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Wang Y, Zhang P, Shao H, Andes LJ, Imperatore G. Medical Costs Associated With Diabetes Complications in Medicare Beneficiaries Aged 65 Years or Older With Type 2 Diabetes. Diabetes Care 2022; 45:2570-2576. [PMID: 36102675 DOI: 10.2337/dc21-2151] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 08/15/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate medical costs associated with 17 major diabetes-related complications and treatment procedures among Medicare beneficiaries aged ≥65 years with type 2 diabetes. RESEARCH DESIGN AND METHODS Claims data from 100% of Medicare beneficiaries enrolled in fee-for-service plans from 2006 to 2017 were analyzed. Records with type 2 diabetes and complications were identified using ICD-9, ICD-10, and diagnosis-related group codes. The index year was the year when a person was first identified as having diabetes with an inpatient claim or an outpatient claim plus another inpatient/outpatient claim in the 2 years following the first claim in Medicare. Included individuals were followed from index years until death, discontinuation of plan coverage, or 31 December 2017. Fixed-effects regression was used to estimate the cost in years when the complication event occurred and in subsequent years. The total cost for each complication was calculated for 2017 by multiplying the complication prevalence by the cost estimate. All costs were standardized to 2017 U.S. dollars. RESULTS Our study included 10,982,900 beneficiaries with type 2 diabetes. Follow-up ranged from 3 to 10 years. The three costliest complications were kidney failure treated by transplant (occurring year $79,045, subsequent years $17,303), kidney failure treated by dialysis ($54,394, $38,670), and lower-extremity amputation ($38,982, $8,084). Congestive heart failure accounted for the largest share (18%) of total complication costs. CONCLUSIONS Costs associated with diabetes complications were substantial. Our cost estimates provide essential information needed for conducting economic evaluation of treatment and programs to prevent and delay diabetes complications in Medicare beneficiaries.
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Affiliation(s)
- Yu Wang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Hui Shao
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.,Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Linda J Andes
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Al-Jedai AH, Almudaiheem HY, Alissa DA, Al-Enazy HS, Korayem GB, Alghamdi A, Alghamdi S. Cost of cardiovascular diseases and renal complications in people with type 2 diabetes mellitus in the Kingdom of Saudi Arabia: A retrospective analysis of claims database. PLoS One 2022; 17:e0273836. [PMID: 36264903 PMCID: PMC9584438 DOI: 10.1371/journal.pone.0273836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/16/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The burden of macro- and microvascular complications in patients with Type 2 diabetes mellitus (T2DM) is substantial in Middle East countries. The current study assessed the healthcare resource utilization (HCRU) and costs related to cardiovascular and renal complications among patients with T2DM. METHODOLOGY This non-interventional, longitudinal, retrospective, cohort study collected secondary data from three insurance claims databases across Kingdom of Saudi Arabia (KSA) of patients diagnosed with T2DM. The study included adult patients aged ≥18 years diagnosed with first cardiovascular disease (CVD) during index time period and at least one T2DM claim anytime during the study time period. The primary analyses were conducted per database, stratified by three cohorts; patients with at least one claim every six months during the 1-year pre-index and 1-year post-index period (cohort 1), patients with at least one claim every six months during the 1-year pre-index, and two years post-index period (cohort 2) and patients with at least one claim every six months during the 1-year pre-index and 3-year post-index period (cohort 3). For each Payer database, demographics, CVD subgroups, HCRU, and costs were analysed. Descriptive statistics were used to analyse the data. RESULTS The study sample comprised of 72-78% male and 22-28% female T2DM patients with CVD and renal complications. Patients in the age group of 35-65 years or above contributed to the significant disease burden. Nearly 68 to 80% of T2DM patients developed one CVD event, and 19 to 31% of patients developed multiple CVD events during the follow-up period. For most patients with comorbid CVD and renal disease, the average HCRU cost for post‑index periods was higher compared to 1-year pre-index period across the different visit types and activities. CONCLUSION The study findings elucidates the need for early initiation of therapies that would reduce the long-term cardiovascular and renal outcomes and the associated costs in patients with T2DM.
