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AHRQ Research Studies
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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 25 of 755 Research Studies Displayed
Ganguli I, Ying W, Shakley T
Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults.
The purpose of this study was to examine the impact of low-value imaging on cascade services and spending in commercially-insured adults with uncomplicated acute low back pain. The researchers analyzed medical claims from Blue Cross Blue Shield of Massachusetts members aged 18-50 years who received a 2018 diagnosis of uncomplicated low back pain, for which imaging was considered inappropriate according to the National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set (HEDIS) criteria. In 2018, 30,892 members were eligible for low-value imaging. Of these, 6009 (19.5%) received low-value imaging: 5091 (16.5%) X-ray and 787 (2.5%) MRI. The study found that when compared to patients without low-value imaging, those with low-value X-ray or MRI had higher adjusted probabilities of receiving cascade services and greater adjusted total spending at 3, 6, and 12 months. These results were robust to falsification testing. Members with high deductible health plans (HDHP) had higher narrowly defined cascade-associated out-of-pocket spending than those in other plans. The most common sources of narrowly defined cascade-associated spending were physical therapy, office visits, radiology studies, laboratory studies, and surgery.
J Gen Intern Med 2023 Mar;38(4):1102-05. doi: 10.1007/s11606-022-07829-2
Citation: Ganguli I, Ying W, Shakley T . Cascade services and spending following low-value imaging for uncomplicated low back pain among commercially insured adults. .
Keywords: Imaging, Back Health and Pain, Pain, Healthcare Costs
Dunbar PJ, Sobotka SA, Rodean J
Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions.
The impact of ear, nose, throat, and respiratory infections (ENTRIs) on children with complex chronic conditions (CCCs) may vary from that of their counterparts. The purpose of this study was to examine the prevalence and expenditure of ENTRIs in children with and without CCCs. A retrospective evaluation of 3,880,456 children aged 0-18 years enrolled in 9 US state Medicaid programs in 2018, as recorded in the IBM Watson Marketscan Database, was conducted. Feudtner's classification system was employed to identify the type and quantity of CCCs. The prevalence of ENTRIs, defined as one or more healthcare visits for ENTRIs, and Medicaid expenditure on ENTRIs were compared based on CCC status using chi-square tests and logistic regression. The study found that ENTRIs were more prevalent in children with CCCs than in those without. Children with a CCC represented approximately one-fourth ($145.8 million [US]) of the total ENTRI expenditure. Excluding throat and sinus infections, the prevalence of ENTRIs rose with the number of CCCs. For instance, the prevalence of lower-airway infections increased from 12.5% to 37.5% as the number of CCCs grew from zero to ≥3. Inpatient care-associated ENTRI expenditure rose from 9.7% to 92.8% as the number of CCCs increased from zero to ≥3.
Citation: Dunbar PJ, Sobotka SA, Rodean J . Prevalence of and spending on ear, nose, throat, and respiratory infections among children with chronic complex conditions. Acad Pediatr 2023 Mar;23(2):434-40. doi: 10.1016/j.acap.2022.07.004.
Keywords: Children/Adolescents, Respiratory Conditions, Chronic Conditions, Healthcare Costs
Kalata S, Howard R, Diaz A
Association of skilled nursing facility ownership by health care networks with utilization and spending.
The objective of this cross-sectional study was to determine the association of vertical integration of skilled nursing facilities (SNFs) within hospital networks with SNF utilization, readmissions, and spending. Claims data from Medicare beneficiaries aged 66 to 99 who had undergone elective hip replacement in nonfederal acute care hospitals during the study period was analyzed. Results showed that vertical SNF integration was associated with a higher rate of SNF utilization and a lower 30-day readmission rate; in spite of higher utilization, 30-day episode payments were slightly lower. Adjusted readmission rates were especially low for patients who were not sent to an SNF but were significantly higher for patients with a length of stay of less than 5 days. The authors concluded these findings support the value of integrating SNFs into hospital networks, but there is room for improvement in postoperative care early in the SNF patients’ stay.
Citation: Kalata S, Howard R, Diaz A . Association of skilled nursing facility ownership by health care networks with utilization and spending. JAMA Netw Open 2023 Feb; 6(2):e230140. doi: 10.1001/jamanetworkopen.2023.0140..
Keywords: Nursing Homes, Healthcare Utilization, Healthcare Costs, Medicare
Mullens CL, Mead M, Kalata S
Evaluation of prices for surgical procedures within and outside hospital networks in the US.
