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BACKGROUND: Investigations by the Competition and Markets Authority into the veterinary sector have highlighted the cost of veterinary care. This paper examines the changing attitudes of early career vets towards these costs. METHODS: Ninety-seven semi-structured interviews were held with 25 vets as part of a 2.5-year longitudinal study. An inductive approach to analysis was adopted with flexible thematic analysis being undertaken using NVivo 12. RESULTS: High veterinary care costs create a financial burden for clients and an emotional burden for vets. Vets felt unprepared to deal with restricted client budgets and were unsupported by their practices in relation to charging. When owners could not afford treatment, vets had fewer opportunities to perform procedures and practise their skills. Eventually, vets distanced themselves from their clients' circumstances to prioritise their own wellbeing and began to value their expertise and charge appropriately. LIMITATIONS: The small sample size and emphasis on graduates of UK universities limit the generalisability of the findings. CONCLUSION: This paper highlights the impact of veterinary care costs on early career vets' wellbeing, practice and learning opportunities and advocates a 'spectrum of care' approach to veterinary education. It also encourages practices to engage with vets regarding charging behaviours.
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BACKGROUND: Despite the substantial impact of depression on individuals and healthcare utilization, little is known about the specific relationship between depression severity and total cost of care (TCC). This study evaluates the association between depression symptom severity and TCC and how changes in severity affect TCC. METHODS: The analysis was conducted using insurance claims data and data from electronic health records between January 1, 2019 and December 31, 2020. Inclusion criteria comprised insured individuals with coverage during 2019 or 2020, aged one year or older, and identified as having depression in at least one year of the study. Depression symptom severity was assessed using the screening Identification and Stratification (IDS) framework and data available to the research team. The main outcome was TCC per member per month (PMPM) evaluated across the two-year period. RESULTS: Across 2019 and 2020, 744,854 members met inclusion criteria. A total of 369,460 members were studied across both years. Greater depression symptom severity was associated with higher TCC across both years. Unchanged severity was associated with limited change in TCC from 2019 to 2020. Decrease in depression symptoms was associated with an average $41 reduction in PMPM spend, whereas increase in depression symptom severity was associated with an average $608 increase. LIMITATIONS: Limitations include fragmented data, retrospective design that limits causality, and the IDS framework design. CONCLUSION: Changes in depression symptom severity were significantly associated with changes in TCC. Findings reveal financial and clinical opportunities associated with early identification and targeted management of depression.
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Aim: Chronic stroke walking impairment is associated with high healthcare resource utilization (HCRU) costs. InTandem™ is a neurorehabilitation system that autonomously delivers a rhythmic auditory stimulation (RAS)-based intervention for the at-home rehabilitation of walking impairment in adults in the chronic phase of stroke recovery. This study was conducted to estimate the budget impact of InTandem in comparison with currently available intervention strategies for improvement of gait/ambulation in individuals with chronic stroke walking impairment. Methods & materials: A budget impact analysis (BIA) for InTandem was conducted based on a 1-million-member US third-party payer perspective over a 1-year time horizon. Key inputs for the budget impact model were: costs for each intervention strategy (InTandem, physical therapy, self-directed walking and no treatment), HCRU costs for persons with chronic stroke and anticipated HCRU cost offsets due to improvements in gait/ambulatory status as measured by self-selected comfortable walking speed (based on functional ability). In addition to the reference case analysis, a sensitivity analysis was conducted. Results: Based on the reference case, introduction of InTandem was projected to result in overall cost savings of $439,954 in one year. Reduction of HCRU costs (-$2,411,778) resulting from improved walking speeds with InTandem offset an increase in intervention costs (+$1,971,824). Demonstrations of cost savings associated with InTandem were robust and were consistently evident in nearly all scenarios evaluated in the sensitivity analysis (e.g., with increased/decreased patient shares, increased HCRU cost or increased InTandem rental duration). Conclusion: The InTandem system is demonstrated to improve walking and ambulation in adults in the chronic phase of stroke recovery after a five-week intervention period. The BIA predicts that introduction of InTandem will be associated with overall cost savings to the payer.
