The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures

The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140194/1/pop.2015.0171.pd

Retrospective Analysis of the Health-Care Costs of Bupropion Sustained Release in Comparison with Other Antidepressants

AbstractObjectiveThe objective of this study was to evaluate the health care costs associated with the treatment of a new episode of depression with bupropion sustained release (SR) rather than with other antidepressants (selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs], and serotonin norepinephrine reuptake inhibitors [SNRIs]).MethodsThis was a retrospective cohort study based on the private-pay, fee-for-service 1997 and 1998 MEDSTAT MarketScan databases. Individuals were included if they were 18 years of age or older, had an initial prescription for an antidepressant under study with an index prescription date between July 1997 and June 1998, and had a claim for a diagnosis of depression diagnosis within 30 days of the index date. All patients' claims from six months before and after receiving their index antidepressant prescription were examined. Total, outpatient, and pharmacy costs were compared among antidepressant groups using an intent-to-treat analysis with exponential regression models and bootstrapped 95% confidence intervals.ResultsA total of 1771 patients were included in the study cohort. The mean age was 41.6 years, and 69.5% of subjects were female. Most patients (75%) continued with the index antidepressant during the 6-month follow-up period. Although the drug acquisition cost was lowest for TCAs, total costs were significantly higher for patients treated with TCAs than for those treated with bupropion SR (p < .05). In comparison with bupropion SR, patients initiating therapy with sertraline had significantly higher mental health payments (p < .05).ConclusionsInitiating treatment of depression with bupropion SR was associated with lower total mental health care costs compared with TCAs and with sertraline. This study reaffirms that formulary and medical decision-makers should consider the overall impact of antidepressant treatment, including but not limited to drug acquisition costs, other health care costs, and drug efficacy and safety

What Are the Total Costs of Surgical Treatment for Uterine Fibroids?

Abstract Objective: To investigate the direct and indirect costs of uterine fibroid (UF) surgery. Methods: Data were obtained from the MarketScan Commercial Claims and Encounters databases for 1999–2004. Our sample included 22,860 women with insurance coverage who were treated surgically for UF and 14,214 women who were treated nonsurgically for UF. Medical care costs and missed workdays were divided into baseline (1 year prior to surgery) and postoperative (1 year after surgery) periods. For a subsample of women, we calculated average annual costs 3 years before and after their surgery. Results: Of patients electing surgery, 85.9% underwent hysterectomy, 7.6% myomectomy, 4.9% endometrial ablation, and 1.6% uterine artery embolization (UAE). Women undergoing UAE incurred the highest medical care costs in the operative year ($16,430 unadjusted,$20,634 adjusted for confounders), followed by hysterectomy ($15,180 unadjusted,$17,390 adjusted), myomectomy ($14,726 unadjusted,$18,674 adjusted), and endometrial ablation ($12,096 unadjusted,$13,019 adjusted). Women treated nonsurgically incurred costs of $7,460 unadjusted and$8,257 adjusted during the year after they were diagnosed with UF. Three years after surgery, patients treated with hysterectomy had the lowest annual costs. Missed workdays in the year after surgery were high, resulting in significant losses to employers in the magnitude of $6,670–$25,229, depending on treatment, values assigned to missed workdays, and whether the analyses adjusted for confounders. Conclusions: UF surgical treatment costs were high. Absenteeism and disability were important components of the cost burden of UF treatment for women, their employers, and the healthcare system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63391/1/jwh.2008.0456.pd

The Impact of Nebulized Levalbuterol on Health Care Payments for Elderly Asthma and Chronic Obstructive Pulmonary Disease Patients in Medicaid Plans

Objective: To compare health expenditures among elderly Medicaid patients with asthma or chronic obstructive pulmonary disease (COPD) who used either nebulized levalbuterol (levosalbutamol) or racemic albuterol (salbutamol) for bronchodilation. Methods: A retrospective, quasi-experimental study was conducted. Trends over time in total medical expenditures and disease-specific expenditures were compared for levalbuterol versus racemic albuterol patients. Differences in these trends were estimated by conducting generalized estimating equation regression analyses of difference-in-difference regression models. Prior to comparing levalbuterol and racemic albuterol users, these models controlled for their differences in demographics, reason for Medicaid eligibility, location, health-plan type, co-morbidities, severity of asthma or COPD, the use of other medications, and the receipt of influenza or pneumonia inoculations. Several sensitivity analyses were also conducted to estimate the reliability of the results, as related to inclusion criteria (e.g. days of therapy), regression methods, or to conduct separate analyses for asthma and COPD patients. Results: When asthma and COPD patients were pooled, every analysis of total healthcare expenditures showed large, statistically significant savings associated with levalbuterol use. These savings ranged from $US1167 to$US1792 per patient over a 6-month period, depending on inclusion criteria or statistical methods. When the analyses were separated by disease, a focus on total health expenditures still favored levalbuterol and the savings associated with levalbuterol use were about twice as high per patient for COPD patients ($US2490) as they were for asthma patients ($US1122). A focus on disease-related expenditures showed a statistically significant loss of approximately $US853 per patient for levalbuterol users who had asthma (p = 0.0031) but a statistically significant saving of approximately$US967 for COPD patients who used levalbuterol (p = 0.0031). Conclusions: A focus on total medical expenditures showed that the added costs of using levalbuterol were more than offset by reductions in other types of healthcare expenditures. Savings were higher for COPD patients than for asthma patients. A focus on disease-related expenditures showed savings for COPD patients who used levalbuterol, but results for asthma patients favored racemic albuterol.Asthma, Chronic-obstructive-pulmonary-disease, Co-payment, Elderly, Levosalbutamol, Salbutamol