The authors conducted an economic evaluation to examine variations in prices for surgical procedures under the Hospital Price Transparency Rule at U.S. hospitals in and outside of networks. The results showed that median negotiated prices were significantly higher at hospitals within networks compared with independent hospitals for 15 of the 16 procedures evaluated. The authors noted that these results ought to be interpreted in the context of certain limitations and that it will be important to understand the mechanisms behind these variations in negotiated prices for surgical care in order to identify areas of unwarranted variation.
AHRQ-funded; HS028606; HS000053.
Citation: Mullens CL, Mead M, Kalata S . Evaluation of prices for surgical procedures within and outside hospital networks in the US. JAMA Netw Open 2023 Feb; 6(2):e2255849. doi: 10.1001/jamanetworkopen.2022.55849..
Keywords: Surgery, Healthcare Costs, Hospitals
Duan KI, Birger M, Au DH
Health care spending on respiratory diseases in the United States, 1996-2016.
The objectives of this study were to estimate health care spending in the U.S. for 11 respiratory conditions from 1996 to 2016, and to provide an evaluation of factors associated with spending growth and detailed trends. Data was taken from the Institute of Health Metrics and Evaluation's Disease Expenditure Project Database. The results showed that spending on respiratory conditions is high, particularly for chronic conditions like asthma and chronic obstructive pulmonary disease. The authors concluded that these findings suggest that service price and intensity should be a key focus for policymakers who seek to reduce health care spending growth.
Citation: Duan KI, Birger M, Au DH . Health care spending on respiratory diseases in the United States, 1996-2016. Am J Respir Crit Care Med 2023 Jan 15; 207(2):183-92. doi: 10.1164/rccm.202202-0294OC..
Keywords: Respiratory Conditions, Healthcare Costs, Asthma, Chronic Conditions
Encinosa W, Moon K, Figueroa J
AHRQ Author: Encinosa W
Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19.
This cross-sectional study’s goal was to determine outcomes from multisystem inflammatory syndrome in children (MIS-C) after COVID-19. Outcomes examined were 50 complications, adverse medication events, costs, and the Social Vulnerability Index. An analysis was conducted using data from the 2021 HCUP in individuals younger than 21 years from 31 states. There were 4107 individuals hospitalized with MIS-C (median age 9 years, 59.5% male, 38.1% White) and 23,686 hospitalizations for COVID-19 without MIS-C (median age 15 years, 54.5% female, 44.1% White). Hospitalization rate for MIS-C was 1.48 per 100,000 children, ranging from 0.97 hospitalizations per 100 for White and 1.99 hospitalizations per 100 for Black children. Outcomes were worse when organ dysfunction increased from 2 to 8 organs, with deaths increasing from less than 1% to 5.8% for MIS-C, and 1% to 17.2% for COVID-19. Median length of stay increased from 4 to 8 days for MIS-C, and 3 to 16 days for COVID-19. Median costs for MIS-C increased from $16,225 to $53 359 and from $6474 to $98,643 for COVID-19. The percentage of MIS-C cases in Black children doubled from 16.2% to 31.7% as organ dysfunction increased, remaining unchanged with COVID-19.
Citation: Encinosa W, Moon K, Figueroa J . Complications, adverse drug events, high costs, and disparities in multisystem inflammatory syndrome in children vs COVID-19. JAMA Netw Open 2023 Jan;6(1):e2244975. doi: 10.1001/jamanetworkopen.2022.44975..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, COVID-19, Medication, Adverse Drug Events (ADE), Adverse Events, Healthcare Costs, Disparities, Racial and Ethnic Minorities
Rao BR, Jung EH, Dickert NW
Getting cost discussions right: nudging patients to avoid cognitive pitfalls.
The purpose of this article was to discuss the challenges of high out-of-pocket medication costs and their negative impact on healthcare, patient behavior, and access to quality care. The authors report that integrating cost information into medical decisions can be a useful tool for improving patient outcomes, but there are several cognitive biases that can skew patients' decisions in different directions. The article emphasizes the need for using nudge strategies as a focused counterweight to address out-of-pocket costs and other complex medical decisions. The authors explain that nudges involving manipulations in framing and choice architecture can be harnessed to impact decisions in a predictable way without restricting options or changing economic incentives. The article suggests several nudge strategies that clinicians can employ to help patients make better decisions and avoid cognitive pitfalls in shared decision-making discussions related to out-of-pocket costs.