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Purpose: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, inform policy, and generate support for research funding. Methods and Patients: Data on the burden of disease (ie, prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years [DALYs]), were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in Canadian dollars was calculated based on prior studies. Data are presented as either rates (per 100â 000) or counts with the associated uncertainty interval. Results: In 2019, plastic surgery related conditions in Canada had an overall age-standardized DALY rate of 556 per 100â 000 [463-664]. Of these conditions, breast cancer was responsible for approximately 50% of the overall burden of disease, with an age-standardized DALY rate of 268 per 100â 000 [244-294] followed by squamous cell carcinoma (66 per 100â 000 [45-94]) and thermal burns (61 per 100â 000 [46-82]). Age-standardized incidence rates were highest for cellulitis (2654 per 100â 000 [2502-2812]). Breast cancer had the highest age-standardized cost of care of all plastic surgery related diseases, at $5.1 billion, approximately half of the total age-standardized cost of $10.6 billion for included plastic surgery diseases. Conclusion: Plastic and reconstructive surgery related diseases, particularly breast cancer, thermal burns, and malignant melanoma, are responsible for a high burden of disease and significant cost to the Canadian healthcare system. These results will help guide national healthcare policy and should provide support to directing funding and research efforts toward impactful diseases facing the Canadian healthcare system.
Objectif: L'identification de la morbidité des maladies liées à la chirurgie plastique et reconstructrice au Canada fournira des données en temps opportun reposant sur la population, permettra de renseigner les politiques et générer un soutien pour le financement de la recherche. Méthodes et patients: Des données sur la morbidité des maladies (c.-à-d. prévalence, incidence, mortalité, années de vie perdues [YLL], années vécues avec une invalidité [YLD], et années de vie corrigées pour l'invalidité [AVCI ou DALY]) ont été extraites de l'outil de résultats sur la morbidité mondiale des maladies 2019 pour toutes les affections disponibles et pertinentes pour la chirurgie plastique. Le poids économique de la maladie en dollars canadiens (CAD) a été calculé sur la base d'études antérieures. Les données sont présentées sous forme de taux (pour 100 000) ou de nombres avec les intervalles d'incertitude (IdI) associés. Résultats: En 2019, les troubles liés à la chirurgie plastique au Canada avaient un taux d'AVCI global standardisé pour l'âge de 556 pour 100 000 (463-664). Parmi ces affections, le cancer du sein était responsable d'environ 50% du fardeau global de la maladie avec un taux d'AVCI standardisé pour l'âge de 268 pour 100 000 (244-294) suivi du cancer épidermoïde (carcinome à cellules squameuses) (66 pour 100 000 [45-94]) et des brûlures thermiques (61 pour 100 000 [46-82]). Les incidences standardisées pour l'âge étaient les plus élevées pour la cellulite (2 654 pour 100 000 [2 502-2 812]). Le cancer du sein avait le coût des traitements standardisé pour l'âge le plus élevé de toutes les maladies liées à la chirurgie plastique, avec 5,1 milliards de dollars, soit environ la moitié des dépenses totales standardisées pour l'âge de 10,6 milliards de dollars pour les maladies incluses liées à la chirurgie plastique. Conclusion: Les maladies liées à la chirurgie plastique et reconstructrive, et plus particulièrement le cancer du sein, les brûlures thermiques et le mélanome malin, sont responsables d'une importante morbidité et de coûts significatifs pour le système de santé canadien. Ces résultats aideront à guider la politique nationale de soins de santé et devraient fournir un soutien pour orienter le financement et les efforts de recherche vers des maladies ayant les plus grandes répercussions sur le système de soins de santé canadien. Mots-clés: chirurgie plastique, morbidité, années de vie corrigées pour l'invalidité, fardeau global de la maladie, coût des soins, morbidité de la maladie.