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Affiliation(s)
- Ahmed Hamden Al-Jedai
- Therapeutic Affairs, Ministry of Health, Riyadh, Saudi Arabia
- Clinical Pharmacy, Colleges of Pharmacy and Medicine, Alfaisal University, Riyadh, Saudi Arabia
- * E-mail:
| | | | | | - Hadi Saeed Al-Enazy
- Department of Family Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Emergency Medicine and Resuscitation, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Simulation and Medical Education, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Wellness Institute, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Central Board for Accreditation of Healthcare Institutions, Riyadh, Saudi Arabia
- Council of Health Insurance, Riyadh, Saudi Arabia
- Family Medicine Scientific Committee, The Saudi Commission for Health Specialities, Riyadh, Saudi Arabia
- Eastern Province Office, Saudi Society of Family Medicine, Riyadh, Saudi Arabia
| | - Ghazwa B. Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ahlam Alghamdi
- Princess Nourah University, Riyadh, Saudi Arabia
- Pharmaceutical Care Services, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Shabab Alghamdi
- Council of Cooperative Health Insurance, Riyadh, Saudi Arabia
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He X, Zhang Y, Zhou Y, Dong C, Wu J. Direct Medical Costs of Incident Complications in Patients Newly Diagnosed With Type 2 Diabetes in China. Diabetes Ther 2021; 12:275-288. [PMID: 33206365 PMCID: PMC7843809 DOI: 10.1007/s13300-020-00967-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/04/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Reliable country-specific incidence and cost data on diabetes-related complications are essential inputs for the projections of the economic burden of diabetes. The aim of this study was to provide patient-level cost estimates of managing and treating complications in patients newly diagnosed with type 2 diabetes mellitus (T2DM) in China. METHODS Patients newly diagnosed with T2DM in the Tianjin Urban Employee Basic Medical Insurance Claims database between 2008 and 2015 were identified and followed up. The cumulative incidence and descriptive costs of certain macrovascular and microvascular complications were examined. A generalized estimating equations model was used to estimate the immediate- and long-term costs for the incident complication in quarterly intervals, controlling for demographics and the confounding effects of comorbid complications. RESULTS A total of 114,847 newly diagnosed patients were identified (mean age 56.9 years, 45.5% women). After 7 years, 80.8% of the patients at risk had developed nephropathy and 75.7% had developed neuropathy. The immediate additional costs were highest for myocardial infarction during the quarterly interval that the complication first occurred (China yuan [CNY] 19,633), and the long-term costs were highest for stroke in the quarterly intervals of subsequent years (CNY 1087). The expected costs for all complications were calculated and presented as costs per quarterly interval and per year for different age and sex subgroups. CONCLUSIONS Managing complications results in substantial costs to the Chinese healthcare system. Our study contributes towards quantifying the economic burden and supports the parametrization of economic models of diabetes in China.
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Affiliation(s)
- Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Yawen Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Yan Zhou
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China.
- College of Management and Economics, Tianjin University, Tianjin, China.
| | - Chaohui Dong
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Yang W, Cintina I, Hoerger T, Neuwahl SJ, Shao H, Laxy M, Zhang P. Estimating costs of diabetes complications in people <65 years in the U.S. using panel data. J Diabetes Complications 2020; 34:107735. [PMID: 32962890 DOI: 10.1016/j.jdiacomp.2020.107735] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 11/17/2022]
Abstract
AIMS To estimate the cost of diabetes complications in the United States (U.S.). METHODS We constructed longitudinal panel data using one of the largest claims databases in the U.S. for privately insured Type 1 (T1DM) and type 2 (T2DM) diabetes patients with a follow-up time of one to ten years. Complication costs were estimated both in years of the first occurrence and in subsequent years, using individual fixed-effects models. All costs were in 2016 dollars. RESULTS 47,166 people with T1DM and 608,237 with T2DM were included in our study. Aside from organ transplants, which were rare, the estimated average costs for the top three most costly conditions in the first vs. subsequent years were: end stage renal disease ($73,534 vs. $97,431 for T1DM; $94,231 vs. $98,981 for T2DM), congestive heart failure ($41,681 vs. $14,855 for T1DM; $31,202 vs. $7062 for T2DM), and myocardial infarction ($40,899 vs. $9496 for T1DM; $45,251 vs. $8572 for T2DM). For both diabetes types, retinopathy and neuropathy tend to have the lowest cost estimates. CONCLUSIONS Our study provides the latest and most comprehensive cost estimates for a broad set of diabetes complications needed to evaluate the long-term cost-effectiveness of interventions for preventing and managing diabetes.
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Affiliation(s)
- Wenya Yang
- The Lewin Group, 3160 Fairview Park Drive #600, Falls Church, VA 22042, USA.
| | - Inna Cintina
- The Lewin Group, 3160 Fairview Park Drive #600, Falls Church, VA 22042, USA.
| | - Thomas Hoerger
- RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709-2194, USA.
| | - Simon J Neuwahl
- RTI International, 2987 Clairmont Rd, Atlanta, GA 30345, USA.
| | - Hui Shao
- College of Pharmacy, Department of Pharmaceutical Outcomes & Policy, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Center of Diabetes Research, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany.
| | - Ping Zhang
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA.
