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1.
Nihon Koshu Eisei Zasshi ; 66(6): 287-294, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31231098

RESUMO

Objective The aim of this nationwide study was to estimate the duration of formal long-term care, provided by Japanese long-term care insurance (LTCI) services, among frail Japanese elderly people living in the community.Methods The study subjects were 2,188,397 (men: 579,422, women: 1,124,022, age≥65 years) beneficiaries who used LTCI services for community living in June 2013. The duration of LTCI services for community living per diem per capita was estimated by converting the benefit amount to duration of care using the code for service in claims bills according to gender and care levels, which are a nationally certified classification of individual needs for long-term care (care level 1: lowest need, care level 5: highest need). Subsequently, LTCI services for community living were categorized into respite services and community services. Community services were further subcategorized into home visiting services and daycare services.Results The overall average duration of formal care per diem per capita for men and women were 97.4 and 112.7 minutes for care level 1, 118.3 and 149.1 for care level 2, 186.9 and 246.4 for care level 3, 215.2 and 273.2 for care level 4, and 213.1 and 261.4 for care level 5, respectively. Length of respite services increased gradually with care level, whereas duration of community services peaked at care level 3 and decreased at care levels 4 and 5. With regard to the community service subcategories, duration of home visiting services increased with care level, but duration of daycare services peaked at care level 3.Conclusion Although the care levels in the LCTI system are designed to assess the need for formal care in terms of duration of care, our results suggest that the use of formal LTCI services for community living is not vertically equitable. Services that efficiently increase duration of formal care for those with higher needs for care may improve the equity and sustainability of formal long-term care services for community living.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Seguro de Assistência de Longo Prazo/economia , Seguro de Assistência de Longo Prazo/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Tempo , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/economia , Feminino , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/economia , Japão/epidemiologia , Assistência de Longa Duração/economia , Masculino
2.
Medicine (Baltimore) ; 98(25): e15986, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232931

RESUMO

This study assessed the impact of intraoperative and early postoperative periprosthetic hip fractures (PPHFx) after primary total hip arthroplasty (THA) on health care resource utilization and costs in the Medicare population.This retrospective observational cohort study used health care claims from the United States Centers for Medicare and Medicaid Standard Analytic File (100%) sample. Patients aged 65+ with primary THA between 2010 and 2016 were identified and divided into 3 groups - patients with intraoperative PPHFx, patients with postoperative PPHFx within 90 days of THA, and patients without PPHFx. A multi-level matching technique, using direct and propensity score matching was used. The proportion of patients admitted at least once to skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), and readmission during the 0 to 90 or 0 to 365 day period after THA as well as the total all-cause payments during those periods were compared between patients in PPHFx groups and patients without PPHFx.After dual matching, a total 4460 patients for intraoperative and 2658 patients for postoperative PPHFx analyses were included. Utilization of any 90-day post-acute services was statistically significantly higher among patients in both PPHFx groups versus those without PPHFx: for intraoperative analysis, SNF (41.7% vs 30.8%), IRF (17.7% vs 10.1%), and readmissions (17.6% vs 11.5%); for postoperative analysis, SNF (64.5% vs 28.7%), IRF (22.6% vs 7.2%), and readmissions (92.8% vs 8.8%) (all P < .0001). The mean 90-day total all-cause payments were significantly higher in both intraoperative ($30,114 vs $21,229) and postoperative ($53,669 vs $ 19,817, P < .0001) PPHFx groups versus those without PPHFx. All trends were similar in the 365-day follow up.Patients with intraoperative and early postoperative PPHFx had statistically significantly higher resource utilization and payments than patients without PPHFx after primary THA. The differences observed during the 90-day follow up were continued over the 1-year period as well.


Assuntos
Artroplastia de Quadril/efeitos adversos , Revisão da Utilização de Seguros/estatística & dados numéricos , Fraturas Periprotéticas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Custos de Cuidados de Saúde , Humanos , Revisão da Utilização de Seguros/economia , Estudos Longitudinais , Masculino , Medicaid/estatística & dados numéricos , Medicare/estatística & dados numéricos , Fraturas Periprotéticas/economia , Fraturas Periprotéticas/etiologia , Fraturas Periprotéticas/reabilitação , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/reabilitação , Estudos Retrospectivos , Estados Unidos/epidemiologia
3.
J Manag Care Spec Pharm ; 25(8): 889-897, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31172866

