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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedBecker NV, Scott JW, Moniz MH
Association of chronic disease with patient financial outcomes among commercially insured adults.
This study examined the association between chronic disease and adverse financial outcomes. The authors used claims data for patients enrolled in a preferred provider organization in Michigan. Patients diagnosed with thirteen common chronic conditions (cancer, congestive heart failure, chronic kidney disease, dementia, depression and anxiety, diabetes, hypertension, ischemic heart disease, liver disease, chronic obstructive pulmonary disease and asthma, serious mental illness, stroke, and substance use disorders) were included in the cohort of 2,854,481 adults aged 21 and over. The cohort included 61.4% with no chronic conditions, 17.7% with 1 chronic condition, 14.8% with 2 to 3 chronic conditions, 5.4% with 4 to 6 chronic conditions, and 0.7% with 7 to 13 chronic conditions. Among the cohort, 9.6% had medical debt in collections, 8.3% had nonmedical debt in collections, 16.3% had delinquent debt, 19.3% had a low credit score, and 0.6% had recent bankruptcy. For individuals with 0 vs 7 to 13 chronic conditions, the predicted probabilities of having any medical debt in collections (7.6% vs 32%), any nonmedical debt in collections (7.2% vs 24%), any delinquent debt (14% vs 43%), a low credit score (17% vs 47%) or recent bankruptcy (0.4% vs 1.7%) were all considerably higher for individuals with more chronic conditions and increased with each added chronic condition. Among individuals with medical debt in collections, the estimated amount increased with the number of chronic conditions ($784 for individuals with 0 conditions vs $1252 for individuals with 7-13 conditions).
AHRQ-funded; HS028672.
Citation: Becker NV, Scott JW, Moniz MH .
Association of chronic disease with patient financial outcomes among commercially insured adults.
JAMA Intern Med 2022 Oct;182(10):1044-51. doi: 10.1001/jamainternmed.2022.3687..
Keywords: Chronic Conditions, Healthcare Costs, Cancer, Kidney Disease and Health
Wu A, Ugiliweneza B, Wang D
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
This study investigates differences in palliative care (PC) timing on outcomes for patients with glioblastoma (GBM) using Surveillance, Epidemiology, and End Results (SEER) Medicare data. Findings showed that, despite an overall increase in PC consultations, only a minority of GBM patients receive PC. Patients with late PC had the longest survival times and had greater hospice use in the last month of life compared to other subgroups.
AHRQ-funded; HS028747.
Citation: Wu A, Ugiliweneza B, Wang D .
Trends and outcomes of early and late palliative care consultation for adult patients with glioblastoma: a seer-Medicare retrospective study.
Neurooncol Pract 2022 Aug;9(4):299-309. doi: 10.1093/nop/npac026.
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Keywords: Palliative Care, Cancer, Quality of Life, Healthcare Costs
Jazowski SA, Wilson L, Dusetzina SB
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
The purpose of this study was to evaluate the relationship between High-deductible health plan (HDHP) enrollment with out-of-pocket spending and uptake of and adherence to lenalidomide anti-cancer therapy. The researchers found that among the highest spenders (95th percentile), HDHP enrollees paid $376 and $217 more for their first and any lenalidomide prescription fill, respectively, compared with non-HDHP enrollees in the 6 months after initiation. High-deductible health plan enrollment was also associated with an increased risk of paying more than $100 for the initial lenalidomide prescription fill. The study concluded that enrollment in HDHP was associated with higher out-of-pocket spending per lenalidomide prescription fill; however, no statistically significant differences in adherence patterns between HDHP and non-HDHP enrollees were observed.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Wilson L, Dusetzina SB .
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
JAMA Netw Open 2022 Jun;5(6):e2215720. doi: 10.1001/jamanetworkopen.2022.15720..
Keywords: Health Insurance, Healthcare Costs, Cancer
Saulsberry L, Liao C, Huo D
Hypofractionated radiation therapy for breast cancer: financial risk and expenditures in the United States, 2008 to 2017.
