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Kovács G, Abonyi-Tóth Z, Fadgyas-Freyler P, Kaló Z. Incremental cost of premature birth - a public health care payer perspective from Hungary. BMC Health Serv Res 2023; 23:686. [PMID: 37353814 DOI: 10.1186/s12913-023-09697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 06/13/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Preterm birth remains a significant burden to families, health systems and societies. The aim was to quantify the incremental prematurity-related public health expenditure in Hungary and to estimate the potential impact of a decrease in the prevalence of prematurity on the public payer's spending. METHODS Over a 6-year time horizon, public financing data of inpatient, outpatient and pharmaceutical care for children born at ≥ 25 weeks of gestation in 2009/2010 were retrieved from the Hungarian National Health Insurance Fund database. In descriptive analysis, the public payer's spending was given as cost/capita. The impact of a decrease in prematurity prevalence was specified as the total budget impact. An exchange rate of 294 Hungarian forint/Euro was applied. RESULTS A total of 93,124 children (including 8.6% who were premature babies) were included in the analysis. A strong negative relationship was shown between gestational age and per capita cost. The 6-year cost of care for the cohort born at 26 weeks of gestation (28,470 Euro per capita) was 24 times higher than that for the cohort born at 40 weeks. First-year inpatient spending accounted for the largest proportion of total health care spending across all gestational ages. All investigated prematurity complications (retinopathy of prematurity, necrotizing enterocolitis, bronchopulmonary dysplasia, intraventricular cerebral bleeding and leukomalacia) resulted in additional significant incremental spending. If 70% of pregnancies ending with preterm birth could be prolonged by 1 week, the savings would be almost 7.0 million Euros in the first 6 years of life. CONCLUSION This comprehensive analysis of prematurity-related health care spending confirmed that premature infants have much higher costs for care than those born at term in Hungary. These quantitative outcomes can provide essential inputs for the cost-effectiveness analysis of medical technologies and public health interventions that can decrease the prevalence of premature birth. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Gábor Kovács
- Doctoral School of Sociology, Eötvös Loránd University, Budapest, Hungary
- Syreon Research Institute, Budapest, Hungary
| | - Zsolt Abonyi-Tóth
- University of Veterinary Medicine, Budapest, Hungary
- RxTarget Ltd, Budapest, Hungary
| | | | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary.
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary.
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Horvitz-Lennon M, Volya R, Hollands S, Zelevinsky K, Mulcahy A, Donohue JM, Normand SLT. Factors Associated With Off-Label Utilization of Second-Generation Antipsychotics Among Publicly Insured Adults. Psychiatr Serv 2021; 72:1031-1039. [PMID: 34074139 PMCID: PMC8410611 DOI: 10.1176/appi.ps.202000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Off-label utilization of second-generation antipsychotic medications may expose patients to significant risks. The authors examined the prevalence, temporal trends, and factors associated with off-label utilization of second-generation antipsychotics among publicly insured adults. METHODS A retrospective repeated panel was used to examine monthly off-label utilization of second-generation antipsychotics among fee-for-service Medicare, Medicaid, and dually eligible White, Black, and Latino adult beneficiaries filling prescriptions for second-generation antipsychotics in California, Georgia, Mississippi, and Oklahoma from July 2008 through June 2013. RESULTS Among 301,367 users of second-generation antipsychotics, between 36.5% and 41.9% had utilization that was always off-label. Payer did not modify effects of race-ethnicity on off-label utilization. Compared with Whites, Blacks had lower monthly odds of off-label utilization in all four states, and Latinos had lower odds of utilization in California and Georgia. Payer was associated with off-label utilization in California, Mississippi, and Oklahoma. California Medicaid beneficiaries were 1.12 (95% confidence interval=1.10-1.13) times as likely as dually eligible beneficiaries to have off-label utilization. Off-label utilization increased relative to the baseline year in all states, but a downward trend followed in three states. CONCLUSIONS Off-label utilization of second-generation antipsychotics was prevalent despite the drugs' cardiometabolic risks and little evidence of their effectiveness. The lower likelihood of off-label utilization among patients from racial-ethnic minority groups might stem from prescribers' efforts to minimize risks, given a higher baseline risk for these groups, or from disparities-associated factors. Variation among payers suggests that payer policies can affect off-label utilization.