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Zhu YY, Yang ZY, Li P, Huang XY, Zhang XH, Ji LN, Tang JL. Comparing the incidence of major cardiovascular events and severe microvascular complications in patients with type 2 diabetes mellitus: A systematic review and meta-analysis. World J Meta-Anal 2020; 8:400-410. [DOI: 10.13105/wjma.v8.i5.400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) causes both macrovascular and microvascular complications. However, currently, selection of glycemic measures and their thresholds to diagnose T2DM, and efficacy outcomes in evaluation of anti-diabetic drugs is predominantly informed by the relation of T2DM to microvascular complications. We can be severely mistaken on T2DM by neglecting macrovascular complications which are generally more severe, if they also occur more commonly than microvascular complications.
AIM To compare the incidence of major cardiovascular events (MACEs) and severe microvascular complications (SMICs) in T2DM patients.
METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from inception to September 2017. Cohort studies or trials of T2DM patients aged 18 years or older that reported incidence of both MACEs and SMICs were included. MACEs were defined as nonfatal myocardial infarction and stroke, and cardiovascular death, while SMICs included serious retinopathy, nephropathy and diabetic disorder. The relative risk (RR) was estimated as the incidence of MACEs divided by that of SMICs in same patients and combined with meta-analysis in a random-effect model.
RESULTS Twelve studies with a total of 16 cohorts and 387376 patients were included, and the combined RR was 2.02 (95%CI: 1.46–2.79). The higher incidence of MACEs remained in various subgroup and sensitivity analyses.
CONCLUSION Patients with T2DM are much more likely to develop MACEs than SMICs. By taking more serious consequences and relatively higher incidence into consideration, macrovascular complications deserve more emphasis in developing the diagnostic criteria of T2DM and in evaluating the efficacy of anti-diabetic drugs.
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Affiliation(s)
- Ying-Ying Zhu
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zu-Yao Yang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Ping Li
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xin-Ying Huang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Xue-Hong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, United States
| | - Li-Nong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Centre, Beijing 100044, China
| | - Jin-Ling Tang
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Wang J, Shi L. Prediction of medical expenditures of diagnosed diabetics and the assessment of its related factors using a random forest model, MEPS 2000-2015. Int J Qual Health Care 2020; 32:99-112. [PMID: 32159759 DOI: 10.1093/intqhc/mzz135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/14/2019] [Accepted: 12/18/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To predict the medical expenditures of individual diabetics and assess the related factors of it. DESIGN AND SETTING Cross-sectional study. SETTING AND PARTICIPANTS Data were collected from the US household component of the medical expenditure panel survey, 2000-2015. MAIN OUTCOME MEASURE Random forest (RF) model was performed with the programs of randomForest in R software. Spearman correlation coefficients (rs), mean absolute error (MAE) and mean-related error (MRE) was computed to assess the prediction of all the models. RESULTS Total medical expenditure was increased from $105 Billion in 2000 to $318 Billion in 2015. rs, MAE and MRE between the predicted and actual values of medical expenditures in RF model were 0.644, $0.363 and 0.043%. Top one factor in prediction was being treated by the insulin, followed by type of insurance, employment status, age and economical level. The latter four variables had no impact in predicting of medical expenditure by being treated by the insulin. Further, after the sub-analysis of gender and age-groups, the evaluating indicators of prediction were almost identical to each other. Top five variables of total medical expenditure among male were same as those among all the diabetics. Expenses for doctor visits, hospital stay and drugs were also predicted with RF model well. Treatment with insulin was the top one factor of total medical expenditure among female, 18-, 25- and 65-age-groups. Additionally, it indicated that RF model was little superior to traditional regression model. CONCLUSIONS RF model could be used in prediction of medical expenditure of diabetics and assessment of its related factors well.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Meishan road, Shushan district, Hefei city,230032, P.R. China
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-1999, USA
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-1999, USA
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Ferrara G, Arnheim-Dahlström L, Bartley K, Janson C, Kirchgässler KU, Levine A, Sköld CM. Epidemiology of Pulmonary Fibrosis: A Cohort Study Using Healthcare Data in Sweden. Pulm Ther 2019; 5:55-68. [PMID: 32026424 PMCID: PMC6967025 DOI: 10.1007/s41030-019-0087-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Indexed: 02/04/2023] Open
Abstract