This study examined the costs of hypofractionated whole breast irradiation (HF-WBI) compared with conventional whole breast irradiation (CF-WBI) and investigated the influences of patient characteristics and commercial insurance on HF-WBI use. This retrospective study used private employer-sponsored insurance claims to obtain a pooled cross-sectional evaluation of radiation therapy in patients with commercial insurance from 2008 to 2017. The study population included female patients with early-stage breast cancer treated with lumpectomy and whole breast irradiation. A total of 15,869 women received HF-WBI, and 59,328 CF-WBI. A higher proportion of college graduates and greater mixed racial composition was associated with increased HF-WBI use. Mean insurer-paid radiation therapy expenditures were significantly lower for HB-WBI versus CF-WBI (adjusted difference $6375). Mean patient out-of-pocket expenditures for HF-WBI was $139 less than for CF-WBI. Geographic variation existed across the United States with no consistent relationship between HF-WBI use and correspondent average cost differences.
AHRQ-funded; HS025806.
Citation: Saulsberry L, Liao C, Huo D .
Hypofractionated radiation therapy for breast cancer: financial risk and expenditures in the United States, 2008 to 2017.
Int J Radiat Oncol Biol Phys 2022 Mar;112(3):654-62. doi: 10.1016/j.ijrobp.2021.10.005..
Keywords: Cancer: Breast Cancer, Cancer, Healthcare Costs, Women
Fendrick AM, Dalton VK, Tilea A
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
The objective of this study was to describe out-of-pocket costs for colposcopy and related services among age-appropriate, commercially insured women from 2006 to 2019. Findings suggested that out-of-pocket costs for colposcopy were very common and significant and have increased over time. Reported out-of-pocket costs for cervical cancer screening-related care, such as office visits, were not included, thus the findings may underestimate patients’ total financial burden.
AHRQ-funded; HS025465.
Citation: Fendrick AM, Dalton VK, Tilea A .
Out-of-pocket costs for colposcopy among commercially insured women from 2006 to 2019.
Obstet Gynecol 2022 Jan;139(1):113-15. doi: 10.1097/aog.0000000000004582..
Keywords: Healthcare Costs, Colonoscopy, Screening, Cancer: Cervical Cancer, Cancer, Prevention, Women
Parikh DA, Ragavan M, Dutta R
Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems.
The financial toxicity of cancer care is a source of significant distress for patients with cancer. The purpose of this study is to understand factors associated with financial toxicity in three distinct care systems. The investigators concluded that low AHI, high OOPCs, and employment changes contributed to financial toxicity; however, there were variations based on site of care.
AHRQ-funded; HS026128.
Citation: Parikh DA, Ragavan M, Dutta R .
Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems.
JCO Oncol Pract 2021 Oct;17(10):e1450-e59. doi: 10.1200/op.20.00890..
Keywords: Cancer, Healthcare Costs
Herb JN, Ollila DW, Stitzenberg KB
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
This study looked at the utility of sentinel lymph node biopsy (SLNB) for non-ulcerated T1b melanoma. The aim of the study was to estimate SLNB use, positivity, prevalence, and procedural costs in patients with non-ulcerated T1b melanoma using a population-based registry. Patients with clinically node-negative, non-ulcerated T1b melanoma were identified in the SEER database from 2010 to 2016. Among 7245 included patients, 53% underwent SLNB of which 156 (4.1%) had a positive SLNB. Higher odds of positivity were associated with younger age, >1 mitosis per mm2, female sex, and truncal tumor location. Estimated SLNB costs to identify one patient with Stage II disease was $71,700. Out-of-pocket expenses for a Medicare patient was estimated to be $652 for a wide local excision (WLE) and SLNB and $79 for WLE alone.
AHRQ-funded; HS000032.
Citation: Herb JN, Ollila DW, Stitzenberg KB .
Use and costs of sentinel lymph node biopsy in non-ulcerated T1b melanoma: analysis of a population-based registry.
Ann Surg Oncol 2021 Jul;28(7):3470-78. doi: 10.1245/s10434-021-09998-6..
