Does the unification of health financing affect the distribution pattern of out‐of‐pocket health expenses in Turkey?

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/149529/1/ijsw12389_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/149529/2/ijsw12389.pd

Indirect and direct costs of acute coronary syndromes with comorbid atrial fibrillation, heart failure, or both

Vahram Ghushchyan,1,2 Kavita V Nair,2 Robert L Page II2,3 1College of Business and Economics, American University of Armenia, Yerevan, Armenia; 2Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA; 3Department of Physical Medicine, School of Medicine, University of Colorado, Aurora, CO, USA Background: The objective of this study was to determine the direct and indirect costs of acute coronary syndromes (ACS) alone and with common cardiovascular comorbidities. Methods: A retrospective analysis was conducted using the Medical Expenditure Panel Survey from 1998 to 2009. Four mutually exclusive cohorts were evaluated: ACS only, ACS with atrial fibrillation (AF), ACS with heart failure (HF), and ACS with both conditions. Direct costs were calculated for all-cause and cardiovascular-related health care resource utilization. Indirect costs were determined from productivity losses from missed days of work. Regression analysis was developed for each outcome controlling for age, US census region, insurance coverage, sex, race, ethnicity, education attainment, family income, and comorbidity burden. A negative binomial regression model was used for health care utilization variables. A Tobit model was utilized for health care costs and productivity loss variables. Results: Total health care costs were greatest for those with ACS and both AF and HF (38,484±5,191) followed by ACS with HF (32,871±2,853), ACS with AF (25,192±2,253), and ACS only (17,954±563). Compared with the ACS only cohort, the mean all-cause adjusted health care costs associated with ACS with AF, ACS with HF, and ACS with AF and HF were $5,073 (95$11,297 (95% CI 5,610–16,985), and $15,761 (95$5,266 (95% CI -7,765, -2,767), when compared with patients without these conditions. Conclusion: ACS imposes a significant economic burden at both the individual and society level, particularly when with comorbid AF and HF. Keywords: acute coronary syndromes, comorbid atrial fibrillation, heart failure, cost

Incremental increases in economic burden parallels cardiometabolic risk factors in the US

R Brett McQueen,1 Vahram Ghushchyan,1,2 Temitope Olufade,3 John J Sheehan,4 Kavita V Nair,1 Joseph J Saseen1,5 1Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Anschutz Medical Campus, Aurora, CO, USA; 2College of Business and Economics, American University of Armenia, Yerevan, Armenia; 3AstraZeneca, Wilmington, DE, 4AstraZeneca, Fort Washington, PA, 5Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA Objective: Estimate the economic burden associated with incremental increases in the number of cardiometabolic risk factors (CMRFs) in the US. Methods: We used the nationally representative Medical Expenditure Panel Survey from 2010 to 2012 to create a retrospective cohort of people based on the number of CMRFs (one, two, and three or four), and a comparison cohort of people with zero CMRFs. CMRFs included abdominal obesity, elevated blood pressure, elevated triglycerides, and elevated glucose and were defined using diagnostic codes, prescribed medications, and survey responses. Adjusted regression analysis was developed to compare health expenditures, utilization, and lost-productivity differences between the cohorts. Generalized linear regression was used for health care expenditures, and negative binomial regression was used for utilization and productivity, controlling for individual characteristics. Results: The number of CMRFs was associated with significantly more annual utilization, health care expenditures, and reduced productivity. As compared with people with zero CMRFs, people with one, two, and three or four CMRFs had 1.15 (95% confidence interval [CI]: 1.06, 1.24), 1.37 (95% CI: 1.25, 1.51), and 1.39 (95% CI: 1.22, 1.57) times higher expected rate of emergency room visits, respectively. Compared with people with zero CMRFs, people with one, two, and three or four CMRFs had increased incremental health care expenditures of US$417 (95$70, $763), US$2,326 (95% CI: $1,864,$2,788), and US$4,117 (95$3,428, $4,807), respectively. Those with three or four CMRFs reported employment of 60%, compared with 80% in patients with zero CMRFs. People with three or four CMFRs had 1.75 (95% CI: 1.42, 2.17) times higher expected rate of days missed at work due to illness, compared with people with zero CMRFs. Conclusion: Our findings demonstrate a direct association between economic burden and number of CMRFs. Although this was expected, the increase in burden that was independent from the cost of cardiovascular disease was surprising. Keywords: economic burden, cardiometabolic risk factors, cardiovascular diseas

Exploring factors associated with health disparities in asthma and poorly controlled asthma among school-aged children in the U.S.