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BACKGROUND: Ovarian cancer is associated with delayed diagnosis and poor survival; thus, interest is high in identifying predictive and prognostic biomarkers and novel therapeutic agents. Although the costs of ovarian cancer care are likely to increase as newer, more effective, but more expensive treatment regimens become available, information on the current costs of care for ovarian cancer-across the care continuum from diagnosis to the end of life-are lacking. OBJECTIVE: This study aimed to estimate real-world mean and median costs of ovarian cancer care within the first 5 years after diagnosis by patients' phase of care, age, race/ethnicity, and geographic region. STUDY DESIGN: We performed a retrospective cohort study of ovarian cancer patients diagnosed between January 1, 2015 and December 31, 2020. We used claims data from Optum's de-identified Clinformatics® Data Mart database, which includes inpatient, outpatient, and prescription claims for commercial insurance and Medicare beneficiaries nationwide. Cost of ovarian cancer care were calculated for the start of care (ie, the first 6 months), continuing care (ie, period between the initial and end-of-life care), and end-of-life care (ie, the last 6 months) phases and reported in 2021 U.S. dollar amounts. Ovarian cancer care costs were stratified by age, race/ethnicity, and geographic region. Due to the skewed nature of cost data, the mean cost data were log-transformed for modelling. Ordinary least-squares regression was conducted on the log costs, adjusting for patient categorical age, race/ethnicity, and geographic region. RESULTS: A total of 7913 patients were included in the analysis. The mean cost per year for ovarian cancer care was >$200,000 during the start of care, between $26,000 and $88,000 during the continuing care phase, and >$129,000 during the end-of-life care phase. There were statistically significant associations between age and costs during each phase of care. Compared to younger patients, older patients incurred higher costs during the continuing care phase and lower costs during the end-of-life care phase. Geographic differences in the costs of ovarian cancer care were also noted regardless of the phase of care. There were no associations between cost and race/ethnicity in our cohort. CONCLUSIONS: Ovarian cancer care costs are substantial and vary by the phase of care, age category, and geographic region. As more effective but expensive treatment options for ovarian cancer become available with potential survival benefit, sustainable interventions to reduce the cost of care for ovarian cancer will be needed throughout the cancer care continuum.
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In addition to the clinical burden of trauma, the financial burden is an important aspect of care globally, especially for patients in low- and middle-income countries. The current retrospective review was done of data from January 2015 to December 2020 related to patients of oral maxillofacial trauma management in a tertiary care setting. Analysis of variance was used to determine the mean difference in the cost incurred depending upon the type of trauma and the number of bone plates used in fracture management. Pearson correlation was applied to explore any correlation involving patient age, aetiology and type of fracture, number of bone plates employed and the length of stay in the hospital. No statistically significant differences were noted in the cost among the different groups. The cost of care was significantly (p<0.001) correlated to the length of stay. Other variables, such as the type of fractures and the number of plates, had no significant impact (p>0.05).
