Health Benefit Costs and Absenteeism Among Employed Patients With Acromegaly.

OBJECTIVE: Acromegaly is associated with increased morbidity and mortality. Limited data are available on these patients' utilization and costs of health care. This study assessed the impact of acromegaly on employees' health benefit (direct and indirect) costs and absenteeism. METHODS: A retrospective analysis was conducted of drug and medical claims and employer data (from January 2010 to April 2019) of patients with an acromegaly diagnosis and matched controls from a U.S. employee database. Patient claims were tracked for 12 months postdiagnosis (or matched) date. Outcomes were analyzed using separate 2-part regression models, controlling for clinical, demographic, and job-related variables. RESULTS: Forty-seven patients with acromegaly and 940 controls were identified. Cohorts were similar in most demographic and job-related variables. Patients with acromegaly had a significantly higher Charlson comorbidity index score and higher incidence of claims for several comorbidities. Acromegaly drugs represented 16.3% of the acromegaly cohort's total costs. Total health benefit costs were $54 821 higher (P < .05) for patients compared with controls, with direct costs representing 79.8% of the difference. Total indirect costs were higher for patients with acromegaly, with short-term and long-term disability comprising most of the difference between the acromegaly and control groups. Patients with acromegaly had significantly more short-term disability days than controls, but total sick days were similar for the 2 groups. CONCLUSION: The presence of acromegaly was associated with increased direct and indirect employee health benefit costs and increased work absenteeism.

The Clinical and Economic Impact of Employees Who Are Care Partners of Patients with Multiple Sclerosis by Disease Severity.

Background: Research on employee care partners of patients with multiple sclerosis (MS) is limited. Objectives: The clinical and economic impact on employee care partners was evaluated by MS disease severity. Methods: Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010-Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners' demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. Results: Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (P<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (P<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (P<.05). Discussion: Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. Conclusions: Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity.

Health outcomes and costs among employees with fibromyalgia treated with pregabalin vs. standard of care.

OBJECTIVE: To compare comorbidities, drug use, benefit costs, absences, medication persistence/adherence between employees with fibromyalgia initiating treatment with pregabalin (PGB) vs. antidepressant Standard of Care ([SOC] amitriptyline, duloxetine, or venlafaxine). METHODS: Retrospective study of 240 adults initiating PGB or SOC after 7/1/2007. Multivariate regression models on propensity-score-matched cohorts compared postindex costs, absences, and adherence between cohorts. RESULTS: Pregabalin users had significantly more preindex muscle pain and dizziness and less depression than SOC (each P < 0.05). Use of some non-PBG/SOC drugs differed. No differences were found in total medical, drug, or absenteeism cost. PGB had more sick leave (9.8 vs. 6.8 days, P = 0.04), but other absence types were similar. All adherence metrics were nonsignificantly greater for PGB vs. SOC. CONCLUSION: Despite several comorbidity and drug use differences, most employee benefit outcomes and adherence did not differ between the cohorts.

Disability and workers' compensation trends for employees with mental disorders and SUDs in the United States.

INTRODUCTION: US employee absence benefits may include workers' compensation (WC) for work-related injuries/illnesses, short- and long-term disability (STD and LTD, respectively) for non-work-related injuries/illnesses, and discretionary sick leave (SL). Absences can significantly impact business performance, and employers are intensifying efforts to manage benefits and connections with employee health. This research compares all-cause STD/LTD/WC/SL use and variation from baseline (2002) for eligible employees (EMPs) with mental disorders (MDs) and SUDs to determine if use/payments varied over time. METHODS: Employees incurring medical claims with Agency for Healthcare Research and Quality MD and SUD ICD-9/10 codes were identified in the WorkPartners database (January 1, 2002 to December 31, 2019). Retrospective analysis was performed on annual prevalence, benefit use, mean days of leave, and median payments as a percent of salary (including lump-sum distributions and potentially extending beyond initiation year). WC claims without work absences were excluded. For each benefit, annual outcomes were calculated as a percent of baseline to show variability. RESULTS: Use was 48.1% to 202.2% (median, 102.8%) of baseline rates for SL (SUD-EMPs), and 87.3% to 108.4% (median, 97.3%) for STD (MD-EMPs). Days of LTD leaves were 21.5% to 657.8% (median, 359.2%) of baseline days (MD-EMPs), and 122.7% to 1042.2% (median, 460.0%) of baseline days for (SUD-EMPs). Median payments for WC were 78.6% to 253.6% (median, 114.6%) of baseline (MD-EMPs) and 97.9% to 481.6% (median, 104.0%) for SUD-EMPs. DISCUSSION: Employees with MD/SUD used absence benefits at differing rates over time with varying days of leave and payments as a percent of salary. Using a constant cost or salary replacement factor over time for all benefits is not accurate or appropriate.