Introduction Data on the epidemiology of idiopathic pulmonary fibrosis (IPF) in Sweden are lacking. This study estimates the incidence and prevalence of IPF in Sweden, and describes the demographic and clinical characteristics and the overall survival of patients with IPF. Methods Two cohorts were studied: a national cohort of 17,247 patients with pulmonary fibrosis (ICD-10 code J84.1 with no competing diagnosis) from the Swedish National Patient Register (cohort 1 [C1]); and an electronic medical record-based regional subset of C1 comprising 1755 patients having pulmonary fibrosis and a radiology procedure (C2). Results The incidence of pulmonary fibrosis in C1 ranged from 10.4 to 15.4 cases per 100,000 population per year between 2001 and 2015. The prevalence increased from 15.4 to 68.0 cases per 100,000 population per year. Patients ≥ 70 years and men had a higher incidence and prevalence of pulmonary fibrosis. Common comorbidities included respiratory infections and cardiovascular disorders. Approximately one-third of patients in each cohort were hospitalised with pulmonary fibrosis within a year of diagnosis. The median survival time from disease diagnosis was 2.6 years in C1 and 5.2 years in C2. Older patients had a higher risk of hospitalisation and mortality. Women had a better prognosis than men. Conclusion This study underscores the importance of pulmonary fibrosis as a cause of respiratory-related morbidity and mortality in Sweden. The stable incidence and increasing prevalence over time suggests longer survival. The higher morbidity and mortality in older patients highlights the importance of early case detection, diagnosis and management for better prognosis. Funding F. Hoffmann-La Roche, Ltd./Genentech, Inc. Electronic supplementary material The online version of this article (10.1007/s41030-019-0087-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Giovanni Ferrara
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lisen Arnheim-Dahlström
- IQVIA, Solna, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | | | | | - C Magnus Sköld
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden. .,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Einarson TR, Acs A, Ludwig C, Panton UH. Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:881-890. [PMID: 30005761 DOI: 10.1016/j.jval.2017.12.019] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) constitute major comorbidities in type 2 diabetes mellitus (T2DM), contributing substantially to treatment costs for T2DM. An updated overview of the economic burden of CVD in T2DM has not been presented to date. OBJECTIVE To systematically review published articles describing the costs associated with treating CVD in people with T2DM. METHODS Two reviewers searched MEDLINE, Embase, and abstracts from scientific meetings to identify original research published between 2007 and 2017, with no restrictions on language. Studies reporting direct costs at either a macro level (e.g., burden of illness for a country) or a micro level (e.g., cost incurred by one patient) were included. Extracted costs were inflated to 2016 values using local consumer price indexes, converted into US dollars, and presented as cost per patient per year. RESULTS Of 81 identified articles, 24 were accepted for analysis, of which 14 were full articles and 10 abstracts. Cardiovascular comorbidities in patients with T2DM incurred a significant burden at both the population and patient levels. From a population level, CVD costs contributed between 20% and 49% of the total direct costs of treating T2DM. The median annual costs per patient for CVD, coronary artery disease, heart failure, and stroke were, respectively, 112%, 107%, 59%, and 322% higher compared with those for T2DM patients without CVD. On average, treating patients with CVD and T2DM resulted in a cost increase ranging from $3418 to $9705 compared with treating patients with T2DM alone. CONCLUSIONS Globally, CVD has a substantial impact on direct medical costs of T2DM at both the patient and population levels.
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Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Fukuda H, Ikeda S, Shiroiwa T, Fukuda T. The Effects of Diagnostic Definitions in Claims Data on Healthcare Cost Estimates: Evidence from a Large-Scale Panel Data Analysis of Diabetes Care in Japan. PHARMACOECONOMICS 2016; 34:1005-1014. [PMID: 27016372 DOI: 10.1007/s40273-016-0402-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Inaccurate estimates of diabetes-related healthcare costs can undermine the efficiency of resource allocation for diabetes care. The quantification of these costs using claims data may be affected by the method for defining diagnoses. OBJECTIVES The aims were to use panel data analysis to estimate diabetes-related healthcare costs and to comparatively evaluate the effects of diagnostic definitions on cost estimates. RESEARCH DESIGN Monthly panel data analysis of Japanese claims data. SUBJECTS The study included a maximum of 141,673 patients with type 2 diabetes who received treatment between 2005 and 2013. MEASURES Additional healthcare costs associated with diabetes and diabetes-related complications were estimated for various diagnostic definition methods using fixed-effects panel data regression models. RESULTS The average follow-up period per patient ranged from 49.4 to 52.3 months. The number of patients identified as having type 2 diabetes varied widely among the diagnostic definition methods, ranging from 14,743 patients to 141,673 patients. The fixed-effects models showed that the additional costs per patient per month associated with diabetes ranged from US$180 [95 % confidence interval (CI) 178-181] to US$223 (95 % CI 221-224). When the diagnostic definition excluded rule-out diagnoses, the diabetes-related complications associated with higher additional healthcare costs were ischemic heart disease with surgery (US$13,595; 95 % CI 13,568-13,622), neuropathy/extremity disease with surgery (US$4594; 95 % CI 3979-5208), and diabetic nephropathy with dialysis (US$3689; 95 % CI 3667-3711). CONCLUSIONS Diabetes-related healthcare costs are sensitive to diagnostic definition methods. Determining appropriate diagnostic definitions can further advance healthcare cost research for diabetes and its applications in healthcare policies.