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Tiempo de Internación , Traumatismos Maxilofaciales , Centros de Atención Terciaria , Humanos , Pakistán , Tiempo de Internación/estadística & datos numéricos , Tiempo de Internación/economía , Estudios Retrospectivos , Centros de Atención Terciaria/economía , Masculino , Femenino , Adulto , Persona de Mediana Edad , Traumatismos Maxilofaciales/economía , Traumatismos Maxilofaciales/terapia , Traumatismos Maxilofaciales/epidemiología , Adulto Joven , Adolescente , Placas Óseas/economía , Fracturas Mandibulares/economía , Fracturas Mandibulares/terapia , Fracturas Mandibulares/cirugía , Fijación Interna de Fracturas/economía , Fijación Interna de Fracturas/métodos , Anciano , Niño , Costos de la Atención en Salud/estadística & datos numéricos , Fracturas Maxilares/economía , Fracturas Maxilares/cirugía , Fracturas Maxilares/terapiaRESUMEN
OBJECTIVE: Previous studies of neurosurgical transfers indicate that substantial numbers of patients may not need to be transferred, suggesting an opportunity to provide more patient-centered care by treating patients in their communities, while probably saving thousands of dollars in transport and duplicative workup. This study of neurosurgical transfers, the largest to date, aimed to better characterize how often transfers were potentially avoidable and which patient factors might affect whether transfer is needed. METHODS: This was a retrospective cohort study of neurosurgical transfers to an urban, tertiary-care, level I trauma center between October 1, 2017, and October 1, 2022. Prior to data analysis, the authors devised criteria to differentiate necessary neurosurgical transfers from potentially avoidable ones. A transfer was considered necessary if 1) the patient went to the operating room within 12 hours of arrival at the emergency department (ED); 2) a neurological MRI study was conducted in the ED; 3) the patient was admitted to the ICU from the ED; or 4) the patient was admitted to either neurology or a surgical service (including neurosurgery). Transfers not meeting any of the above criteria were deemed potentially avoidable. Patient and clinical characteristics, including diagnostic groupings from Clinical Classification Software categories, were collected retrospectively via electronic health record data abstraction and stratified by whether the transfer was necessary or potentially avoidable. Statistical differences were assessed with a chi-square test. RESULTS: A total of 5113 neurosurgical transfers were included in the study, of which 1701 (33.3%) were classified as potentially avoidable. Four percent of all transferred patients went to the operating room within 12 hours of reaching the receiving ED, 23.4% were admitted to the ICU from the ED, 26.6% had a neurological MRI study performed in the ED, and 54.4% were admitted to a surgical service or to neurology. Potentially avoidable transfers had a higher proportion of traumatic brain injury, headache, and syncope (p < 0.0001), as well as of spondylopathies/spondyloarthropathies (p = 0.0402), whereas patients needing transfer had a higher proportion of acute hemorrhagic cerebrovascular disease and cerebral infarction (p < 0.0001). CONCLUSIONS: This study demonstrates that a large number of neurosurgical transfers can probably be treated in their home hospitals and highlights that the vast majority of patients transferred for neurosurgical conditions do not receive emergency neurosurgery. Further research is needed to better guide transferring and receiving facilities in reducing the burden of excessive transfers.
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BACKGROUNDS: Frequent hospitalization and the costs of hospitalization are the main burdens in China for patients with acute pancreatitis. Most admitted patients have mild disease conditions that do not require hospitalization. AIMS: Here, we compare some health and economic aspects of patients with mild acute pancreatitis who received nurse-led care at home visits against those who were hospitalized on follow-up. METHODS: Patients discharged from the hospital after treatment for mild acute pancreatitis received (NC cohort, n = 104) or did not receive (HN cohort, n = 141) regular home visits by nurses for treatment and care. Patients were rehospitalized by caregivers with or without help of nurse. RESULTS: Hospital readmission events occurred in both cohorts at a follow-up care time of 2 months. Compared with the time of discharge from the hospital, unwanted effects were higher in follow-up care in all patients (p < 0.001 for all). Patients in the NC cohort had less time to resolution of pain, less time to resumption of oral solid food intake, smaller number of patients with hospital readmissions, less average time of hospitalization, lower cost of care, and lower occurrence of unwanted effects than those of patients in the HN cohort during 2 months of follow-up care (p < 0.05 for all). CONCLUSIONS: Patients with mild acute pancreatitis who undergo treatment require nurse-led nontreatment intervention(s) for rehabilitation in follow-up. Nurse-led follow-up care at-home visits increase recovery, are beneficial and cost-effective, and decrease unwanted adverse effects in patients receiving treatment for mild acute pancreatitis. LEVEL OF EVIDENCE: IV. TECHNICAL EFFICACY: Stage 5.