Direct and Indirect Costs Among Caregivers of Patients With Major Depressive Disorder and Suicidal Ideation or Suicidal Attempt.

Objective: To compare direct and indirect costs among caregivers of patients with major depressive disorder (MDD) and suicidal ideation and/or suicide attempts (MDSI) versus caregivers of patients with MDD alone versus caregivers of patients without MDD or suicidal ideation and/or suicide attempts (controls).Methods: Cohorts were based on caregivers of adult patients with MDSI, MDD alone, and controls. Patients were identified by Workpartners employer database ICD-9/ICD-10 codes (January 2010 to July 2019) and were spouses or domestic partners of employees (caregivers). Twenty controls and 20 MDD-alone caregivers were matched to each MDSI caregiver on sex, age, and index year. All caregiver-patient pairs had 6 months pre/postindex information and met additional inclusion/exclusion criteria. Patient and caregiver medical and prescription claims and caregiver absenteeism (payment/time) were analyzed. Direct costs (medical, prescription) and indirect costs (absence payments by benefit type) were analyzed using separate, 2-part stepwise regression models and controlling for demographics, job-related variables, region, index year, and Charlson Comorbidity Index score.Results: 570 MDSI caregiver-patient pairs and 11,400 matched MDD-alone and control pairs were identified. MDSI and MDD-alone caregivers had higher medical costs compared with controls ($5,131 and $4,548 versus $3,885, respectively; P < .0001). Prescription costs were highest among MDSI caregivers, followed by MDD-alone and control caregivers ($1,852, $1,425, and $1,005, respectively; P < .001). MDSI caregivers had the highest total indirect costs. MDSI patient medical and prescription costs were highest, followed by MDD-alone and control patients.Conclusion: MDSI caregivers had significantly greater direct and indirect costs compared with MDD-alone and non-MDD caregivers.

The implications of suboptimal year-1 outcomes with disease-modifying therapy in employees with multiple sclerosis.

AIM: Multiple sclerosis (MS) poses a substantial employer burden in medically related absenteeism and disability costs due to the chronic and debilitating nature of the disease. Although previous studies have evaluated relapse, nonadherence, discontinuation, and switching individually, little is known about their overall collective prevalence and implications in employees with MS treated with disease-modifying therapies (DMTs). This study evaluated the proportion of employees with MS with suboptimal DMT year-1 outcomes and to quantify the clinical and economic burden of suboptimal year-1 outcomes from a US employer perspective. MATERIALS AND METHODS: Employees with MS were selected from the Workpartners database. Eligibility criteria were: ≥2 MS diagnosis claims (ICD-9-CM 340.xx/ICD-10-CM G35) from January 1, 2010-March 31, 2019, ≥1 once-/twice-daily oral or self-injectable DMT claim (first claim = index), continuous eligibility 6-months pre-/1-year post-index, no baseline DMT, and age 18-64 years. Suboptimal year-1 outcomes included: non-adherence (proportion of days covered <80%), discontinuation (gap >60 days), switch, or relapse (MS-related hospitalization, emergency room visit, or outpatient visit with corticosteroid). A two-part logistic-generalized linear model evaluated costs. RESULTS: Of 488 eligible patients, half (n = 247; 50.6%) had suboptimal year-1 outcomes (39.5% non-adherence, 9.8% discontinuation, 10.9% switching, 20.7% relapse; not mutually exclusive). Employees with suboptimal year-1 outcomes had higher all-cause medical ($12,730 vs. $6,428; p < 0.0001), MS-related medical ($5,444 vs. $2,652; p < 0.0001), non-DMT pharmacy ($2,920 vs. $2,169; p = 0.0199), sick leave ($1247 vs. $908; p = 0.0274), and short-term disability ($934 vs. $146; p = 0.0001) costs. Long-term disability ($751 vs. $0; p = 0.1250) and Workers' Compensation ($56 vs. $24; p = 0.1276) did not significantly differ. LIMITATIONS: Administrative claims lack clinical information. Results may not be generalizable to other patients or care settings. CONCLUSIONS: Half of the employees with MS in this sample had suboptimal year-1 outcomes (i.e. non-adherence, discontinuation, switching, or relapse). These suboptimal year-1 outcomes were associated with greater medical, sick leave, and short-term disability costs.

Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care.