RESUMO

BACKGROUND: Corticosteroids are used in the management of castration-resistant prostate cancer (CRPC) to reduce tumor-related symptoms because of CRPC therapies. Since corticosteroids have been associated with a range of toxicities, their use may increase the economic burden sustained by patients with CRPC. However, the economic impact of using corticosteroids in patients with CRPC has not been well characterized. OBJECTIVE: To assess the effect of previous corticosteroid use on health care resource utilization (HRU) and health care costs among men with CRPC. METHODS: Using administrative claims data (2007-2016), adult chemotherapy-naive patients who initiated CRPC treatment following surgical or medical castration were identified. Based on the cumulative corticosteroid dose during the 12 months before CRPC treatment initiation, patients were grouped into 4 cohorts: no corticosteroid (0 gm), low corticosteroid (< 0.5 gm), medium corticosteroid (0.5-2.0 gm), and high corticosteroid (> 2.0 gm). All-cause HRU and costs (2017 U.S. dollars) were compared between cohorts during the 1-year study period following CRPC treatment initiation using the no corticosteroid cohort as reference. Multivariable regression models were used to adjust for baseline covariates, including age, region, index year, Charlson Comorbidity Index score, presence of bone metastases, baseline all-cause HRU, and corticosteroid-related clinical events during baseline. RESULTS: 9,425 patients were included (no corticosteroid = 6,765, low corticosteroid = 1,660, medium corticosteroid = 655, and high corticosteroid = 345). On average, patients in the no corticosteroid cohort were older and had a lower baseline HRU and comorbidity burden than patients in the other 3 cohorts. During the study period, patients with corticosteroid exposure (across all corticosteroid cohorts) had significantly more inpatient admissions (high corticosteroid vs. no corticosteroid adjusted incidence rate ratio [IRR] = 1.56; P < 0.001), emergency department visits (high corticosteroid vs. no corticosteroid adjusted IRR = 1.30; P = 0.001), and outpatient visits (high corticosteroid vs. no corticosteroid adjusted IRR = 1.11; P < 0.001). In addition, compared with the no corticosteroid cohort, patients with corticosteroid exposure had significantly higher monthly total costs (high corticosteroid vs. no corticosteroid adjusted difference = $2,600; P < 0.001), including medical service costs (high corticosteroid vs. no corticosteroid adjusted difference = $1,564; P < 0.001) and pharmacy costs (high corticosteroid vs. no corticosteroid adjusted difference = $825; P < 0.001). CONCLUSIONS: Cumulative corticosteroid exposure before CRPC treatment initiation was associated with significantly higher HRU and costs. This increase in economic burden was more prominent among patients with annual cumulative corticosteroid doses of more than 2.0 gm. These results suggest that previous corticosteroid use may result in a higher economic burden among patients with CRPC. DISCLOSURES: This study was funded by Astellas Pharma (Northbrook, IL) and Medivation, a Pfizer Company (San Francisco, CA), the codevelopers of enzalutamide. The study sponsor was involved in the study design, data interpretation, and review. All authors contributed to the development of the manuscript and maintained control over the final content. Schultz and Wilson are employed by Astellas Pharma. Schultz owns stock in Gilead Sciences and Shire. Song and Yang are employed by Analysis Group, which received consultancy fees from Astellas Pharma. Ramaswamy is employed by Pfizer, and Lowentritt is employed by Chesapeake Urology and has served as a speaker and consultant for Astellas Pharma, Pfizer, Bayer, Dendreon, and Janssen. A synopsis of the current research was presented in poster format at the AMCP Managed Care & Specialty Pharmacy Annual Meeting 2019, which took place in San Diego, CA, on March 25-28, 2019.


Assuntos
Corticosteroides/economia , Corticosteroides/uso terapêutico , Neoplasias de Próstata Resistentes à Castração/tratamento farmacológico , Neoplasias de Próstata Resistentes à Castração/economia , Idoso , Estudos de Coortes , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Recursos em Saúde/economia , Hospitalização/economia , Humanos , Revisão da Utilização de Seguros/economia , Masculino , Programas de Assistência Gerenciada/economia , Aceitação pelo Paciente de Cuidados de Saúde
4.
Z Gastroenterol ; 57(5): 574-583, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30873578

RESUMO

INTRODUCTION: Perianal fistulas (PF) are presumably a frequent extraintestinal manifestation of Crohn's disease (CD), causing significant functional impairment. This study aims to gain representative data on the prevalence, characteristics, and treatment of CD patients suffering from PF in Germany. MATERIALS AND METHODS: A retrospective cross-sectional analysis of claims data from several German company health insurance funds included adult patients with CD and PF in 2015. The dataset comprised in- and outpatient services with diagnoses, drug prescriptions, and other patient data. It is representative for age, gender, and region and allows extrapolation to the total German statutory health insurance (SHI) population. A systematic literature review was conducted to discuss these results in the international context. RESULTS: A CD prevalence of 299 per 100 000 and a PF prevalence in CD patients of 3.4 % was observed in this cross-sectional study. PF are most prevalent in young age groups (< 24 to 39). One-third of patients with PF received biologics and surgery. Surgical procedures were performed in 31.3 % of PF patients in the inpatient setting and in 4.4 % of PF patients in the outpatient setting. All complicated perianal fistula patients received at least 1 inpatient surgery and 44.8 % received biologic therapy. DISCUSSION: This claims data analysis in German patients estimates a CD prevalence in the SHI population that corresponds well to previously reported data. The prevalence rate for PF in CD patients is comparable with a previous cross-sectional German claims data analysis but is markedly lower than cumulative risks reported in longitudinal cohort studies. PF patients are young and treatment intensive with one-third requiring biologic treatment or inpatient surgery.