Citation: Rao BR, Jung EH, Dickert NW . Getting cost discussions right: nudging patients to avoid cognitive pitfalls. Circ Cardiovasc Qual Outcomes 2023 Jan; 16(1):e009447. doi: 10.1161/circoutcomes.122.009447..
Keywords: Healthcare Costs, Decision Making, Clinician-Patient Communication, Communication
Ko H, Martin BI, Nelson RE
How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care?
This article described differences in costs, quality, and patient selection between hospitals that continued to participate in the comprehensive Care for Joint Replacement (CJR) program after the CMS policy revision and those that withdrew from CJR before and after the implementation of CJR. Study subjects were Medicare beneficiaries who had undergone elective lower extremity joint replacement from 2013 to 2017. The results indicated that hospitals that continued to participate in CJR achieved a greater cost reduction. The authors noted that these the cost reductions were partly attributable to the avoidance of potential higher-cost patients.
Citation: Ko H, Martin BI, Nelson RE . How does the effect of the comprehensive Care for Joint Replacement model vary based on surgical volume and costs of care? Med Care 2023 Jan;61(1):20-26. doi: 10.1097/mlr.0000000000001785..
Keywords: Orthopedics, Surgery, Healthcare Costs, Medicare, Payment
Chang E, Ali R, Seibert J
Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis.
The authors of this article reviewed evidence on the effectiveness of complex interventions designed to change the healthcare of high-need, high-cost patients. They found limited evidence of intervention effectiveness in relation to cost and use, but note that additional evidence is needed to strengthen their confidence in these findings. Few studies reported clinical/functional or social risk factor outcomes or sufficient details for determining why individual interventions work. They conclude that future evaluations could provide additional insights in assessing the impact of complex interventions.
Citation: Chang E, Ali R, Seibert J . Interventions to improve outcomes for high-need, high-cost patients: a systematic review and meta-analysis. J Gen Intern Med 2023 Jan; 38(1):185-94. doi: 10.1007/s11606-022-07809-6..
Keywords: Healthcare Costs, Healthcare Delivery, Chronic Conditions, Healthcare Utilization
Nuckols TK, Dworsky M, Conlon C
The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: a prospective observational study.
The authors sought to examine whether quality of care for work-associated carpal tunnel syndrome (CTS) is associated with healthcare expenditures or disability. They examined workers' compensation claims for CTS and created patient-level aggregate quality scores for underuse and overuse of care. They concluded that improved quality of care might increase or lower short-term healthcare expenditures, depending on how often care is underused or overused. Future research is needed in varied workers' compensation contexts. Quality of care was not found to be associated with disability.
Citation: Nuckols TK, Dworsky M, Conlon C . The quality of occupational healthcare for carpal tunnel syndrome, healthcare expenditures, and disability outcomes: a prospective observational study. Muscle Nerve 2023 Jan;67(1):52-62. doi: 10.1002/mus.27718..
Keywords: Chronic Conditions, Healthcare Costs
Toseef MU, Durfee J, Podewils LJ
Total cost of care associated with opioid use disorder treatment.
Researchers conducted a retrospective study among adult patients diagnosed with opioid use disorder (OUD) and who had a clinical encounter at a safety-net institution in Denver in 2020 to investigate the association of medication for opioid use disorder (MOUD) treatment initiation and ongoing care on overall healthcare costs of Medicaid Fee-for-Service patients. Results indicated that patients with OUD who initiated MOUD treatment but were not linked to ongoing care had the highest healthcare cost, while those who were linked to ongoing MOUD treatment had the lowest cost. The researchers concluded that MOUD treatment was not only effective at addressing the morbidity and mortality burden of OUD, but also associated with decreased financial costs. They noted that additional policy and care delivery changes will be needed to focus efforts for improve linkage to ongoing treatment
Citation: Toseef MU, Durfee J, Podewils LJ . Total cost of care associated with opioid use disorder treatment. Prev Med 2023 Jan;166:107345. doi: 10.1016/j.ypmed.2022.107345.
Keywords: Opioids, Healthcare Costs, Substance Abuse, Behavioral Health, Medication
Berkman ND, Chang E, Seibert J
Characteristics of high-need, high-cost patients : a "best-fit" framework synthesis.