Keywords: Cancer: Skin Cancer, Cancer, Surgery, Healthcare Costs, Skin Conditions
Medbery RL, Fernandez FG, Kosinski AS
Costs associated with lobectomy for lung cancer: an analysis merging STS and Medicare data.
Researchers sought to identify underlying case mix factors that contribute to variability of 90-day costs of lobectomy for early-stage lung cancer. Using the Society of Thoracic Surgeons General Thoracic Surgery Database, they found that lobectomy is associated with substantial variability of episode-of-care costs. Variability is driven by patient demographic and clinical factors, hospital characteristics, and the occurrence and severity of complications.
AHRQ-funded; R01 HS022279.
Citation: Medbery RL, Fernandez FG, Kosinski AS .
Costs associated with lobectomy for lung cancer: an analysis merging STS and Medicare data.
Ann Thorac Surg 2021 Jun;111(6):1781-90. doi: 10.1016/j.athoracsur.2020.08.073..
Keywords: Cancer: Lung Cancer, Cancer, Healthcare Costs, Surgery, Elderly, Medicare
Cowper PA, Feng L, Kosinski AS
Initial and longitudinal cost of surgical resection for lung cancer.
This study looked at the 4-year longitudinal cost of surgical resection of non-small cell lung cancer (NSCLC). The study describes initial and 4-year resource use and cost for NSCLC patients aged 65 years of age or older who were treated surgically from 2008 to 2013. Clinical data for NSCLC resections from The Society of Thoracic Surgery Database linked to Medicare claims, resource use and cost of preoperative staging, surgery, and subsequent care through 4 years were examined. Outcomes were stratified by pathologic stage and surgical approach for stage I lobectomy patients. In the first 90 days costs ranged from $12,430 for stage I to $26,350 for stage IV. Cumulative costs ranged from $131,032 for stage I to $205,368 for stage IV. For the stage I lobectomy cohort, patients who had minimally invasive procedures had lower 4-year costs than thoracotomy patients ($120,346 versus $136,250).
AHRQ-funded; R01 HS022279.
Citation: Cowper PA, Feng L, Kosinski AS .
Initial and longitudinal cost of surgical resection for lung cancer.
Ann Thorac Surg 2021 Jun;111(6):1827-33. doi: 10.1016/j.athoracsur.2020.07.048..
Keywords: Cancer: Lung Cancer, Cancer, Surgery, Healthcare Costs
Stone BV, Laviana AA, Luckenbaugh AN
Patient-reported financial toxicity associated with contemporary treatment for localized prostate cancer.
Contemporary treatment modalities for localized prostate cancer provide comparable overall and cancer-specific survival. However, the degree of financial burden imposed by treatment, the factors contributing to that burden, and how different treatments compare with regard to financial toxicity remain poorly understood. The investigators sought to explore these factors. They concluded that external beam radiotherapy was associated with the highest financial burden, even when controlling for age, education and income.
AHRQ-funded; HS019356; HS022640.
Citation: Stone BV, Laviana AA, Luckenbaugh AN .
Patient-reported financial toxicity associated with contemporary treatment for localized prostate cancer.
J Urol 2021 Mar;205(3):761-68. doi: 10.1097/ju.0000000000001423..
Keywords: Cancer: Prostate Cancer, Cancer, Healthcare Costs
Diaz A, Chhabra KR, Dimick JB
Variations in surgical spending within hospital systems for complex cancer surgery.
Researchers sought to measure variations in episode spending within and across hospital systems among Medicare beneficiaries undergoing complex cancer surgery. They found wide variations in surgical episode spending both within and across hospital systems. They recommended that system leaders seek better understanding of variations in practices among their hospitals to standardize care and reduce variations in outcomes, use, and costs.
AHRQ-funded; HS024763.
Citation: Diaz A, Chhabra KR, Dimick JB .
Variations in surgical spending within hospital systems for complex cancer surgery.
Cancer 2021 Feb 15;127(4):586-97. doi: 10.1002/cncr.33299..