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Visita Domiciliaria , Pancreatitis , Readmisión del Paciente , Humanos , Masculino , Femenino , Pancreatitis/enfermería , Pancreatitis/terapia , Pancreatitis/economía , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Readmisión del Paciente/estadística & datos numéricos , Visita Domiciliaria/economía , China/epidemiología , Enfermedad Aguda , Índice de Severidad de la Enfermedad , HospitalizaciónRESUMEN
Aim: Novel treatment options for relapsed/refractory diffuse large B-cell lymphoma include T-cell targeting therapies. Practice efficiency and cost are important for informed treatment decisions.Materials/methods: An institutional decision-maker cost model was developed for 6-month, 1-year and median cycles of treatment time horizons comparing practice efficiency and costs of epcoritamab vs glofitamab and axicabtagene ciloleucel (axi-cel).Results: Overall, epcoritamab required the shortest personnel and chair time, except over 1 year (second shortest chair time). Across all time horizons, epcoritamab was cost-saving vs axi-cel and had similar costs to glofitamab on a per-month basis.Conclusion: Epcoritamab reduced personnel and chair time. Additionally, epcoritamab was cost-saving vs axi-cel and had similar costs to glofitamab on a per-month basis.
There are new ways to treat diffuse large B-cell lymphoma, which is a type of cancer called lymphoma. When new treatments are available it is important to see if they take more or less time to give to patients and how much they cost versus other treatments. This study looked at three drugs used to treat diffuse large B-cell lymphoma, including epcoritamab, axi-cel and glofitamab. It estimated the time and cost with those treatments in patients who get them for 6 months, 1 year or for the most common length of time in the clinical trials. In most of the scenarios, epcoritamab had the least time needed for nurses or doctors and the least time needed for a patient to be in a chair in a clinic. When thinking about the cost per month, epcoritamab saved money versus axi-cel and was similar to glofitamab.
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Introduction: As the shortage of primary care providers widens nationwide, access to care utilizing non-physician providers is one strategy to ensure equitable access to care. This study aimed to compare community pharmacist-provided care for minor ailments to care provided at three traditional sites of care: primary care, urgent care, and emergency department, to determine if care provided by pharmacists improved access with comparable quality and reduced financial strain on the healthcare system. Methods: Pharmacy data was provided from 46 pharmacies and 175 pharmacists who participated across five pharmacy corporations over a 3-year period (2016-2019). Data for non-pharmacy sites of care was provided by a large health plan, matching episodes of care for conditions seen in the community pharmacy. Cost-of-care analysis was conducted using superiority study design and revisit data analysis was conducted using noninferiority study design. Results: Median cost-of-care across traditional sites of care was $277.78 higher than care provided at the pharmacies, showing superiority. Noninferiority was demonstrated for revisit care when the initial visit was conducted by a pharmacist compared to traditional sites. Discussion: The authors conclude community pharmacist-provided care for minor ailments improved cost-effective access for patients with comparable quality and reduced financial strains on the healthcare system.
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Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers.
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Aceptación de la Atención de Salud , Humanos , República de Corea/epidemiología , Estudios Transversales , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Anciano , Aceptación de la Atención de Salud/estadística & datos numéricos , Lesiones del Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/terapia , Adolescente , Síndrome de Abducción Dolorosa del Hombro/cirugía , Síndrome de Abducción Dolorosa del Hombro/terapia , Seguro de Salud/estadística & datos numéricosRESUMEN
Vertical integration of health systems-the common ownership of different aspects of the health care system-continues to occur at increasing rates in the United States. This systematic review synthesizes recent evidence examining the association between two types of vertical integration-hospital-physician (n = 43 studies) and hospital-post-acute care (PAC; n = 10 studies)-and cost, quality, and health services utilization. Hospital-physician integration is associated with higher health care costs, but the effect on quality and health services utilization remains unclear. The effect of hospital-PAC integration on these three outcomes is ambiguous, particularly when focusing on hospital-SNF integration. These findings should raise some concern among policymakers about the trajectory of affordable, high-quality health care in the presence of increasing hospital-physician vertical integration but perhaps not hospital-PAC integration.