Cost Implications for the Use of Inhaled Anti-Inflammatory Medications in the Treatment of Asthma

Objective: To compare the expected costs of treating patients with asthma with versus without inhaled anti-inflammatory medications, adjusting for other factors that also influence medical care expenditures. Design: Nonlinear exponential regression analyses were used to estimate relationships between medical care expenditures and treatment with inhaled corticosteroids, sodium cromoglycate (cromolyn) or nedocromil. The regressions adjusted for differences in patients' demographics, location, plan type and severity of illness. Setting: Large, self-insured, corporate-sponsored medical plans represented in MarketScan database. Patients and Participants: 7466 continuously enrolled patients with asthma. Interventions: Treatment with inhaled corticosteroids, sodium cromoglycate or nedocromil. Main Outcome Measures: 1. Total inpatient, outpatient and pharmaceutical expenditures; and 2. asthma-related expenditures in the 1996 calendar year. Results: If all patients had been treated with inhaled anti-inflammatory drugs, total expenditures would be expected to be about $US944.82 per patient lower, on average, than would be the case if no patients received these drugs. Asthma-related expenditures would be about$US498.74 per patient higher, on average, if all patients were treated with these drugs. Conclusions: Using inhaled anti-inflammatory agents would be associated with higher asthma-related expenditures but lower total expenditures. Treatment with inhaled anti-inflammatory drugs may represent an investment in better care that pays off with better health and lower total medical care expenditures.Antiasthmatics, Asthma, Corticosteroids, Cost analysis, Nedocromil, Pharmacoeconomics, Sodium cromoglycate

Economic Burden of Osteoporosis-Related Fractures in Medicaid

AbstractObjectivesThere are limited studies concerning the economic burden of osteoporosis in the Medicaid population. This study estimated the direct cost of osteoporosis-related fractures (OPFx) to state Medicaid budgets.MethodsThis retrospective analysis utilized Medicaid claims databases from three states, which included approximately 8 million Medicaid recipients. The study sample had at least one claim for an osteoporosis diagnosis (733.0x) between January 1, 2000 and December 31, 2001. Beneficiaries with a fracture and a diagnosis of osteoporosis were assigned to the case cohort. A propensity score-based matching method was used to select a cohort of controls with osteoporosis but without a fracture. An exponential conditional mean model was used to estimate the incremental annual cost associated with fractures.ResultsThe study cohort (n = 7626) and a 1:1 matched control group were identified. The study cohort was 85.8% female, had an average age of 65 years, were 53.2% white, and 48.9% were eligible for Medicare. There were significant increases (all P < 0.05) from the preperiod to study period for this cohort in the proportion that had at least one hospital admission (14.0% vs. 26.5%), nursing home admission (9.2% vs. 17.2%), home health (39.1% vs. 49.3%), or emergency room visit (21.3% vs. 31.9%). In contrast, the control cohort had very little increase in utilization. The regression-adjusted incremental cost for osteoporosis-related expenses in the year after fracture was estimated at $4007 per patient. The estimated incremental cost was$5370 for the subset of patients who were eligible for Medicare.ConclusionThe economic burden of osteoporosis-related fractures on state Medicaid budgets is substantial

The Impact of Loneliness on Quality of Life and Patient Satisfaction Among Older, Sicker Adults

Objective: This study estimated prevalence rates of loneliness, identified characteristics associated with loneliness, and estimated the impact of loneliness on quality of life (QOL) and patient satisfaction. Method: Surveys were mailed to 15,500 adults eligible for care management programs. Loneliness was measured using the University of California Los Angeles (UCLA) three-item scale, and QOL using Veteran’s RAND 12-item (VR-12) survey. Patient satisfaction was measured on a 10-point scale. Propensity weighted multivariate regression models were utilized to determine characteristics associated with loneliness as well as the impact of loneliness on QOL and patient satisfaction. Results: Among survey respondents ( N = 3,765), 28% reported severe and 27% moderate loneliness. The strongest predictor of loneliness was depression. Physical and mental health components of QOL were significantly reduced by loneliness. Severe loneliness was associated with reduced patient satisfaction. Discussion: Almost 55% of these adults experienced loneliness, negatively affecting their QOL and satisfaction with medical services. Screening for loneliness may be warranted