Keywords: Surgery, Cancer, Healthcare Costs, Health Systems, Hospitals
Geynisman DM, Chien CR, Smieliauskas F
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
The researchers performed a comprehensive literature review of cost and cost-effectiveness research on therapeutic cancer vaccines and monoclonal antibodies, to better understand the economic impacts of these treatments. They discussed the implications surrounding the economic factors involved in cancer immunotherapies and suggested that further research on cost and cost-effectiveness of newer cancer vaccines and immunotherapies were warranted as this is a rapidly growing field with many new drugs on the horizon.
AHRQ-funded; HS018535.
Citation: Geynisman DM, Chien CR, Smieliauskas F .
Economic evaluation of therapeutic cancer vaccines and immunotherapy: a systematic review.
Hum Vaccin Immunother 2014;10(11):3415-24. doi: 10.4161/hv.29407.
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Keywords: Cancer, Healthcare Costs, Vaccination
de Souza JA, Santana IA, de Castro Jr G
Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective.
This review aims to evaluate the current literature related to economic analyses of treatment modalities for squamous cell cancer of the head and neck. The variation in findings among the studies reviewed demonstrates the challenges of performing economic analyses in a disease that requires an evolving and complex multidisciplinary approach.
AHRQ-funded; HS018535
Citation: de Souza JA, Santana IA, de Castro Jr G .
Economic analyses in squamous cell carcinoma of the head and neck: a review of the literature from a clinical perspective.
Int J Radiat Oncol Biol Phys. 2014 Aug 1;89(5):989-96. doi: 10.1016/j.ijrobp.2014.03.040..
Keywords: Cancer, Healthcare Costs
Smieliauskas F, Chien CR, Shen C
Cost-effectiveness analyses of targeted oral anti-cancer drugs: a systematic review.
The researchers’ objective was to perform the first comprehensive review of cost-effectiveness analyses of targeted oral anti-cancer medications (OAMs). They concluded that in over half of the treatment settings in which a targeted OAM was compared with treatment that was not a targeted OAM, targeted OAMs were considered cost-effective.
AHRQ-funded; HS018535.
Citation: Smieliauskas F, Chien CR, Shen C .
Cost-effectiveness analyses of targeted oral anti-cancer drugs: a systematic review.
Pharmacoeconomics 2014 Jul;32(7):651-80. doi: 10.1007/s40273-014-0160-z..
Keywords: Cancer, Healthcare Costs, Medication
Ekwueme DU, Yabroff KR, Guy GP, Jr.
AHRQ Author: Soni A, Davidoff A
Medical costs and productivity losses of cancer survivors--United States, 2008-2011.
In order to estimate annual medical costs and productivity losses among male and female cancer survivors and persons without a cancer history, the CDC, along with other organizations, analyzed data from the 2008-2011 Medical Expenditure Panel Survey (MEPS) and found that the economic burden of cancer survivorship is substantial among all survivors. These findings identified a need to develop and evaluate health and employment intervention programs aimed at improving outcomes for cancer survivors and their families.
AHRQ-authored.
Citation: Ekwueme DU, Yabroff KR, Guy GP, Jr. .
Medical costs and productivity losses of cancer survivors--United States, 2008-2011.
MMWR Morb Mortal Wkly Rep 2014 Jun 13;63(23):505-10.
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Keywords: Cancer, Healthcare Costs, Medical Expenditure Panel Survey (MEPS)
Huo J, Lairson DR, Du XL
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
The authors analyzed the association of hospice use with survival and health care costs among patients diagnosed with metastatic melanoma. They found that the median survival time was 6.1 months for patients with no hospice care, 6.5 months for patients enrolled in hospice for 1 to 3 days, and 10.2 months for patients enrolled for 4 or more days. Patients with 4 or more days of hospice care incurred lower end-of-life costs than the comparison groups.
AHRQ-funded; HS018956.
Citation: Huo J, Lairson DR, Du XL .
Survival and cost-effectiveness of hospice care for metastatic melanoma patients.
Am J Manag Care 2014 May;20(5):366-73.
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Keywords: Cancer, Cancer: Skin Cancer, Healthcare Costs, Palliative Care, Patient-Centered Outcomes Research