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OBJECTIVE: To conduct a business case analysis for Department of Veterans Affairs (VA) program STRIDE (ASsisTed EaRly MobIlization for hospitalizeD older VEterans), which was designed to address immobility for hospitalized older adults. DATA SOURCES AND STUDY SETTING: This was a secondary analysis of primary data from a VA 8-hospital implementation trial conducted by the Function and Independence Quality Enhancement Research Initiative (QUERI). In partnership with VA operational partners, we estimated resources needed for program delivery in and out of the VA as well as national implementation facilitation in the VA. A scenario analysis using wage data from the Bureau of Labor Statistics informs implementation decisions outside the VA. STUDY DESIGN: This budget impact analysis compared delivery and implementation costs for two implementation strategies (Replicating Effective Programs [REP]+CONNECT and REP-only). To simulate national budget scenarios for implementation, we estimated the number of eligible hospitalizations nationally and varied key parameters (e.g., enrollment rates) to evaluate the impact of uncertainty. DATA COLLECTION: Personnel time and implementation outcomes were collected from hospitals (2017-2019). Hospital average daily census and wage data were estimated as of 2022 to improve relevance to future implementation. PRINCIPAL FINDINGS: Average implementation costs were $9450 for REP+CONNECT and $5622 for REP-only; average program delivery costs were less than $30 per participant in both VA and non-VA hospital settings. Number of walks had the most impact on delivery costs and ranged from 1 to 5 walks per participant. In sensitivity analyses, cost increased to $35 per participant if a physical therapist assistant conducts the walks. Among study hospitals, mean enrollment rates were higher among the REP+CONNECT hospitals (12%) than the REP-only hospitals (4%) and VA implementation costs ranged from $66 to $100 per enrolled. CONCLUSIONS: STRIDE is a low-cost intervention, and program participation has the biggest impact on the resources needed for delivering STRIDE. TRIAL REGISTRATION: ClinicalsTrials.gov NCT03300336. Prospectively registered on 3 October 2017.
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Federally Qualified Health Centers (FQHCs) are pivotal in delivering healthcare services to underserved populations in the United States. While the number of FQHCs and FQHC look-alikes has been increasing, intensifying competition, limited research has examined the cost implications associated with this growing competition among FQHCs. This study aims to fill the research gap by analyzing the relationship between the level of competition among FQHCs and the cost of care per patient. Understanding this relationship is crucial for managers and policymakers in deriving informed decisions related to the expansion of FQHCs. The study comprehensively analyzed data from FQHCs from 2016 to 2022. The analysis involved examining the cost per patient in relation to the level of FQHC competition, measured by FQHC saturation in the area. The study's findings reveal a positive association between FQHC competition and the cost of care. Specifically, FQHCs in areas with higher levels of FQHC competition reported a higher cost per patient. This relationship underscores the potential financial dynamics influenced by the competitive environment among FQHCs. The results of this study have important implications for healthcare management and policy formulation. FQHC managers are suggested to consider the cost implications of increased competition in their strategic planning and operations. Meanwhile, policymakers should consider the potential cost ramifications of FQHC competition when designing and implementing policies related to FQHC expansion, especially those aimed at optimizing resource allocation and ensuring care affordability. Recognizing the impact of competition on cost can lead to more informed decisions regarding the funding, establishment, and distribution of FQHCs, ultimately contributing to the sustainability and efficacy of healthcare services in underserved areas.
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Competencia Económica , Humanos , Estados Unidos , Proveedores de Redes de Seguridad/economía , Costos de la Atención en Salud/estadística & datos numéricosRESUMEN
Intensive care unit (ICU) care is expensive for patients and providers, and utilization and spending on ICU resources have increased. The No Surprises Act, passed in 2022, specifically prohibits balance billing by ICU specialists (intensivists) for emergency and most non-emergency care. The potential economic impact of this remains unclear, given few data exist on the magnitude of balance billing in the ICU. Using the MarketScan Commercial (IBM) database, we studied hospitalizations in which ICU care was provided ("ICU hospitalizations") between 2010 and 2019. Hospitalizations were characterized as fully in-network, fully out-of-network, or "mixed" (contained both in- and out-of-network services). The share of "mixed" hospitalizations among all ICU hospitalizations rose from 26% to 33% over the study period. Over half of these mixed hospitalizations contained out-of-network services specifically delivered within the ICU. Total hospitalization spending averaged $81 047, with ICU spending averaging $15 799. On average, 11% of ICU spending within these hospitalizations was out-of-network. Patients were plausibly balance-billed in approximately one-third of ICU hospitalizations, for thousands of dollars per hospitalization. Given that the No Surprises Act prevents this type of balance billing, the portended revenue loss may lead to changes in provider negotiations with insurers concerning network status and prices, which could affect the care patients receive.