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Affiliation(s)
- Haruhisa Fukuda
- Department of Health Care Administration and Management, Kyushu University Graduate School of Medical Sciences, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Shunya Ikeda
- School of Pharmacy, International University of Health and Welfare, 2600-1, Kitakanemaru, Ōtawara, Tochigi, 324-8501, Japan
| | - Takeru Shiroiwa
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6, Minami, Wako, Saitama, 351-0197, Japan
| | - Takashi Fukuda
- Department of Health and Welfare Services, National Institute of Public Health, 2-3-6, Minami, Wako, Saitama, 351-0197, Japan
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Nicholson G, Gandra SR, Halbert RJ, Richhariya A, Nordyke RJ. Patient-level costs of major cardiovascular conditions: a review of the international literature. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:495-506. [PMID: 27703385 PMCID: PMC5036826 DOI: 10.2147/ceor.s89331] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events. METHODS MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values. RESULTS Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union. CONCLUSION This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.
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Johnston SS, Sheehan JJ, Shah M, Cappell K, Princic N, Smith D, Kalsekar I. Cardiovascular event costs in patients with Type 2 diabetes mellitus. J Med Econ 2015; 18:1032-40. [PMID: 26189723 DOI: 10.3111/13696998.2015.1074078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To quantify the cost of acute major adverse cardiac events (MACE; myocardial infarction [MI] and stroke) stratified by cardiovascular disease (CVD) risk factors in commercially, Medicare Supplemental-, and Medicaid-insured patients with type 2 diabetes mellitus (T2DM). METHODS US administrative claims data were used to identify patients with T2DM aged ≥18 and continuously enrolled with insurance benefits from July 1, 2009-June 30, 2010 (baseline). Patients were classified into three baseline CVD risk groups (highest, medium, and lowest) and followed from July 1, 2010 until 1 year or censoring (follow-up) to measure per-patient per-month (PPPM) all-cause healthcare costs. Multivariable regression compared costs between patients with/without MACE during follow-up. Patients with MACE were further followed for up to 1 year after initial event to quantify longitudinal event costs. RESULTS Sample comprised 1,415,598 T2DM patients. Over average follow-up ranging from 301-343 days across CVD risk groups, 10,399 patients experienced MACE. Expected multivariable-adjusted mean PPPM costs of MACE per 100 covered patients within each CVD risk group varied by payer and generally increased with CVD risk (range = $1555 in lowest-risk commercially insured patients to $18,727 in highest-risk Medicaid-insured patients). Longitudinal costs of MACE were lowest among Medicare Supplemental-insured patients with stroke ($22,657 initial event, $2488 PPPM up-to 1-year follow-up care) and highest among Medicaid-insured patients with MI ($41,505 initial event, $4799 PPPM up to 1-year follow-up care). CONCLUSIONS These results illustrate the potential clinical and economic importance of considering patients' CVD risk and medications' cardiovascular safety profile when treating T2DM patients.