Assuntos
Doença de Crohn/complicações , Doença de Crohn/economia , Administração Financeira , Custos de Cuidados de Saúde/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Fístula Retal/etiologia , Adulto , Doença de Crohn/patologia , Estudos Transversais , Alemanha , Humanos , Revisão da Utilização de Seguros/economia , Prevalência , Fístula Retal/patologia , Estudos Retrospectivos
6.
J Med Econ ; 22(7): 706-712, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30912723

RESUMO

Objective: This study evaluated the frequency of reoperation within 1 year of initial intramedullary fixation for patients with pertrochanteric hip fracture and compared 1-year healthcare resource utilization and cost burden for patients with and without reoperation. Methods: This is a retrospective evaluation of medical claims from the US Centers for Medicare and Medicaid Standard Analytic File. Patients aged ≥65 years who underwent fixation with an intramedullary implant for a pertrochanteric fracture between 2013 and 2015 were included. Healthcare resources that were evaluated included skilled nursing facility (SNF), inpatient rehabilitation facility (IRF), readmissions, and outpatient hospital visits. All-cause payments for these services comprised overall cost burden. Generalized Linear Models were used to evaluate healthcare resources and cost burden over 1-year post-surgery and to adjust for confounding between patients with and without a reoperation. Results: A total of 6,423 Medicare patients were included in the analysis. Mean (SD) age was 82.4 (7.8) years, 76.0% were female, and 93.3% were white. A second hip surgery within 1 year after the index fixation procedure was performed in 414 patients (6.4%): 121 (29.2%) contralateral, 115 (27.8%) ipsilateral, and 178 (43.0%) without specified laterality. After adjusting for confounding factors, Medicare patients with ipsilateral reoperations had statistically significantly higher readmissions (100% vs 32.5%, p < 0.0001), outpatient hospital visits (96.4% vs 88.8%, p = 0.018), admissions to a SNF (88.5% vs 80.4%, p = 0.024), and admissions to an IRF (38.8% vs 22.0%, p < 0.0001) compared to patients without reoperations. The adjusted mean total all-cause payments ($90,162 vs $55,131, p < 0.0001) during the 1-year follow-up were statistically significantly higher among patients with reoperations as compared to patients without reoperations. Conclusions: Patients who require a second hip surgery after initial fixation with an intramedullary implant for pertrochanteric hip fractures have significantly higher 1-year healthcare resource utilization and 63.5% higher costs than patients without reoperation.


Assuntos
Fixação Intramedular de Fraturas/economia , Custos de Cuidados de Saúde , Fraturas do Quadril/economia , Medicare/economia , Reoperação/economia , Idoso , Idoso de 80 Anos ou mais , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Fraturas do Quadril/cirurgia , Humanos , Revisão da Utilização de Seguros/economia , Modelos Logísticos , Masculino , Análise Multivariada , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Estados Unidos
7.
Clin Drug Investig ; 39(4): 379-384, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30778886

RESUMO

BACKGROUND: Phenylketonuria is a well-known rare disease included in the neonatal screening of many countries. Therefore, there are few published data on the admissions and costs of phenylketonuria in Spain. OBJECTIVE: The objective of this study was to assess the number of admissions and the economic burden of phenylketonuria in Spain. METHODS: Patients with phenylketonuria were identified from a Spanish database containing data from public and private healthcare centres from 1997 to 2015. The parameters obtained were characteristics of the patients, type of admissions, readmissions, discharges, length of stay, medical service, annual number of visits, annual number of patients, visit-associated costs and patient-associated costs. RESULTS: Five hundred and ninety-four patients with phenylketonuria were identified: 48.32% were male with a mean (standard deviation) age of 4.50 (10.23) years. The hospital admissions were divided into emergency visits (55.94%) and scheduled visits (43.92%). The majority of patients were discharged home (98.86%). The mean (standard deviation) duration of stay was 4.04 (4.98) days. The number of admissions per year ranged between 13 and 88, with an average of 1.18 admissions per patient per year. Finally, the mean cost per visit increased from €1064.91 to €3709.40, and the mean cost per patient increased from €1818.90 to €4239.32 from 1999 to 2015. CONCLUSIONS: The access to economic and social data on phenylketonuria in Spain has been updated. The number of admissions in Spain between 1997 and 2015 and healthcare costs between 1999 and 2015 were calculated. There were 24 admissions as a result of a phenylketonuria diagnosis in 2015 and the mean healthcare cost per patient was €4239.32. This information can help to adapt and improve each healthcare system to take into consideration rare diseases.