This paper’s objective was to identify characteristics and criteria to distinguish high-need, high-cost (HNHC) patients. Searches of multiple databases and gray literature from 2000 to January 2022 were conducted. The final review included 64 studies comprising multivariate exposure studies (n = 47), cluster analyses (n = 11), and qualitative studies (n = 6). National Academy of Medicine (NAM) taxonomy was used for organizing the synthesis of findings. Patient characteristics associated with being defined as HNHC included number and severity of comorbid conditions and having chronic clinical conditions, particularly heart disease, chronic kidney disease, chronic lung disease, diabetes, cancer, and hypertension. HNHC risk was often amplified by behavioral health conditions and social risk factors. The authors revised the NAM taxonomy to create a final framework, adding chronic pain and prior patterns of high health care use as characteristics associated with an increased risk for being HNHC.
Citation: Berkman ND, Chang E, Seibert J . Characteristics of high-need, high-cost patients : a "best-fit" framework synthesis. Ann Intern Med 2022 Dec;175(12):1728-41. doi: 10.7326/m21-4562..
Keywords: Chronic Conditions, Healthcare Costs, Healthcare Delivery
Keita Fakeye MB, Samuel LJ, Wolff JL
Financial contributions and experiences of non-spousal, employed family caregivers.
Investigators examined out-of-pocket spending among employed, retired, and unemployed caregivers. Using data from the 2015 National Health and Aging Trends Study (NHATS) and the National Study of Caregiving, they found that employed caregivers incur more out-of-pocket spending on caregiving than retired and unemployed counterparts. They concluded that caregiving exacerbates economic well-being among employed caregivers, particularly for those with socioeconomic vulnerability.
Citation: Keita Fakeye MB, Samuel LJ, Wolff JL . Financial contributions and experiences of non-spousal, employed family caregivers. J Appl Gerontol 2022 Dec;41(12):2459-68. doi: 10.1177/07334648221115261..
Keywords: Elderly, Caregiving, Healthcare Costs
Encinosa W, Nguyen P
AHRQ Author: Encinosa W
Is the recent surge in physician-hospital consolidation finally producing cost-savings?
This article revisits earlier integration studies using IBM MarketScan data 2010–2016 to re-examine the relationship between primary care physicians integrated with hospitals and spending under the Affordable Care Act (ACA) during that period. The authors observe an association between physician-hospital integration and overall cost-savings, a reversal of the relationship noted in earlier studies. They recommend that future research examine the precise mechanism of physician-hospital clinical integration in greater detail.
Citation: Encinosa W, Nguyen P . Is the recent surge in physician-hospital consolidation finally producing cost-savings? J Gen Intern Med 2022 Dec;37(16):4289-91. doi: 10.1007/s11606-022-07634-x..
Keywords: Healthcare Costs, Provider: Physician, Hospitals, Primary Care
Sachs RE, Jazowski SA, Gavulic KA
Medicaid and accelerated approval: spending on drugs with and without proven clinical benefits.
The purpose of this article was to assess what level of Medicaid programs' accelerated approval spending is expended on products that have verified clinical benefits versus those that do not. The study found evidence of states’ concerns that pharmaceutical companies frequently do not complete the mandatory post-approval confirmatory studies within the FDA's required timeline. The study also illuminated an issue often overlooked by policy stakeholders: the utilization of surrogate endpoints involved in the post-approval confirmatory studies for most of the sample products. The researchers reported that the detailed nature of their results allowed them to evaluate the impact of different policy recommendations and to inform the current policy debate.
Citation: Sachs RE, Jazowski SA, Gavulic KA . Medicaid and accelerated approval: spending on drugs with and without proven clinical benefits. J Health Polit Policy Law 2022 Dec 1;47(6):673-90. doi: 10.1215/03616878-10041107..
Keywords: Medicaid, Medication, Healthcare Costs
Yeung K, Bloudek L, Ding Y
AHRQ Author: Ding Y
Value-based pricing of US prescription drugs: estimated savings using reports from the Institute for Clinical and Economic Review.
The purpose of this cross-sectional study was to estimate how annual United States drug spending would change if prices for drugs were set to the Institute for Clinical and Economic Review- (ICER-) reported value-based prices (VBPs). The study included 73 unique drugs, the sum of which accounted for $110.4 billion in annual U.S. drug spending, approximately one-fifth of total U.S. drug spending in 2020. The researchers found that 11 unique drugs had multiple ICER-reported VBPs. 86.3% had observed net prices higher than the VBPs at $100,000 per quality-adjusted life-year (QALY) and and 72.6%, had $150,000 per QALY thresholds. Applying VBPs at $100,000 per QALY and $150,000 per QALY reduced the median spending per drug by $373 million. The researchers concluded that the reduction in median spending per drug reduction equated to an estimated total annual savings of $11.8 billion to $40.3 billion for the 73 drugs included in the study.
