RESUMEN
OBJECTIVES: To evaluate the cost savings outcomes, from the payer's perspective, of deploying vibration-controlled transient elastography/controlled attenuation parameter (VCTE/CAP) machines for detecting and monitoring fatty liver disease (FLD). STUDY DESIGN: We modeled disease transitions and costs under the current observed pathway and under an alternative pathway in which VCTE/CAP devices are adopted. Marginal savings (or costs) due to implementing the device are derived by comparing the aggregate costs between the 2 pathways. Sources of potential savings are 2-fold. First, VCTE/CAP tests result in early identification of patients with FLD (the majority are currently undiagnosed), allowing for proactive intervention and behavior change to slow the progression of disease in these patients. Second, VCTE/CAP tests can reduce the aggregate volume of some current diagnosis methods, such as liver biopsy, imaging, and laboratory work. METHODS: Our model relied on administrative claims data consisting of 5 million commercial members and 3 million Medicare members to inform baseline statistics on disease prevalence, health care cost and utilization, and disease progression associated with different severities of liver disease. We consulted expert clinical opinion and medical literature to inform our assumptions related to device adoption and use. RESULTS: Scenario testing demonstrated positive net savings within 2 to 3 years after device deployment. Across a 5-year time span, we estimate net savings up to $2.64 per member per month (PMPM) for Medicare payers and up to $1.91 PMPM for commercial payers. CONCLUSIONS: We conclude that deploying VCTE/CAP devices is a financially advantageous solution to address the epidemic of FLD.
Asunto(s)
Diagnóstico por Imagen de Elasticidad , Anciano , Biopsia , Ahorro de Costo , Costos de la Atención en Salud , Humanos , Medicare , Estados UnidosRESUMEN
Although the Centers for Medicare & Medicaid Services has focused on Medicare hospital readmissions for select diagnoses through the Hospital Readmissions Reduction program, there is no similar initiative for employers, who account for the majority of the 48% of private health care spending in the United States. Readmissions are costly and it is estimated that as many as half of these may be preventable. This study analyzes a national claims database to understand post-discharge transitions and their cost in the working population. Within an employer-sponsored, commercially-insured population, this study found that 4% of members are hospitalized annually and drive 37% of population health care cost. Of these members, 17% undergo additional admissions in the year following discharge and drive approximately 67% of the cost of the admitted population. This study found that the post-discharge site of care transitions has significant implications for the cumulative cost of care. More than a third of patients discharged home will transition to higher cost settings over the course of a year. Mental health and substance abuse diagnoses add significantly to admission/readmission rates and costs. Prior research indicates that post-discharge interventions that activate and engage patients in self-management are beneficial in mitigating overall cost and readmissions.