Assuntos
Bases de Dados Factuais/economia , Custos de Cuidados de Saúde , Revisão da Utilização de Seguros/economia , Admissão do Paciente/economia , Fenilcetonúrias/economia , Fenilcetonúrias/epidemiologia , Pré-Escolar , Bases de Dados Factuais/tendências , Assistência à Saúde/economia , Assistência à Saúde/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Hospitalização/economia , Hospitalização/tendências , Humanos , Revisão da Utilização de Seguros/tendências , Masculino , Admissão do Paciente/tendências , Fenilcetonúrias/terapia , Estudos Retrospectivos , Espanha/epidemiologia
8.
PLoS One ; 14(1): e0210517, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30682042

RESUMO

At the time of this study, prior to the introduction of biologics in the US, systemic therapies used for the treatment of moderate-to-severe atopic dermatitis included off-label immunosuppressants and corticosteroids. Immunosuppressant therapy is associated with a substantial risk of side-effects, therefore needing clinical monitoring, and is likely to incur a significant healthcare burden for patients and payers. This retrospective cohort study based on claims data measured immunosuppressant use and its associated burden among US adult patients with atopic dermatitis covered under commercial or Medicare Supplemental insurance from January 01, 2010, to September 30, 2015. Overall, based on age, gender, region, and index year, 4201 control patients with atopic dermatitis without immunosuppressant use were matched with 4204 patients treated with immunosuppressants. The majority (68.5%) of patients using immunosuppressants were non-persistent with immunosuppressant treatment during the 12-month follow-up period after a mean (standard deviation) of 88.1 (70.7) days of immunosuppressant use; 72.3% required systemic steroid rescue treatment. Immunosuppressant users had higher incidence of immunosuppressant-related clinical events than controls; in addition, a larger proportion of immunosuppressant users versus controls developed cancer (0.28% vs 0.14%, respectively; P < 0.0001). Healthcare utilization and costs associated with clinical events and monitoring were also higher for immunosuppressant users compared with controls (total costs, $9516 vs $1630, respectively; P < 0.0001; monitoring costs, $363 vs $54, respectively; P < 0.0001). This study revealed that patients treated with systemic immunosuppressants often require systemic steroids or changes to treatment. The increase in immunosuppressant-related clinical events, including the need for increased monitoring with immunosuppressant treatment, compared with controls demonstrates a substantial treatment burden and highlights the unmet need for more effective long-term therapies for atopic dermatitis with improved safety profiles and reduced monitoring requirements.


Assuntos
Corticosteroides/uso terapêutico , Dermatite Atópica/tratamento farmacológico , Imunossupressores/uso terapêutico , Revisão da Utilização de Seguros/economia , Adulto , Idoso , Custos e Análise de Custo/economia , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Humanos , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
9.
J Epidemiol ; 29(10): 377-383, 2019 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-30249946

RESUMO

BACKGROUND: This study aimed to determine whether there are disparities in healthcare services utilization according to household income among people aged 75 years or older in Japan. METHODS: We used data on medical and long-term care (LTC) insurance claims and on LTC insurance premiums and needs levels for people aged 75 years or older in a suburban city. Data on people receiving public welfare were not available. Participants were categorized according to household income level using LTC insurance premiums data. The associations of low income with physician visit frequency, length of hospital stay (LOS), and medical and LTC expenditures were evaluated and adjusted for 5-year age groups and LTC needs level. RESULTS: The study analyzed 12,852 men and 18,020 women, among which 13.3% and 41.5%, respectively, were categorized as low income. Participants with low income for both genders were more likely to be functionally dependent. In the adjusted analyses, lower income was associated with fewer physician visits (incidence rate ratio [IRR] 0.90; 95% confidence interval [CI], 0.87-0.92 for men and IRR 0.97; 95% CI, 0.95-0.99 for women), longer LOS (IRR 1.98; 95% CI, 1.54-2.56 and IRR 1.42; 95% CI, 1.20-1.67, respectively), and higher total expenditures (exp(ß) 1.09; 95% CI, 1.01-1.18 and exp(ß) 1.09; 95% CI, 1.05-1.14, respectively). CONCLUSIONS: This study suggests that older people with lower income had fewer consultations with physicians but an increased use of inpatient services. The income categorization used in this study may be an appropriate proxy of socioeconomic status.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Renda , Revisão da Utilização de Seguros/estatística & dados numéricos , Assistência de Longa Duração/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Utilização de Instalações e Serviços/economia , Feminino , Disparidades em Assistência à Saúde , Humanos , Revisão da Utilização de Seguros/economia , Seguro de Assistência de Longo Prazo , Assistência de Longa Duração/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Vigilância da População
10.
Prog Urol ; 29(1): 18-28, 2019 Jan.
Artigo em Francês | MEDLINE | ID: mdl-30448010

RESUMO

OBJECTIVE: Presentation of data collected on urology claims from the register of a French insurance company. MATERIAL AND METHOD: Compensation claims involving urologists covering the period 2009-2018 were identified and analyzed. RESULTS: A total of 37 files were found. Oncological and functional surgical interventions accounts for 78% of repair claims. Postoperative complications represent 76% of the cases. The most represented acts are total prostatectomy (5) and promonto-fixation (4). The average time of complaint is 28.6 months [1-144 months], the average duration of a procedure (opening-closing) is 32.8 months [12-72 months]. The Conciliation and Compensation Commissions (CCC) and the High Court Courts (HCC) were solicited respectively in 51% and 33% of the proceedings. An amicable agreement is found in 16% of cases. There was no criminal or disciplinary proceedings. The average cost of a closed urology file is 7836 € [0-31,120 €]. In total, 64.8% of the expertises confirm practices in the respect of the rules of the art. CONCLUSION: This series presents the first forensic analysis of a portfolio of urologists on a period of 9 years in French urology. There is a rate of responsibility retained against the practitioner in only 27% of cases. The low rate of faulty files, the absence of a conviction for breach of the duty to provide information and in connection with antibiotic prophylaxis seem to confirm that the practice of urology in France is of good quality, a further study on a longer period of time and on a larger cohort of urologists would allow a finer medico-legal approach. LEVEL OF EVIDENCE: 3.