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AIMS: To describe healthcare resource utilization (HRU) and costs of patients with metastatic castration-sensitive prostate cancer (mCSPC). METHODS: Linked data from Flatiron Metastatic PC Core Registry and Komodo's Healthcare Map were evaluated (01/2016-12/2021). Patients with chart-confirmed diagnoses for metastatic PC without confirmed castration resistance in Flatiron who initiated androgen deprivation therapy (ADT) monotherapy or advanced therapy for mCSPC in 2017 or later (index date) with a corresponding pharmacy or medical claim in Komodo Health were included. Advanced therapies considered were androgen-receptor signaling inhibitors, chemotherapies, estrogens, immunotherapies, poly ADP-ribose polymerase inhibitors, and radiopharmaceuticals. Patients with <12 months of continuous insurance eligibility before index were excluded. Per-patient-per-month (PPPM) all-cause and PC-related HRU and costs (medical and pharmacy; from a payer's perspective in 2022 $USD) were described in the 12-month baseline period and follow-up period (from the index date to castration resistance, end of continuous insurance eligibility, end of data availability, or death). RESULTS: Of 871 patients included (mean age: 70.6 years), 52% initiated ADT monotherapy as their index treatment without documented advanced therapy use. During baseline, 31% of patients had a PC-related inpatient admission and 94% had a PC-related outpatient visit; mean all-cause costs were $2551 PPPM and PC-related costs were $839 PPPM with $787 PPPM attributable to medical costs. Patients had a mean follow-up of 15 months, during which 38% had a PC-related inpatient admission and 98% had a PC-related outpatient visit; mean all-cause costs were $5950 PPPM with PC-related total costs of $4363 PPPM, including medical costs of $2012 PPPM. LIMITATIONS: All analyses were descriptive; statistical testing was not performed. Treatment effectiveness and clinical outcomes were not assessed. CONCLUSION: This real-world study demonstrated a significant economic burden in mCSPC patients, and a propensity to use ADT monotherapy in clinical practice despite the availability and guideline recommendations of advanced life-prolonging therapies.
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Antagonistas de Andrógenos , Neoplasias de la Próstata , Masculino , Humanos , Estados Unidos , Anciano , Antagonistas de Andrógenos/uso terapéutico , Andrógenos , Estrés Financiero , Estudios Retrospectivos , Neoplasias de la Próstata/tratamiento farmacológico , Castración , Costos de la Atención en SaludRESUMEN
BACKGROUND: Alcohol use disorder (AUD) is the most common substance use disorder and is characterized by heavy alcohol use and the inability to control drinking. This study sought to compare the rate, timing, length, and total costs of hospital readmissions among cancer survivors with and without AUD. METHODS: We used the Nationwide Readmissions Database in 2017 and 2018 in this cohort study. Cancer survivors with an AUD diagnosis during their index hospitalization were included in the exposure group. Propensity score matching was used to identify cancer survivors without AUD for the control group. The primary outcome was all-cause readmission, and secondary outcomes included days to, length of, and total cost of readmission. Outcomes were measured after 90 and 180 days of follow-up. Logistic regression was used to measure the likelihood of readmission, and negative binomial regression and gamma regression were used for the other outcomes. RESULTS: Of 485,962 cancer survivors, 13,953 (2.9%) had co-occurring AUD. Cancer survivors with AUD had slightly higher odds of 90-day (odds ratio, 1.14; 95% CI, 1.06-1.22) and 180-day (odds ratio, 1.11; 95% CI, 1.05-1.18) readmission compared with those without AUD. Cancer survivors with AUD who were readmitted after 90 days also had higher readmission costs ($3,785 vs $3,376; P=.03). No differences in time to and length of readmission were observed between groups. The odds of readmission were higher among cancer survivors with AUD irrespective of age and type of cancer. Male, but not female, cancer survivors with AUD were more likely than those without AUD to be readmitted in both follow-up periods. CONCLUSIONS: This population-based cohort study of cancer survivors in the United States found that AUD is associated with higher 90- and 180-day readmission rates and higher related health care costs after 90 days of follow-up. Hospitalized cancer survivors with AUD may benefit from addiction treatment and discharge planning that addresses their co-occurring AUD.