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Affiliation(s)
| | | | - Manan Shah
- c c Bristol-Myers Squibb , Plainsboro , NJ , USA
| | | | | | - David Smith
- d d Truven Health Analytics , Ann Arbor , MI , USA
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Whitlock R, Healey JS, Connolly SJ, Wang J, Danter MR, Tu JV, Novick R, Fremes S, Teoh K, Khera V, Yusuf S. Predictors of early and late stroke following cardiac surgery. CMAJ 2014; 186:905-11. [PMID: 25047983 DOI: 10.1503/cmaj.131214] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Much is known about the short-term risks of stroke following cardiac surgery. We examined the rate and predictors of long-term stroke in a cohort of patients who underwent cardiac surgery. METHODS We obtained linked data for patients who underwent cardiac surgery in the province of Ontario between 1996 and 2006. We analyzed the incidence of stroke and death up to 2 years postoperatively. RESULTS Of 108,711 patients, 1.8% (95% confidence interval [CI] 1.7%-1.9%) had a stroke perioperatively, and 3.6% (95% CI 3.5%-3.7%) had a stroke within the ensuing 2 years. The strongest predictors of both early and late stroke were advanced age (≥ 65 year; adjusted hazard ratio [HR] for all stroke 1.9, 95% CI 1.8-2.0), a history of stroke or transient ischemic attack (adjusted HR 2.1, 95% CI 1.9-2.3), peripheral vascular disease (adjusted HR 1.6, 95% CI 1.5-1.7), combined coronary bypass grafting and valve surgery (adjusted HR 1.7, 95% CI 1.5-1.8) and valve surgery alone (adjusted HR 1.4, 95% CI 1.2-1.5). Preoperative need for dialysis (adjusted odds ratio [OR] 2.1, 95% CI 1.6-2.8) and new-onset postoperative atrial fibrillation (adjusted OR 1.5, 95% CI 1.3-1.6) were predictors of only early stroke. A CHADS2 score of 2 or higher was associated with an increased risk of stroke or death compared with a score of 0 or 1 (19.9% v. 9.3% among patients with a history of atrial fibrillation, 16.8% v. 7.8% among those with new-onset postoperative atrial fibrillation and 14.8% v. 5.8% among those without this condition). INTERPRETATION Patients who had cardiac surgery were at highest risk of stroke in the early postoperative period and had continued risk over the ensuing 2 years, with similar risk factors over these periods. New-onset postoperative atrial fibrillation was a predictor of only early stroke. The CHADS2 score predicted stroke risk among patients with and without atrial fibrillation.
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Affiliation(s)
- Richard Whitlock
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Jeff S Healey
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Stuart J Connolly
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Julie Wang
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Matthew R Danter
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Jack V Tu
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Richard Novick
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont.
| | - Stephen Fremes
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Kevin Teoh
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Vikas Khera
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
| | - Salim Yusuf
- Population Health Research Institute and McMaster University (Whitlock, Healey, Connolly, Teoh, Khera, Yusuf), Hamilton, Ont.; Sunnybrook Schulich Heart Centre (Tu, Fremes), University of Toronto, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Wang, Tu), Toronto, Ont.; Vanderbilt University (Danter), Nashville, Tenn.; London Health Sciences Centre (Novick), London, Ont
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Brennan VK, Colosia AD, Copley-Merriman C, Mauskopf J, Hass B, Palencia R. Incremental costs associated with myocardial infarction and stroke in patients with type 2 diabetes mellitus: an overview for economic modeling. J Med Econ 2014; 17:469-80. [PMID: 24773097 DOI: 10.3111/13696998.2014.915847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To identify cost estimates related to myocardial infarction (MI) or stroke in patients with type 2 diabetes mellitus (T2DM) for use in economic models. METHODS A systematic literature review was conducted. Electronic databases and conference abstracts were screened against inclusion criteria, which included studies performed in patients who had T2DM before experiencing an MI or stroke. Primary cost studies and economic models were included. Costs were converted to 2012 pounds sterling. RESULTS Fifty-four studies were identified: 13 primary cost studies and 41 economic evaluations using secondary sources for complication costs. Primary studies provided costs from 10 countries. Estimates for a fatal event ranged from £2482-£5222 for MI and from £4900-£6694 for stroke. Costs for the year a non-fatal event occurred ranged from £5071-£29,249 for MI and from £5171-£38,732 for stroke. Annual follow-up costs ranged from £945-£1616 for an MI and from £4704-£12,926 for a stroke. Economic evaluations from 12 countries were identified, and costs of complications showed similar variability to the primary studies. DISCUSSION The costs identified within primary studies varied between and within countries. Many studies used costs estimated in studies not specific to patients with T2DM. Data gaps included a detailed breakdown of resource use, which affected the ability to compare data across countries. CONCLUSIONS In the development of economic models for patients with T2DM, the use of accurate estimates of costs associated with MI and stroke is important. When country-specific costs are not available, clear justification for the choice of estimates should be provided.