Objective: Certain populations suffer disproportionately from asthma and asthma morbidity. The objective was to provide a national descriptive profile of asthma control and treatment patterns among school-aged children (SAC: aged 6–17) in the U.S. Methods: This was a cross-sectional analysis using the nationally representative 2007–2014 Medical Expenditure Panel Survey. Among SAC with asthma, indicators of poor control included: exacerbation/asthma attack; \u3e3 canisters short-acting beta agonist (SABA)/3 months; and asthma-specific Emergency Department or inpatient visits (ED/IP). Results: Non-Hispanic black, non-Hispanic multiple races, Puerto Rican, obese, Medicaid, poor, ≥2 non-asthma chronic comorbidities (CC), and family average CC ≥ 2 were associated with higher odds of having asthma. The following had significantly higher odds ratios (OR) of excessive SABA use compared to non-Hispanic whites [OR; CI; p \u3c 0.05]: Puerto Rican (3.8; 2.1–6.9), Mexican (3.6; 2.0–6.4), Central/South American (3.0; 1.2–7.7), Hispanic-other (3.1; 1.1–9.0), non-Hispanic black (2.5; 1.6–3.9), and non-Hispanic Asian (4.0; 1.7–9.2). SABA OR were also significant for Spanish spoken at home (2.5; 1.6–3.8), obese (2.1; 1.3–3.3), Medicaid (2.9; 2.0–4.1), no medical insurance (2.1; 1.1–4.1), no prescription insurance (2.5; 1.8–3.5), poor (2.8; 1.7–4.7), CC ≥ 2 (2.1; 1.6–2.8), parent-without high-school degree (2.5; 1.8–3.6), parent-SF-12 Physical Component Scale \u3c50 (1.6; 1.2–2.1) and Mental Component Scale \u3c50 (1.5; 1.1–2.0). Significant differences also existed across subgroups for ED/IP visits. Conclusions: There are disparities in asthma control and prevalence among certain populations in the U.S. These results provide national data on disparities in several indicators of poor asthma control beyond the standard race/ethnicity groupings

The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States

Objective: The degree of poorly controlled asthma and its association with missed school days and parental missed work days is not well understood. Methods: This was a retrospective analysis of missed school days and missed work days for school-aged children (SAC; aged 6–17) and their caregivers in the nationally representative 2007–2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included: exacerbation in previous 12 months; use of \u3e3 canisters of short-acting beta agonist (SABA) in 3 months; and annual asthma-specific (AS) Emergency Department (ED) or inpatient (IP) visits. Negative binomial regression was used for missed school days, and a Heckman two-step selection model was used for missed work days. All analyses controlled for sociodemographics and other covariates. Results: There were 44,320 SAC in MEPS, of whom 5,890 had asthma. SAC with asthma and an indicator of poor control missed more school days than SAC without asthma: exacerbation (1.8 times more; p \u3c 0.001); \u3e3 canisters SABA (2.7 times more; p \u3c 0.001) and ED/IP visit (3.8 times more; p \u3c 0.001). The parents/caregivers of SAC with asthma and an exacerbation missed 1.2 times more work days (p \u3c 0.05), while those with SAC with asthma and an ED/IP visit missed 1.8 times more work days (p \u3c 0.01) than the parents of SAC without asthma. Conclusions: This study provides evidence of the significant national burden of poorly controlled asthma due to missed school and work days in the United States. More effective and creative asthma management strategies, with collaboration across clinical, community and school-based outreach, may help address this burden

The cost of inpatient death associated with acute coronary syndrome

Robert L Page II,1 Vahram Ghushchyan,2 Jill Van Den Bos,3 Travis J Gray,3 Greta L Hoetzer,4 Durgesh Bhandary,4 Kavita V Nair1 1Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, 2College of Business and Economics, American University of Armenia, Yerevan, Armenia; 3Milliman, Inc, Denver, CO, 4AstraZeneca, US Medical Affairs, Wilmington, DE, USA Background: No studies have addressed the cost of inpatient mortality during an acute coronary syndrome (ACS) admission. Objective: Compare ACS-related length of stay (LOS), total admission cost, and total admission cost by day of discharge/death for patients who died during an inpatient admission with a matched cohort discharged alive following an ACS-related inpatient stay. Methods: Medical and pharmacy claims (2009–2012) were used to identify admissions with a primary diagnosis of ACS from patients with at least 6 months of continuous enrollment prior to an ACS admission. Patients who died during their ACS admission (deceased cohort) were matched (one-to-one) to those who survived (survived cohort) on age, sex, year of admission, Chronic Condition Index score, and prior revascularization. Mean LOS, total admission cost, and total admission cost by the day of discharge/death for the deceased cohort were compared with the survived cohort. A generalized linear model with log transformation was used to estimate the differences in the total expected incremental cost of an ACS admission and by the day of discharge/death between cohorts. A negative binomial model was used to estimate differences in the LOS between the two cohorts. Costs were inflated to 2013 dollars. Results: A total of 1,320 ACS claims from patients who died (n=1,320) were identified and matched to 1,319 claims from the survived patients (n=1,319). The majority were men (68%) and mean age was 56.7±6.4 years. The LOS per claim for the deceased cohort was 47% higher (adjusted incidence rate ratio: 1.47, 95% confidence interval: 1.37–1.57) compared with claims from the survived cohort. Compared with the survived cohort, the adjusted mean incremental total cost of ACS admission claims from the deceased cohort was US43,107±US3,927 (95% confidence interval: US35,411–US50,803) higher. Conclusion: Despite decreasing ACS hospitalizations, the economic burden of inpatient death remains high. Keywords: death, acute coronary syndrome, hospitalization, cost, health resource utilizatio