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Affiliation(s)
- Marcela Horvitz-Lennon
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Rita Volya
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Simon Hollands
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Katya Zelevinsky
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Andrew Mulcahy
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Julie M Donohue
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
| | - Sharon-Lise T Normand
- RAND Corporation, Boston (Horvitz-Lennon), Santa Monica, California (Hollands), and Washington, D.C. (Mulcahy); Institute for Health Care Policy, Massachusetts General Hospital, Boston (Volya); Department of Health Care Policy, Harvard Medical School, Boston (Zelevinsky, Normand); Department of Biostatistics, Harvard School of Public Health, Boston (Normand); Department of Health Policy and Management, University of Pittsburgh, Pittsburgh (Donohue)
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Horvitz-Lennon M, Volya R, Zelevinsky K, Shen M, Donohue JM, Mulcahy A, Normand SLT. Significance and Factors Associated with Antipsychotic Polypharmacy Utilization Among Publicly Insured US Adults. Adm Policy Ment Health 2021; 49:59-70. [PMID: 34009492 DOI: 10.1007/s10488-021-01141-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
Antipsychotic polypharmacy (APP) lacks evidence of effectiveness in the care of schizophrenia or other disorders for which antipsychotic drugs are indicated, also exposing patients to more risks. Authors assessed APP prevalence and APP association with beneficiary race/ethnicity and payer among publicly-insured adults regardless of diagnosis. Retrospective repeated panel study of fee-for-service (FFS) Medicare, Medicaid, and dually-eligible white, black, and Latino adults residing in California, Georgia, Iowa, Mississippi, Oklahoma, South Dakota, or West Virginia, filling antipsychotic prescriptions between July 2008 and June 2013. Primary outcome was any monthly APP utilization. Across states and payers, 11% to 21% of 397,533 antipsychotic users and 12% to 19% of 9,396,741 person-months had some APP utilization. Less than 50% of person-months had a schizophrenia diagnosis and up to 19% had no diagnosed mental illness. Payer modified race/ethnicity effects on APP utilization only in CA; however, the odds of APP utilization remained lower for minorities than for whites. Elsewhere, the odds varied by race/ethnicity only in OK, with Latinos having lower odds than whites (odds ratio 0.76; 95% confidence interval 0.60-0.96). The odds of APP utilization varied by payer in several study states, with odds generally higher for Dual eligibles, although the differences were generally small; the odds also varied by year (lower at study end). APP was frequently utilized but mostly declined over time. APP utilization patterns varied across states, with no consistent association with race/ethnicity and small payer effects. Greater use of APP-reducing strategies are needed, particularly among non-schizophrenia populations.
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Affiliation(s)
- Marcela Horvitz-Lennon
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, USA.
- Cambridge Health Alliance, Cambridge, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Rita Volya
- Institute for Health Care Policy, Massachusetts General Hospital, Boston, MA, USA
| | - Katya Zelevinsky
- The Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Mimi Shen
- RAND Corporation, Santa Monica, CA, USA
| | - Julie M Donohue
- The Department of Health Policy and Management, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sharon-Lise T Normand
- The Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- The Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
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Cohen-Mekelburg S, Gold S, Schneider Y, Dennis M, Oromendia C, Yeo H, Michelassi F, Scherl E, Steinlauf A. Delays in Initiating Post-operative Prophylactic Biologic Therapy Are Common Among Crohn's Disease Patients. Dig Dis Sci 2019; 64:196-203. [PMID: 29876778 DOI: 10.1007/s10620-018-5159-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 05/31/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Studies have shown that prophylactic biologic therapy can reduce post-surgical Crohn's disease recurrence. AIMS We aimed to identify the frequency of delay and risk factors associated with a delay in the initiation of prophylactic post-surgical biologic therapy in high-risk patients. METHODS We performed a cohort study of Crohn's disease patients who underwent a bowel resection. We identified those at risk of recurrence and explored multiple characteristics for those with and without a delay post-operatively. RESULTS A total of 84 patients were included in our analysis of which 69.0% had a greater than 4-week delay and 56.0% a greater than 8-week delay in post-surgical biologic prophylaxis. Publicly insured patients had a 100% delay in post-surgical prophylaxis initiation (p = 0.039, p = 0.003 at 4 and 8 weeks, respectively). Patients on a biologic pre-surgery were less likely to have a delay (p < 0.001) in post-operative prophylaxis. Care at an inflammatory bowel disease (IBD) center was associated with timely therapy when considering a post-operative immunomodulator or biologic strategy. CONCLUSIONS There are a substantial number of delays in initiating post-operative prophylactic biologic therapy in high-risk patients. Identifying susceptible patients by insurance type or absence of pre-operative therapy can focus future improvement efforts. Additionally, consultation with IBD-specialized providers should be considered in peri-surgical IBD care.
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Affiliation(s)
- Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA.
| | - Stephanie Gold
- Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Yecheskel Schneider
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Madison Dennis
- Department of Medicine, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Clara Oromendia
- Division of Healthcare Policy and Research, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Heather Yeo
- Department of Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Fabrizio Michelassi
- Department of Surgery, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Ellen Scherl
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
| | - Adam Steinlauf
- Division of Gastroenterology and Hepatology, New York Presbyterian Weill Cornell Medical Center, New York, NY, 10021, USA
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