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de Vries FM, Denig P, Visser ST, Hak E, Postma MJ. Cost-effectiveness of statins for primary prevention in patients newly diagnosed with type 2 diabetes in the Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2014; 17:223-230. [PMID: 24636380 DOI: 10.1016/j.jval.2013.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 11/14/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Statins are lipid-lowering drugs that reduce the risk of cardiovascular events in patients with diabetes. OBJECTIVES The objective of this study was to determine whether statin treatment for primary prevention in newly diagnosed type 2 diabetes is cost-effective, taking nonadherence, baseline risk, and age into account. METHODS A cost-effectiveness analysis was performed by using a Markov model with a time horizon of 10 years. The baseline 10-year cardiovascular risk was estimated in a Dutch population of primary prevention patients with newly diagnosed diabetes from the Groningen Initiative to Analyse Type 2 Diabetes Treatment (GIANTT) database, using the United Kingdom Prospective Diabetes Study risk engine. Statin adherence was measured as pill days covered in the IADB.nl pharmacy research database. Cost-effectiveness was measured in costs per quality-adjusted life-year (QALY) from the health care payers' perspective. RESULTS For an average patient aged 60 years, the base case, statin treatment was highly cost-effective at €2245 per QALY. Favorable cost-effectiveness was robust in sensitivity analysis. Differences in age and 10-year cardiovascular risk showed large differences in cost-effectiveness from almost €100,000 per QALY to almost being cost saving. Treating all patients younger than 45 years at diabetes diagnosis was not cost-effective (weighted cost-effectiveness of almost €60,000 per QALY). CONCLUSIONS Despite the nonadherence levels observed in actual practice, statin treatment is cost-effective for primary prevention in patients newly diagnosed with type 2 diabetes. Because of large differences in cost-effectiveness according to different risk and age groups, the efficiency of the treatment could be increased by targeting patients with relatively higher cardiovascular risk and higher ages.
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Affiliation(s)
- Folgerdiena M de Vries
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands.
| | - Petra Denig
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sipke T Visser
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), University of Groningen, Groningen, The Netherlands
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Stålhammar J, Stern L, Linder R, Sherman S, Parikh R, Ariely R, Deschaseaux C, Wikström G. The burden of preserved ejection fraction heart failure in a real-world Swedish patient population. J Med Econ 2014; 17:43-51. [PMID: 24066839 DOI: 10.3111/13696998.2013.848808] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate resource use and associated costs in patients with a diagnosis of heart failure with preserved ejection fraction (HF-PEF) in Sweden. METHODS This retrospective study identified real-world patients with an ICD-10 diagnosis code for heart failure (I50) for the period between July 1, 2005 and December 31, 2006 from electronic medical records of primary care centers in Uppsala County Council, and in the Swedish patient registry data. Patients were categorized as having HF-PEF (left ventricle ejection fraction [LVEF] > 50%) during the index period. The study assessed medication utilization, outpatient visits, hospitalizations, and associated healthcare costs, as well as the incidence rates and time to all-cause and heart failure mortality following the index period. RESULTS The study included 137 HF-PEF patients with a mean age of 77.1 (SD = 9.1) years. Over 50% of HF-PEF patients were female and hypertensive. Nearly all patients received ≥ 1 medication post-index. Patients had an average of 1.5 heart failure related hospitalizations per follow-up year. The average annual per patient cost for the management of a HF-PEF patient was found in Sweden to be Swedish Krona (SEK) 108,246 (EURO [EUR] 11,344). Hospitalizations contributed to more than 80% of the total cost. All-cause mortality over the 18-month study period was 25.5%, and more than 50% of these deaths occurred within 1 year of index. LIMITATIONS Due to the limitations of registry data, it is not possible to confirm the HF diagnosis, and therefore the accuracy of registry records must be assumed. Other factors such as short follow-up time, the study-mandated LVEF assessment, and a lack of drug duration data may also have an impact on the study results. CONCLUSIONS All-cause mortality was high in the HF-PEF population, with more than half of patients dying within 1 year of study follow-up. Study results also indicate that 60% of HF-PEF patients have ≥ 1 hospitalization during follow-up. Hospitalizations, especially heart failure related admissions, represent a substantial proportion of the total healthcare burden of patients with HF-PEF in Sweden.
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Geue C, Lewsey J, Lorgelly P, Govan L, Hart C, Briggs A. Spoilt for choice: implications of using alternative methods of costing hospital episode statistics. HEALTH ECONOMICS 2012; 21:1201-16. [PMID: 21905152 DOI: 10.1002/hec.1785] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 05/13/2011] [Accepted: 07/05/2011] [Indexed: 05/12/2023]
Abstract
In the absence of a 'gold standard' to estimate the economic burden of disease, a decision about the most appropriate costing method is required. Researchers have employed various methods to cost hospital stays, including per diem or diagnosis-related group (DRG)-based costs. Alternative methods differ in data collection and costing methodology. Using data from Scotland as an illustrative example, costing methods are compared, highlighting the wider implications for other countries with a publicly financed healthcare system. Five methods are compared using longitudinal data including baseline survey data (Midspan) linked to acute hospital admissions. Cost variables are derived using two forms of DRG-type costs, costs per diem, costs per episode-using a novel approach that distinguishes between variable and fixed costs and incorporates individual length of stay (LOS), and costs per episode using national average LOS. Cost estimates are generated using generalised linear model regression. Descriptive analysis shows substantial variation between costing methods. Differences found in regression analyses highlight the magnitude of variation in cost estimates for subgroups of the sample population. This paper emphasises that any inference made from econometric modelling of costs, where the marginal effect of explanatory variables is assessed, is substantially influenced by the costing method.