Assuntos
Responsabilidade Legal , Erros Médicos , Urologia/legislação & jurisprudência , Adulto , Criança , Compensação e Reparação/legislação & jurisprudência , Feminino , França/epidemiologia , Humanos , Doença Iatrogênica/economia , Doença Iatrogênica/epidemiologia , Recém-Nascido , Seguradoras , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/estatística & dados numéricos , Responsabilidade Legal/economia , Masculino , Imperícia/legislação & jurisprudência , Imperícia/estatística & dados numéricos , Erros Médicos/economia , Erros Médicos/estatística & dados numéricos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos , Procedimentos Cirúrgicos Urológicos Masculinos/economia , Procedimentos Cirúrgicos Urológicos Masculinos/estatística & dados numéricos , Urologia/economia
11.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30541827

RESUMO

BACKGROUND: The health care costs associated with treating autism spectrum disorder (ASD) in children can be substantial. State-level mandates that require insurers to cover ASD-specific services may lessen the financial burden families face by shifting health care spending to insurers. METHODS: We estimated the effects of ASD mandates on out-of-pocket spending, insurer spending, and the share of total spending paid out of pocket for ASD-specific services. We used administrative claims data from 2008 to 2012 from 3 commercial insurers, and took a difference-in-differences approach in which children who were subject to mandates were compared with children who were not. Because mandates have heterogeneous effects based on the extent of children's service use, we performed subsample analyses by calculating quintiles based on average monthly total spending on ASD-specific services. The sample included 106 977 children with ASD across 50 states. RESULTS: Mandates increased out-of-pocket spending but decreased the share of spending paid out of pocket for ASD-specific services on average. The effects were driven largely by children in the highest-spending quintile, who experienced an average increase of $35 per month in out-of-pocket spending (P < .001) and a 4 percentage point decline in the share of spending paid out of pocket (P < .001). CONCLUSIONS: ASD mandates shifted health care spending for ASD-specific services from families to insurers. However, families in the highest-spending quintile still spent an average of >$200 per month out of pocket on these services. To help ease their financial burden, policies in which children with higher service use are targeted may be warranted.


Assuntos
Transtorno do Espectro Autista/economia , Transtorno do Espectro Autista/terapia , Gastos em Saúde , Cobertura do Seguro/economia , Seguro Saúde/economia , Programas Obrigatórios/economia , Transtorno do Espectro Autista/epidemiologia , Criança , Feminino , Gastos em Saúde/tendências , Humanos , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/tendências , Cobertura do Seguro/tendências , Seguro Saúde/tendências , Masculino , Programas Obrigatórios/tendências
12.
Health Policy ; 122(11): 1240-1248, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30220552

RESUMO

BACKGROUND: Administrative costs (AC) are a relevant spending category in health care, and several approaches exist on how to define and measure them. Based on available AC studies, this paper aims to provide a map for this multifaceted research topic. METHODS: A scoping review was conducted using the databases MEDLINE, EconLit, and Business Source Premier. Literature was screened focussing on the research question: What is known about the methodology of AC research from scientific publications? RESULTS: Definition concepts mostly rely on national cost documentations. The international cost reporting framework of the Systems of Health Accounts was a critical reference point in six studies. Indications on how to operationalise AC independently from periodical cost reports were suggested by ten publications. In this context, time and full time equivalents are the most common cost measurements. CONCLUSIONS: The results indicate a lack of evidence regarding patients' perceptions of administrative issues in health care. Also, research on administrative impact on working conditions for health care employees beyond hospitals and physicians' offices is underrepresented. A systematic approach to reporting AC studies is needed. Reporting should include the appointment of entities actually empowered to change administrative resource usage. This would help to promote principles of a balanced administration.


Assuntos
Análise Custo-Benefício , Assistência à Saúde/economia , Administração Hospitalar/economia , Humanos , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/organização & administração
13.
Per Med ; 15(6): 481-494, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30256179

RESUMO

AIM: To evaluate payer costs associated with treating psychiatric disorders utilizing a combinatorial pharmacogenomics test versus treatment-as-usual (TAU). PATIENTS & METHODS: Administrative claims data were analyzed from health plan members whose treatment was guided by GeneSight® Psychotropic testing (CPGx® cohort) and those who received TAU (TAU cohort). Reimbursed costs were calculated over the 12-month pre-index and post-index event periods. RESULTS: 205 CPGx and 478 TAU members were included. Post-index cost savings (US$5505) drove a per-member-per-month savings of US$0.07. Disease-specific analyses resulted in similar savings. CONCLUSION: Use of CPGx yielded reduced spending for a commercial health plan across the patient population with psychiatric disorders, as well as among high-cost subpopulations.


