017 US dollars to estimate cost. To address double counting, costs were adjusted to minimize potential overlap of comorbidities. RESULTS: Overall modeled cost savings were $16.7 billion (range=$6.7 billion to $25.4 billion) to $31.5 billion (range=$23.9 billion to $38.9 billion) based on a 20% increase in the MED and HEI-2015, respectively, resulting from reductions in cardiovascular disease, cancer, and type 2 diabetes for both patterns and including Alzheimer's disease and hip fractures for the MED. In the case that diet quality of US adults were to improve to achieve 80% of the maximum MED and HEI-2015, cost savings were estimated at $88.2 billion (range=$35.7 billion to $133 billion) and $55.1 billion (range=$41.8 billion to $68.2 billion), respectively. CONCLUSIONS: This is the first study quantifying savings from all health outcomes identified to be associated with the HEI and the MED to assess conformance with two eating patterns recommended as part of the 2015-2020 DGA. Findings from this study suggest that increasing conformance with healthy eating patterns among US adults could reduce costs, with billions of dollars in potential savings.

Evaluation of Medicare costs of endophthalmitis among patients after cataract surgery.

PURPOSE: Endophthalmitis, an ophthalmic condition characterized by an inflammation of the intraocular cavity, can have substantial implications for vision. However, little is known about the cost of treatment. The objective of this study was to estimate the direct medical cost of treatment for endophthalmitis in the United States. DESIGN: Retrospective data analysis using the 1997 through 2001 Medicare Beneficiary Encrypted Files. PARTICIPANTS: Beneficiaries who underwent cataract surgery were identified; baseline and clinical characteristics at the time of diagnosis were determined. Analyses stratified patients based on development of endophthalmitis in the year after surgery. METHODS: Claims and reimbursements for cases (patients undergoing cataract extraction in whom endophthalmitis developed) and controls (patients who did not experience endophthalmitis) were determined and rates of resource use and costs were calculated from the perspective of Medicare. MAIN OUTCOME MEASURES: Annual Medicare payments and claims. RESULTS: A total of 417 beneficiaries with endophthalmitis occurring after cataract surgery were found; 139 558 had cataract surgery without subsequent endophthalmitis. Three fifths of beneficiaries were female and 89% were white. Ophthalmic claims and reimbursements were more than 1.45 times greater for cases than controls ($12 578 in higher claims and $3464 in higher reimbursements; P<0.0001). CONCLUSIONS: These findings demonstrate a substantial cost associated with endophthalmitis. With recent studies suggesting that prophylaxis is effective in preventing endophthalmitis, there is potential that inexpensive prophylaxis could result in cost and resource savings to Medicare.

The economic implications of glaucoma: a literature review.

Glaucoma is a common ophthalmic condition, often associated with elevated intraocular pressure (IOP). It affects >2 million people in the US, and the incidence is expected to exceed 3 million by 2020. However, relatively little is known about the cost of glaucoma compared with costs for other eye conditions. This comprehensive report reviews published literature on costs and cost effectiveness of treatments for glaucoma. Cost-of-illness studies in glaucoma focus on direct medical costs and generally exclude indirect costs. In general, increased costs are associated with increased severity or lack of control over IOP and the distribution of costs (e.g. medication vs procedures) varies with severity. A large number of studies have evaluated the cost of glaucoma medications, assessing the number of drops per bottle and associated cost per drop or per treatment dose. These studies have limited usefulness as they generally evaluate unit medication costs without including differential effectiveness or adverse effects associated with various therapies, and thus provide only one component of real-world costs for glaucoma. Broader comparative cost studies, mainly adopting a cost-minimisation approach, have evaluated the impact of differing treatments and management strategies on all types of medical care resource utilisation and associated costs, but a variety of metrics for success makes interpretation challenging. Studies have generally found beta2-adrenoceptor antagonists to be associated with greater healthcare costs than newer therapies. Among newer treatments such as prostaglandin analogues, no specific treatment has demonstrated a clear cost advantage over other treatments. A number of studies have modelled hypothetical cohorts of glaucoma patients through courses of therapy, projecting costs, outcomes and cost effectiveness. A majority of these cost-effectiveness models compare one of the newer prostaglandin analogues with older medications or with one another. Existing studies suggest that bimatoprost may be more cost effective than other agents. However, the effectiveness outcomes used in these studies vary, including achieving IOP thresholds, IOP-controlled days, percent reduction in IOP and QALYs. Methods used to determine costs also vary substantially between studies. Future evaluations of the burden of glaucoma need to consider the issues of comparability between, and generalisability of, study results. Differences in methods have created barriers to understanding the cost of glaucoma and comparing costs or cost effectiveness between studies. Furthermore, future studies should also consider direct costs of glaucoma generally not covered by health insurance as well as indirect costs of glaucoma. As new screening technologies for early detection of individuals at elevated risk of glaucoma are now in use, more complete estimates of the cost of glaucoma are critical for issues of resource allocation and health policy.