BACKGROUND: Limited information is available on the utilization and healthcare costs among patients with acromegaly. The purpose of this study was to assess the impact of acromegaly on healthcare utilization and costs by locations of care (LoC). METHODS: Patients with acromegaly and controls were identified from an analysis of drug and medical claims filed from January 2010 to April 2019 from a US employer database. Each patient with acromegaly was matched with 20 random controls (without acromegaly) selected from the database. Claims were tracked for 12 months postdiagnosis (or matched date for controls). Outcomes by LoC, including costs, services, and likelihood of use, were compared using two-stage regression models or logistic regression models, controlling for demographic and job-related variables, and Charlson comorbidity index scores. RESULTS: Claims from 60 patients with acromegaly and 1,200 controls were analyzed. Compared with the control group, patients with acromegaly had significantly higher likelihoods of receiving care in a physician's office [odds ratio > 1,000], inpatient [OR = 8.010], outpatient [OR = 12.656], laboratory [OR = 3.681], and 'other' locations [OR = 4.033] (all p < .001), except in an emergency department (ED). Significantly more services were performed at each LoC for those with acromegaly (p < .01) but not in an ED. Total costs were more than 5-fold higher for the acromegaly cohort compared with controls (p < .05). Costs by LoC were consistently higher (p < .001) for patients with acromegaly vs. controls, with mean annual cost differences greatest in outpatient hospital/clinic ($9,611 vs $1,355), inpatient ($8,646 vs $739), physicians' office ($4,762 vs $1,301), other ($2,001 vs $367), and laboratory ($508 vs $66). ED-related treatment costs were not significantly different between cohorts. CONCLUSIONS: Compared with matched controls, patients with acromegaly were more likely to utilize healthcare services in nearly all LoCs and accrue higher expenditures at each LoC, with the exception of ED services.

United States comparative costs and absenteeism of diabetic ophthalmic conditions.

OBJECTIVE: This retrospective cohort study examined the impact of diabetic macular edema (DME), diabetic retinopathy (DR), or diabetes on annual health benefit costs and absenteeism in US employees. METHODS: Claims data from 2001 to 2012 was extracted from the Human Capital Management Services Group Research Reference Database on annual direct/indirect health benefit costs and absences for employees aged ≥ 18 years. Employees with DME, DR, or diabetes were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Employees were divided into two groups, drivers or nondrivers, and examined in separate analyses. For drivers and nondrivers, the DME, DR, and diabetes cohorts were compared with their respective control groups (without diabetes). Two-part regression models controlled for demographics and job-related characteristics. RESULTS: A total of 39,702 driver and 426,549 nondriver employees were identified as having ≥ 1 year's continuous health plan enrollment. Direct medical costs for drivers with DME, DR, or diabetes were $6470, $8021, and $5102, respectively (>2.8 times higher and statistically significant compared with driver controls). Nondrivers with DME and DR incurred significantly higher sick leave and short-term disability costs compared with the nondrivers with diabetes and nondriver controls. In drivers with DME, the majority of days of absence were for short- and long-term disability (12.41 and 11.43 days, respectively). In drivers with DR, the majority of days of absence were for short-term disability (10.70 days). In nondrivers with DME and nondrivers with DR, the majority of days of absence were for sick leave (5.74 and 4.93 days, respectively) and short-term disability (5.08 and 4.93 days, respectively). CONCLUSION: DME and DR are associated with substantial direct medical cost and absenteeism in this real-world sample of medically insured employees. This research highlights the negative impact of DME and DR on annual costs and absenteeism and may assist employers in assessing the impact of these conditions on employees.

Work-related and health care cost burden of community-acquired pneumonia in an employed population.

OBJECTIVE: To estimate community-acquired pneumonia (CAP) incidence, turnover, episode length, inpatient length-of-stay, and cost burden. METHODS: Using 2007 to 2010 employee demographic, payroll, and claims data, CAP episodes were identified in employees aged 18 to 64 years. Semiannual medical, drug, sick leave, short-term disability (STD), long-term disability, and workers' compensation costs and absence days were compared between employees with and without CAP (controls) using two-part regression modeling. RESULTS: In a population of 250,000, the number of CAP episodes per 100,000 employees was 628. The incidence rate increased with age and comorbidity. CAP employees' turnover rate nearly doubled that of controls (P < 0.01). In every age and risk group, employees with CAP had significantly (P < 0.01) higher medical and drug costs than controls and double the STD costs and days (P < 0.05). CONCLUSIONS: CAP and underlying comorbidity are associated with increased medical, pharmacy, and STD costs and employee turnover rates.

Comparing costs and absences for multiple sclerosis among US employees: pre- and post-treatment initiation.