Assuntos
Revisão da Utilização de Seguros/economia , Transtornos Mentais/economia , Testes Farmacogenômicos/economia , Adulto , Redução de Custos/métodos , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Saúde Mental , Pessoa de Meia-Idade , Farmacogenética/economia , Farmacogenética/métodos , Testes Farmacogenômicos/métodos , Estudos Retrospectivos
14.
Fed Regist ; 83(160): 41144-784, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-30192475

RESUMO

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2019. Some of these changes implement certain statutory provisions contained in the 21st Century Cures Act and the Bipartisan Budget Act of 2018, and other legislation. We also are making changes relating to Medicare graduate medical education (GME) affiliation agreements for new urban teaching hospitals. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis, subject to these limits for FY 2019. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2019. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs (now referred to as the Promoting Interoperability Programs). In addition, we are finalizing modifications to the requirements that apply to States operating Medicaid Promoting Interoperability Programs. We are updating policies for the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to the required supporting documentation for an acceptable Medicare cost report submission and the supporting information for physician certification and recertification of claims.


Assuntos
Economia Hospitalar/legislação & jurisprudência , Medicaid/economia , Medicare/economia , Sistema de Pagamento Prospectivo/economia , Registros Eletrônicos de Saúde , Interoperabilidade da Informação em Saúde/economia , Interoperabilidade da Informação em Saúde/legislação & jurisprudência , Humanos , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/legislação & jurisprudência , Reembolso de Seguro de Saúde , Medicaid/legislação & jurisprudência , Medicare/legislação & jurisprudência , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/legislação & jurisprudência , Reembolso de Incentivo/economia , Reembolso de Incentivo/legislação & jurisprudência , Estados Unidos
15.
J Manag Care Spec Pharm ; 24(9): 921-928, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30156448

RESUMO

BACKGROUND: Cluster headache (CH) is a rare trigeminal cephalalgia that is associated with extremely painful unilateral headache attacks and autonomic symptoms. Attacks may be episodic or chronic and associated with substantial suffering due to excruciating pain and limited treatment options. Frequent cluster headaches cause substantial burden for patients, resulting in reduced productivity caused by disability, as well as direct costs in some European countries. Less is known, however, about direct costs of recurring health care resource utilization (HCRU) in the United States. OBJECTIVE: To characterize HCRU and direct costs associated with CH in the United States from a third-party payer perspective. METHODS: This retrospective observational study analyzed claims data from the Truven Health Analytics MarketScan Research Databases from 2009-2014. Two cohorts were compared: CH (> 2 diagnostic CH claims) and controls (nonheadache patients). All patients were enrolled continuously for ± 12 months from date of first CH claim. HCRU and direct costs were examined during 12 months post-index as all-cause and CH-specific. Cost and HCRU differences were compared using propensity score-adjusted bin bootstrapping. RESULTS: CH and control cohorts comprised 6,562 and 143,761 patients (aged ≥ 18 years), respectively. Post-index, 36.9% of CH patients versus 16.2% of controls were admitted to the emergency department (ED), and 14.8% versus 6.1% were hospitalized for any reason, respectively (each P < 0.001). CH patients had a 2- to 3-fold significantly greater number of all-cause mean claims for outpatient visits (26.5 vs. 12.4 visits), hospital visits (0.2 vs. 0.1 visits), and ED visits (1.0 vs. 0.3 visits) versus controls (all P < 0.001). The mean number of all-cause visits with reported radiology and laboratory claims was 1.5- to 2.0-fold greater in CH patients versus controls (each P < 0.001). Mean total direct costs for all-cause claims were more than 2-fold greater in post-index ($16,530) for CH patients versus controls ($7,197, P < 0.0001). Similarly, mean direct all-cause costs attributable to outpatient, inpatient, and pharmacy claims were significantly (2-fold) greater; radiology and ED claims were 3- to 4-fold greater among CH patients versus controls (all P < 0.001). However, CH was cited infrequently as a reason for HCRU, indicating that comorbid conditions may substantially increase HCRU in CH patients. The most common reasons for ED admission in CH patients were gastric ulcer with hemorrhage, sub-arachnoid hemorrhage, and headache symptoms. The most common hospital discharge diagnoses for CH patients not observed in top 10 reasons in controls included cerebral artery occlusion/unspecified with cerebral infarction, headache symptoms, syncope/collapse, and diverticulitis. CONCLUSIONS: These findings suggest that, from a payer perspective, CH patients incur significantly higher health care costs versus controls. However, these high costs were not exclusively headache-related. Extrapolating our cost findings to estimated U.S. prevalence rates, approximate total direct cost for CH is greater than $2.8 billion/year. DISCLOSURES: Eli Lilly and Company was the sole sponsor and funder for this study and was responsible for the study design, data collection, data analysis, interpretation of data, and decision to publish the findings. All authors are employees and minor stockholders of Eli Lilly and Company.