Impacts of a smoking cessation benefit among employed populations.

OBJECTIVE: The objective of this study was to project the health and economic impacts of providing a workplace smoking cessation benefit. METHODS: The authors conducted an update of a previously published outcomes model using recently published data and clinical trial results. RESULTS: In four example workplace types evaluated, coverage of a cessation benefit resulted in greater numbers of successful cessations and decreased rates of smoking-related diseases. Total savings from benefit coverage (decreased healthcare and workplace costs) exceeded costs of the benefit within 4 years. Total savings per smoker ranged from 350 dollars to 582 dollars at 10 years and 1152 dollars to 1743 dollars at 20 years. Internal rate of return ranged from 39% to 60% at 10 years. CONCLUSION: Providing a workplace smoking cessation benefit results in substantial health and economic benefits with economic savings exceeding the cost of the benefit within a relatively short period. CLINICAL SIGNIFICANCE: Providing a workplace smoking cessation benefit is projected to increase the rate of smoking cessation as well as decrease the incidence of smoking-related conditions and healthcare costs. In addition, workplace cessation benefits can result in decreased absenteeism, increased productivity, and net cost savings within 4 years.

The cost effectiveness of varenicline for smoking cessation.

A decision-analysis model was developed to evaluate health and economic effects of varenicline compared with other smoking-cessation aids for private health plans, Medicaid plans, or employee populations. Use of varenicline is projected to increase the number of successful smoking cessations after 10 years by approximately 14% compared with bupropion, 25% compared with nicotine patches, and 38% when compared with no pharmacologic aids. Varenicline use also results in immediate health care cost savings, compared with use of bupropion and savings within two years compared with nicotine patches or no aids. Comparing varenicline with no aids, the cost effectiveness of varenicline at two years ranged from $648 per additional cessation in the private health plan model to $836 per additional cessation in the Medicaid model. Employers often experience additional savings from decreased absenteeism and increased productivity, with combined savings in health care plus workplace costs associated with varenicline use of $165 to $457 per smoker over two years.

Cost-Effectiveness of Remote Cardiac Monitoring With the CardioMEMS Heart Failure System.

Heart failure (HF) is a leading cause of cardiovascular mortality in the United States and presents a substantial economic burden. A recently approved implantable wireless pulmonary artery pressure remote monitor, the CardioMEMS HF System, has been shown to be effective in reducing hospitalizations among New York Heart Association (NYHA) class III HF patients. The objective of this study was to estimate the cost-effectiveness of this remote monitoring technology compared to standard of care treatment for HF. A Markov cohort model relying on the CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) clinical trial for mortality and hospitalization data, published sources for cost data, and a mix of CHAMPION data and published sources for utility data, was developed. The model compares outcomes over 5 years for implanted vs standard of care patients, allowing patients to accrue costs and utilities while they remain alive. Sensitivity analyses explored uncertainty in input parameters. The CardioMEMS HF System was found to be cost-effective, with an incremental cost-effectiveness ratio of $44,832 per quality-adjusted life year (QALY). Sensitivity analysis found the model was sensitive to the device cost and to whether mortality benefits were sustained, although there were no scenarios in which the cost/QALY exceeded $100,000. Compared with standard of care, the CardioMEMS HF System was cost-effective when leveraging trial data to populate the model.

Effect of battery longevity on costs and health outcomes associated with cardiac implantable electronic devices: a Markov model-based Monte Carlo simulation.

INTRODUCTION: The effects of device and patient characteristics on health and economic outcomes in patients with cardiac implantable electronic devices (CIEDs) are unclear. Modeling can estimate costs and outcomes for patients with CIEDs under a variety of scenarios, varying battery longevity, comorbidities, and care settings. The objective of this analysis was to compare changes in patient outcomes and payer costs attributable to increases in battery life of implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-D). METHODS AND RESULTS: We developed a Monte Carlo Markov model simulation to follow patients through primary implant, postoperative maintenance, generator replacement, and revision states. Patients were simulated in 3-month increments for 15 years or until death. Key variables included Charlson Comorbidity Index, CIED type, legacy versus extended battery longevity, mortality rates (procedure and all-cause), infection and non-infectious complication rates, and care settings. Costs included procedure-related (facility and professional), maintenance, and infections and non-infectious complications, all derived from Medicare data (2004-2014, 5% sample). Outcomes included counts of battery replacements, revisions, infections and non-infectious complications, and discounted (3%) costs and life years. An increase in battery longevity in ICDs yielded reductions in numbers of revisions (by 23%), battery changes (by 44%), infections (by 23%), non-infectious complications (by 10%), and total costs per patient (by 9%). Analogous reductions for CRT-Ds were 23% (revisions), 32% (battery changes), 22% (infections), 8% (complications), and 10% (costs). CONCLUSION: Based on modeling results, as battery longevity increases, patients experience fewer adverse outcomes and healthcare costs are reduced. Understanding the magnitude of the cost benefit of extended battery life can inform budgeting and planning decisions by healthcare providers and insurers.