BACKGROUND: Limited data exist on the effects of Disease Modifying Treatments (DMTs) on direct and indirect costs among employees treated for Multiple Sclerosis (MS). The objective was to compare costs and absences among employees treated with DMTs (e.g., interferons [IFNs]: IFN-ß1a-IM = Avonex = 'A', IFN-ß1b = Betaseron = 'B', IFN-ß1a-SC = Rebif = 'R', or glatiramer acetate = Copaxone = 'C') for MS pre and post therapy initiation. METHODS: A healthcare claims database of US employees (2001-2008) was used to identify patients with two or more DMT prescriptions or one DMT prescription with a MS diagnosis (ICD-9 = 340.X) who were continuously employed and with health plan coverage 6 months pre and post DMT initialization. Outcome measures included: direct costs; indirect costs and absences associated with sick leave (SL) and short-term disability (STD); and medical costs and utilization by place of service (POS). All costs are inflation-adjusted to 2010 US$. Between- and within-group outcomes were compared using Student's t-tests for continuous and chi-square tests for discrete variables and considered significant when P ≤ 0.05. RESULTS: Overall, 153 eligible employees were identified: 'A' = 68, 'B' = 22, 'R' = 21, 'C' = 42; 76 employees had SL eligibility; 89 had STD eligibility; and 97 employees had POS indicators. Following treatment initiation, healthcare costs decreased significantly for 'A' users (-53.8%, -$3084) and 'B' users (-67.1%, -$4103), while SL costs only decreased significantly for 'A' users (-60.5%, -$704); changes in SL absence days for 'A' and 'B' users were significantly lower than for 'C' users (both P < 0.05). In the POS sample, total medical costs significantly decreased for 'A' (-$3643), 'B' (-$3470), and 'C' (-$3762), while 'R' increased ($2093) non-significantly. Only 'A' users had significant proportion-of-care reductions (Emergency Department, Outpatient Hospital, and 'Other' locations). CONCLUSION: Among MS employees treated with DMTs in the real-world, 'A' and 'B' users had significantly greater reductions in SL costs post therapy initiation compared with 'C' and 'R'. Only 'A' users showed a significant reduction in SL absence days, while the other cohorts reported increases. LIMITATIONS: Small sample sizes may limit the interpretability of these results.

Medication adherence with disease modifying treatments for multiple sclerosis among US employees.

OBJECTIVE: Medication adherence in chronic diseases like multiple sclerosis (MS) plays an important role in predicting long-term outcomes, yet existing data on adherence in employee populations are not found. The objective of this study is to compare adherence among employees treated with disease modifying treatments (DMTs) for MS in the year following treatment initiation. METHODS: A healthcare claims database of US employees from 2001 to 2008 was used to identify patients with MS based on two or more DMT prescriptions or one DMT prescription with an MS diagnosis (ICD-9 340.xx). Employees continuously employed and with health plan coverage for 1 year following DMT initiation were eligible. Two measures were used in estimating adherence after DMT initiation: (1) persistence (the number of days from DMT initiation to the first 30-day gap in supply) and, (2) annual compliance, assessed by the medication possession ratio (MPR = number of days with a medication supply in the year divided by 365 days). Wilcoxon tests on time-to-event data and t-tests were used to compare persistence and MPR, respectively, between DMT groups. Other measures of resource utilization were also compared. RESULTS: Overall, 358 employees [179 interferon [IFN]-ß1a-IM (Avonex* = 'A'); 63 IFN-ß1b (Betaseron† = 'B'); 20 IFN-ß1a-SC (Rebif‡ = 'R'); 96 glatiramer acetate (Copaxone§ = 'C')] were eligible for analysis. No significant differences in age, gender, and certain job-related variables existed between cohorts. Persistence was better for 'A' than 'B' (p = 0.039), 'C' (p = 0.0007), and 'R' (p = 0.130). At 1 year, a greater proportion of 'A' employees were persistent (60.34%) than 'B' (42.86%, p = 0.016), 'C' (42.71%, p = 0.0052), and 'R' (45.00%, p = 0.190). 'A' also had the highest MPR (0.782) which was significantly higher than 'C' (MPR = 0.698, p = 0.0160) and statistically equivalent to 'B' (MPR = 0.705, p = 0.0576) and 'R' (MPR = 0.761, p = 0.7347). LIMITATIONS: The study has limitations characteristic of administrative claims database studies and small sample sizes. The population may not be representative of undiagnosed/untreated MS patients, those not able to maintain employment, and those not using the initial therapy. CONCLUSIONS/RELEVANCE: Among employees treated with 'A', 'B', 'C', and 'R' for MS, 'A' patients had significantly greater medication adherence.