Assuntos
Cefaleia Histamínica/economia , Cefaleia Histamínica/epidemiologia , Gastos em Saúde/tendências , Revisão da Utilização de Seguros/economia , Revisão da Utilização de Seguros/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Idoso , Cefaleia Histamínica/terapia , Estudos de Coortes , Bases de Dados Factuais/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
16.
Am J Manag Care ; 24(8 Spec No.): SP279-SP285, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30020740

RESUMO

OBJECTIVES: To determine the rate of timely disease-modifying antirheumatic drug (DMARD) initiation in patients newly diagnosed with rheumatoid arthritis (RA), as recommended per a quality measure endorsed by the National Quality Forum. STUDY DESIGN: Retrospective analysis of claims data from the Truven Health MarketScan commercial and Medicare claims databases. METHODS: Patients newly diagnosed with RA were identified in the claims databases. Outcomes included rate of nonbiologic or biologic DMARD initiation within 12 months of diagnosis; initiation by year (2009-2012), US state, and prescription drug plan; and time to initiation. Multivariate modeling was performed to identify factors associated with initiation or noninitiation. RESULTS: Of 40,040 newly diagnosed patients, 55.5% initiated RA therapy within 12 months, including 21,154 (52.8%) initiating DMARD therapy and 1051 (2.6%) initiating biologic DMARD therapy. Rates were similar for years 2009 (53.3%), 2010 (55.7%), 2011 (56.3%), and 2012 (56.8%), but they varied widely by US state (range, 33.3%-88.0%) and prescription plan (range, 42.6%-63.5% across 8 largest plans). Mean (SD) time to initiation of any RA therapy was 39 (65) days. Predictors of initiation included point-of-service (odds ratio [OR], 1.18) and consumer-driven/high-deductible (OR, 1.19) plans, comorbid psoriasis (OR, 1.30) or diabetes (OR, 1.17), rheumatoid factor test (OR, 3.02), and diagnosis by a rheumatologist (OR, 3.17). Predictors of noninitiation included female sex (OR, 0.94), preferred provider organization plan (OR, 0.87), higher comorbidity score (OR, 0.94), select comorbidities (OR range, 0.65-0.92), and number of prescriptions for any cause (OR, 0.98). CONCLUSIONS: Only slightly more than half of patients initiated RA therapy within 12 months of diagnosis in this commercially insured population.


Assuntos
Antirreumáticos/economia , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/economia , Custos de Cuidados de Saúde , Revisão da Utilização de Seguros/economia , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/economia , Produtos Biológicos/uso terapêutico , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Custos de Medicamentos , Diagnóstico Precoce , Feminino , Humanos , Cobertura do Seguro/economia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
17.
Am J Manag Care ; 24(8 Spec No.): SP338-SP345, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30020745

RESUMO

OBJECTIVES: To estimate total costs among patients with rheumatoid arthritis (RA) who persisted on or switched from newly initiated biologic therapy. STUDY DESIGN: A retrospective claims database analysis. METHODS: This analysis included adults in the HealthCore Integrated Research Database with RA who initiated treatment with a biologic for RA (abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab, rituximab, or tocilizumab) between January 2009 and November 2014. Total healthcare costs (plan- and patient-paid) were estimated for 1 year post index. Treatment persistence was defined as no discontinuation (ie, no refill gap >45 days) and no biologic switch. RESULTS: Of 7468 patients, 45.2% persisted on the index biologic for at least 1 year without a refill gap and 16.7% switched to another biologic in the first year; other patients discontinued the index biologic (23.2%) or restarted after a refill gap (15.0%). Mean 1-year total healthcare costs per patient were $41,901 (95% CI, $40,855-$42,947) among persistent patients and $44,244 (95% CI, $40,820-$47,668) among switchers. In a multivariable analysis of all patients, switchers had 5% higher postindex costs on average than persistent patients (exp(ß) = 1.05; 95% CI, 1.01-1.08), and etanercept had the lowest postindex costs (exp(ß) ranged from 1.03 to 1.51 for other biologics relative to etanercept). CONCLUSIONS: Patients with RA who switched biologic therapy incurred higher 1-year total postswitch healthcare costs compared with patients who were persistent on the index biologic. Healthcare costs were lowest for patients who started on etanercept, particularly those who persisted on etanercept.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Custos de Cuidados de Saúde , Adesão à Medicação/estatística & dados numéricos , Adulto , Antirreumáticos/economia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/economia , Produtos Biológicos/economia , Estudos de Coortes , Análise Custo-Benefício , Substituição de Medicamentos , Feminino , Humanos , Revisão da Utilização de Seguros/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Estados Unidos
18.
Am J Manag Care ; 24(8 Spec No.): SP329-SP337, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-30020748