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Alcoholismo , Supervivientes de Cáncer , Neoplasias , Humanos , Masculino , Estados Unidos/epidemiología , Readmisión del Paciente , Estudios de Cohortes , Alcoholismo/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Neoplasias/complicaciones , Neoplasias/epidemiología , Neoplasias/terapiaRESUMEN
PURPOSE: Financial toxicity is a source of significant distress for patients with urologic cancers, yet few studies have addressed financial burden in this patient population. METHODS: We developed a financial toxicity screening program using a lay health worker (LHW) and social worker (SW) to assess and mitigate financial toxicity in a single academic medical clinic. As part of a quality improvement project, the LHW screened all newly diagnosed patients with advanced stages of prostate, kidney, or urothelial cancer for financial burden using three COST tool questions and referred patients who had significant financial burden to an SW who provided personalized recommendations. The primary outcome was feasibility defined as 80% of patients with financial burden completing the SW consult. Secondary outcomes were patient satisfaction, change in COST Tool responses, and qualitative assessment of financial resources utilized. RESULTS: The LHW screened a total of 185 patients for financial toxicity; 82% (n = 152) were male, 65% (n = 120) White, and 75% (n = 139) reported annual household income >$100,000 US Dollars; 60% (n = 114) had prostate cancer. A total of 18 (9.7%) participants screened positive for significant financial burden and were referred to the SW for consultation. All participants (100%) completed and reported satisfaction with the SW consultation and had 0.83 mean lower scores on the COST Tool post-intervention assessment compared to pre-intervention (95% confidence interval [0.26, 1.41]). CONCLUSION: This multidisciplinary financial toxicity intervention using an LHW and SW was feasible, acceptable, and associated with reduced financial burden among patients with advanced stages of urologic cancers. Future work should evaluate the effect of this intervention among cancer patients in diverse settings.
Asunto(s)
Neoplasias de la Próstata , Neoplasias Urológicas , Humanos , Masculino , Estrés Financiero , Personal de Salud , Derivación y ConsultaRESUMEN
BACKGROUND: Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non-LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost-coping behaviors such as crowdfunding is understudied. METHODS: We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community-engaged and technology-based methods. Crowdfunding campaigns were web-scraped from GoFundMe and classified as cancer-related and LGBTQ+ or non-LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy. RESULTS: A total of N = 188,342 active cancer-related crowdfunding campaigns were web-scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019-2022), LGBTQ+ campaigns raised $1608 (95% CI: -2139, -1077) less than non-LGBTQ+ campaigns. LGBTQ+ campaigns with low (26-45 donors), moderate (46-87 donors), and high (88-240 donors) online reach raised on average $1152 (95% CI: -$1589, -$716), $1050 (95% CI: -$1737, -$364), and $2655 (95% CI: -$4312, -$998) less than non-LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti-LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: -2640, -1182) less than non-LGBTQ+ campaigns from the same states. CONCLUSIONS AND RELEVANCE: Our findings revealed LGBTQ+ inequity in cancer-related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non-LGBTQ+ cancer survivors-potentially widening existing economic inequities.