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Affiliation(s)
- Claudia Geue
- Centre for Population and Health Sciences, University of Glasgow, Glasgow, Scotland.
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Martinell M, Stålhammar J, Hallqvist J. Automated data extraction--a feasible way to construct patient registers of primary care utilization. Ups J Med Sci 2012; 117:52-6. [PMID: 22335391 PMCID: PMC3282243 DOI: 10.3109/03009734.2011.653015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Electronic medical records (EMRs) enable analysis of health care data by using data mining techniques to build research databases. Though the reliability of the data extraction process is crucial for the credibility of the final analysis, there are few published validations of this process. In this paper we validate the performance of an automated data mining tool on EMR in a primary care setting. METHODS The Pygargus Customized eXtraction Program (CXP) was programmed to find and then extract data from patients meeting criteria for type 2 diabetes mellitus (T2DM) at one primary health care clinic (PHC). The ability of CXP to extract relevant cases was assessed by comparing cases extracted by an EMR integrated search engine. The concordance of extracted data with the original EMR source was manually controlled. RESULTS Prevalence of T2DM was 4.0%, which correspond well to previous estimations. By searching for drug prescriptions, diagnosis codes, and laboratory values, 38%, 53%, and 91% of relevant cases were found, respectively. The sensitivity of CXP regarding extraction of relevant cases was 100%. The specificity was 99.9% due to 12 non-T2DM cases extracted. The congruity at single-item level was 99.6%. The 13 incorrect data items were all located in the same structural module. CONCLUSION The CXP is a reliable and accurate data mining tool to extract selective data from EMR.
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Affiliation(s)
- Mats Martinell
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Box 564, SE 751 22, Uppsala, Sweden
| | - Jan Stålhammar
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Box 564, SE 751 22, Uppsala, Sweden
| | - Johan Hallqvist
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Box 564, SE 751 22, Uppsala, Sweden
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Stålhammar J, Stern L, Linder R, Sherman S, Parikh R, Ariely R, Wikström G. Resource utilization and cost of heart failure associated with reduced ejection fraction in Swedish patients. J Med Econ 2012; 15:938-46. [PMID: 22510016 DOI: 10.3111/13696998.2012.686464] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The purpose of this study was to assess healthcare utilization and costs for heart failure patients with reduced ejection fraction (HF-REF) in Sweden. METHODS AND RESULTS This was a retrospective, population-based cohort study of patients diagnosed with HF-REF during a period of 18 months at 31 primary care centers in Uppsala County, Sweden. Data was obtained from computerized records from these centers, the Swedish Patient Registry, the Swedish Prescription Registry, the Cause of Death Registry, and a local echocardiography registry maintained by the Department of Physiology, Uppsala University Hospital. Main outcome measures were cardiovascular and heart-failure-related hospitalizations, outpatient visits, medication utilization, mortality (all-cause, cardiovascular, and heart-failure), and healthcare costs for HF-REF patients. During the index period, 252 heart failure patients had a left ventricular ejection fraction measurement ≤ 40% and were categorized as having HF-REF. More than half of the patients had ≥ 1 cardiovascular or heart failure-related hospitalization. On average, patients had >2 such hospitalizations annually. They also averaged ∼1 cardiovascular or heart-failure-related outpatient visit per year. All-cause mortality was high: 15.9% patients died within 1 year after the index date. The mean annual cost per patient for heart-failure-related hospitalizations was SEK 72,613 (EUR 7610). In contrast, annual prescription costs were low, on average 3% of total cost (SEK 3503, EUR 367 per patient) LIMITATIONS The main limitations of this study include a short follow-up time and small sample size. Also, certain data were missing, such as echocardiograms (available for only 28% of patients), and information on patients' New York Heart Association (NYHA) functional class, validity period for prescriptions or the units of medication prescribed, and medication dosing. Furthermore, the overall mortality could have been under-estimated, as only the primary cause of death was included in the analysis. CONCLUSIONS The main burden associated with HF-REF is related to hospitalizations for heart-failure events. Effective treatment options that decrease hospitalization rates could reduce patients' suffering and potentially offer considerable cost savings.
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Affiliation(s)
- Jan Stålhammar
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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