RESUMO

OBJECTIVES: To evaluate the treatment patterns among commercially insured adults in the United States with attention-deficit/hyperactivity disorder (ADHD) who received long-acting (LA) combination therapy (CT) or monotherapy for ADHD. STUDY DESIGN: Retrospective observational study. METHODS: Adults with at least 1 ADHD diagnosis and at least 1 LA ADHD medication were identified from the MarketScan claims database (April 1, 2009, to March 31, 2014). The index date was randomly selected among LA medication initiation dates (index treatment). CT was identified if a different ADHD medication was filled within 30 days of the index date and the 2 medications overlapped by 30 days or more; otherwise, the treatment was considered monotherapy. Adherence was measured using proportion of days covered (PDC) during the 1 year post index date and was defined as a PDC of 0.8 or greater. Persistence was defined as time to discontinuation (TTD) (ie, ≥30-day supply gap). Adherence and persistence were compared between CT and monotherapy using multivariable logistic and Cox models, respectively, adjusting for baseline characteristics. RESULTS: Of 225,600 eligible patients, 7.3% received LA CT and 92.7% received LA monotherapy (mean age, 29 vs 31 years, respectively). Patients receiving LA CT had significantly lower adherence than those receiving LA monotherapy (mean PDC, 0.33 vs 0.41; adherence rate, 7% vs 16%, respectively; adjusted odds ratio, 0.38; P <.001). They also demonstrated significantly lower persistence than patients receiving LA monotherapy (median TTD, 59 vs 79 days, respectively; adjusted hazard ratio, 1.32; P <.001). CONCLUSIONS: Among US adults with ADHD treated with LA medications, LA CT was associated with significantly lower adherence and persistence compared with LA monotherapy.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Autacoides/administração & dosagem , Estimulantes do Sistema Nervoso Central/economia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Revisão da Utilização de Seguros/economia , Adesão à Medicação/estatística & dados numéricos , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Autacoides/economia , Estimulantes do Sistema Nervoso Central/farmacologia , Estudos de Coortes , Custos de Medicamentos , Quimioterapia Combinada , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Estados Unidos , Adulto Jovem
19.
Geriatr Gerontol Int ; 18(9): 1405-1409, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30044052

RESUMO

AIM: The present study aimed to investigate the effects of the 2014 Japanese fee schedule revision on trends in artificial nutrition routes, including gastrostomy, nasogastric tube and parenteral nutrition, among older people with dementia, using time series analysis. METHODS: The study used claim data in Japan submitted to Fukuoka Late Elders' Health Insurance from fiscal year 2010 to fiscal year 2016. We identified older people with dementia provided for the first time with artificial nutrition via gastrostomy, nasogastric tube or central venous line and aggregated their data by month. Interrupted time series analyses were used to examine trends in artificial nutrition routes over time. RESULTS: The numbers of older people with dementia receiving nutrition via gastrostomy, nasogastric tube and parenterally declined consistently. The slopes for pre-revision trends in gastrostomy, nasogastric tube and parenteral nutrition procedures were all significantly negative in the interrupted time series analyses. The post-revision trends in gastrostomy and parenteral nutrition continuously had significant negative slopes. In contrast, the significant negative trend in nasogastric tube procedures in the pre-revision period had disappeared during the post-revision period. CONCLUSIONS: The study showed that the fee schedule revision had limited impact on gastrostomy and parenteral nutrition. However the trend for nasogastric tube was ambiguous; hence, sustainable surveillance is required for evidence-based health policy. Geriatr Gerontol Int 2018; 18: 1405-1409.


Assuntos
Análise Custo-Benefício , Demência/epidemiologia , Tabela de Remuneração de Serviços/economia , Gastrostomia/economia , Nutrição Parenteral/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Demência/fisiopatologia , Tabela de Remuneração de Serviços/tendências , Feminino , Gastrostomia/métodos , Avaliação Geriátrica , Humanos , Revisão da Utilização de Seguros/economia , Japão , Modelos Lineares , Masculino , Desnutrição/prevenção & controle , Nutrição Parenteral/métodos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento
20.
Qual Manag Health Care ; 27(3): 165-171, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29944629

RESUMO

Health systems typically lose approximately 3% to 5% of net revenues annually due to insurance claim denials. While most denials can be appealed, the administrative burden of sorting through and appealing them can be time consuming and delays the revenue collection process. This article describes how the Lean Six Sigma methodology was used to improve the revenue cycle by reducing insurance claim denials for a leading pediatric hospital in the United States. The use of this approach is demonstrated through a case example focused on reducing denials by improving the hospital's Emergency Center registration process. Multiple pilot tests were performed to ensure the proposed changes sufficiently addressed the problem of missing/incomplete insurance information. Results indicated that the revised registration form reduced missing/incomplete fields by 67%. As a result, the revised form was implemented, which helped greatly reduce insurance claim denials. In addition to providing an example from which other health systems can learn to successfully implement Lean Six Sigma to enhance the performance of their revenue cycle, this work helped the hospital in which this research was performed improve its patient experience by making it easier for patients to complete their Emergency Center registration form.


Assuntos
Eficiência Organizacional , Revisão da Utilização de Seguros/organização & administração , Melhoria de Qualidade , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/normas , Humanos , Revisão da Utilização de Seguros/economia , Seguro Saúde/economia , Seguro Saúde/organização & administração , Projetos Piloto , Melhoria de Qualidade/organização & administração , Estados Unidos
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