Developing Alternative Methods for Determining the Incidence, Prevalence, and Cost Burden of Coronary Heart Disease in a Corporate Population

Medication Adherence and Incident Preventable Hospitalizations for Hypertension

INTRODUCTION

Potentially preventable hospitalizations (PPHs) for hypertension (HTN) is one indicator of possible failed ambulatory care. Rates of PPHs for HTN have remained fairly level since the late 1980s, which may reflect a lack of understanding of the drivers of these hospitalizations. Anti-HTN medication non-adherence has been studied as a potential risk factor for other cardiovascular disease outcomes but not for PPHs for HTN.

METHODS

A cohort analysis was conducted during 2005-2012 of people with HTN enrolled in commercial and employee health plans with claims in the MarketScan database. PPH for HTN was defined according to specifications published by the Agency for Healthcare Research and Quality. The proportion of days covered (PDC) algorithm was used to assess adherence to antihypertensives. Crude- and multivariate-adjusted incident PPHs for HTN rates were calculated, as well as third-party payments for selected PPH for HTN-related expenses.

RESULTS

During 9,344,528 person-years of follow-up (mean=3 years), 6,008 incident PPHs for HTN were identified among 3,099,291 people. The crude rate for good adherence (PDC ≥80%) was 23.2 per 100,000 person-years compared with 102.6 per 100,000 person-years for poor adherence (PDC <40%). Over the 8-year study, PPH for HTN-associated payments equaled $41 million. Payments for those with poor adherence were four times higher than for those with good adherence.

CONCLUSIONS

Poor anti-HTN medication adherence is strongly associated with PPHs for HTN. Improving the percentage of people who achieve good medication adherence is one possible approach to reducing the burden of PPHs for HTN in the U.S.

National prevalence of coronary heart disease and its relationship with human development index: A systematic review

BACKGROUND

Coronary heart disease has become a major health concern over the past several decades. Several reviews have assessed the effects of socioeconomic status on the coronary heart disease epidemic in communities and countries, but only a few reviews have been performed at a global level. This study was to explore the relationship between the prevalence of coronary heart disease and socioeconomic development worldwide using the Human Development Index.

DESIGN

Systematic review.

METHODS

The data in this study were collected from the MEDLINE database. Cross-sectional studies reporting the prevalence of coronary heart disease until November 2014 were collected. The Human Development Index was sourced from the United Nations Development Programme Database and was used to measure the socioeconomic achievements of countries. Each country was classified as a developing or developed country based on its level of development according to the Human Development Index value.

RESULTS

Based on the data analysis on the global level, coronary heart disease prevalence had no association with the national Human Development Index (rho = 0.07). However, there was a positive association between coronary heart disease prevalence and the national Human Development Index in developing countries, although a negative association existed in developed countries (rho = 0.47 and -0.34, respectively). In addition, the past decades have witnessed a growing coronary heart disease epidemic in developing countries, with reverse trends observed in developed countries (P = 0.021 and 0.002, respectively).

CONCLUSIONS

With the development of socioeconomic status, as measured by the Human Development Index, the prevalence of coronary heart disease is growing in developing countries, while declining in developed countries. Future research needs to pay more attention to the reasonable allocation of medical resources and control of coronary heart disease risk factors.

A data mining approach for grouping and analyzing trajectories of care using claim data: the example of breast cancer

Background

With the increasing burden of chronic diseases, analyzing and understanding trajectories of care is essential for efficient planning and fair allocation of resources. We propose an approach based on mining claim data to support the exploration of trajectories of care.

Methods

A clustering of trajectories of care for breast cancer was performed with Formal Concept Analysis. We exported Data from the French national casemix system, covering all inpatient admissions in the country. Patients admitted for breast cancer surgery in 2009 were selected and their trajectory of care was recomposed with all hospitalizations occuring within one year after surgery. The main diagnoses of hospitalizations were used to produce morbidity profiles. Cumulative hospital costs were computed for each profile.

Results

57,552 patients were automatically grouped into 19 classes. The resulting profiles were clinically meaningful and economically relevant. The mean cost per trajectory was 9,600€. Severe conditions were generally associated with higher costs. The lowest costs (6,957€) were observed for patients with in situ carcinoma of the breast, the highest for patients hospitalized for palliative care (26,139€).

Conclusions

Formal Concept Analysis can be applied on claim data to produce an automatic classification of care trajectories. This flexible approach takes advantages of routinely collected data and can be used to setup cost-of-illness studies.