Citation: Yeung K, Bloudek L, Ding Y . Value-based pricing of US prescription drugs: estimated savings using reports from the Institute for Clinical and Economic Review. JAMA Health Forum 2022 Dec;3(12):e224631. doi: 10.1001/jamahealthforum.2022.4631..
Keywords: Value, Healthcare Costs, Medication
Scott JW, Scott KW, Moniz M
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
This cross-sectional study linked insurance claims and consumer credit report data to evaluate the experience of financial distress in commercially insured adults after traumatic injury. Data from Blue Cross Blue Shield of Michigan’s preferred provider organization insurance claims from 2019 through 2021 were included. The authors identified working-age adults aged 21 to 64 whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury. This cohort of 3164 adults was compared demographically to 2223 patients in the comparison cohort. Relative to the comparison cohort, the post injury cohort had a 23% higher likelihood of having medical debt in collections, a 70% higher amount of medical debt in collections, and a 110% higher bankruptcy rate. For many commercially insured patients, the burden of out-of-pocket costs after hospitalization exceeded their ability to pay and could be associated with bankruptcy risk.
AHRQ-funded; HS028672; HS025465; HS028817.
Citation: Scott JW, Scott KW, Moniz M . Financial outcomes after traumatic injury among working-age US adults with commercial insurance. JAMA Health Forum 2022 Nov;3(11):e224105. doi: 10.1001/jamahealthforum.2022.4105..
Keywords: Healthcare Costs, Health Insurance
Chovatiya R, Begolka WS, Thibau IJ, R, Begolka WS, Thibau IJ
Impact and associations of atopic dermatitis out-of-pocket health care expenses in the United States.
The purpose of this study was to describe the impact and associations of out of pocket (OOP) health care expenses for atopic dermatitis (AD). The researchers administered a 25-question online survey to 113,502 National Eczema Association members aged 18 years or older. The study found that respondents with monthly OOP expenses over $200 were more likely to have increased AD severity, flares, health care provider visits, prescription polypharmacy, use of step-up therapy, frequent skin infections, and poorer disease control. Respondents with OOP yearly expenditures greater than $1000 had similar associations and additionally increased rates of comorbid asthma, allergic rhinitis, and anxiety/depression. A total of 64.6% of participants reported a harmful household financial impact of OOP expenses. Predictors of harmful impact included severe AD, comorbid asthma, 5 health care provider visits or more in a year, greater than $200 OOP monthly expenditures, and $1000 annual OOP expenditures or more. The study concluded that OOP expenses for AD are associated with increased disease severity and health care utilization and significantly impact household finances.
Citation: Chovatiya R, Begolka WS, Thibau IJ, R, Begolka WS, Thibau IJ . Impact and associations of atopic dermatitis out-of-pocket health care expenses in the United States. Dermatitis 2022 Nov-Dec;33(6s):S43-S51. doi: 10.1097/der.0000000000000795..
Keywords: Skin Conditions, Healthcare Costs
Likosky DS, Yang G, Zhang M
Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries.
The purpose of this study was to examine differences in durable ventricular assist device implantation infection rates and associated costs across hospitals. The researchers utilized clinical data for 8,688 patients who received primary durable ventricular assist devices from the Society of Thoracic Surgeons Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) hospitals (n = 120) and merged that data with post-implantation 90-day Medicare claims. The primary outcome included infections within 90 days of implantation and Medicare payments. The study found that 27.8% of patients developed 3982 identified infections. The median adjusted incidence of infections (per 100 patient-months) across hospitals was 14.3 and differed according to hospital. Total Medicare payments from implantation to 90 days were 9.0% more in high versus low infection tercile hospitals. The researchers concluded that health-care-associated infection rates post durable ventricular assist device implantation varied according to hospital and were associated with increased 90-day Medicare expenditures.
Citation: Likosky DS, Yang G, Zhang M . Interhospital variability in health care-associated infections and payments after durable ventricular assist device implant among Medicare beneficiaries. J Thorac Cardiovasc Surg 2022 Nov;164(5):1561-68. doi: 10.1016/j.jtcvs.2021.04.074..
Keywords: Healthcare-Associated Infections (HAIs), Medical Devices, Medicare, Heart Disease and Health, Cardiovascular Conditions, Hospitals, Payment, Healthcare Costs
O'Connell J, Grau L, Goins T
The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs.
This study analyzed the costs of treatment for all-cause dementia among American Indians and Alaska native (AI/AN) adults who access services through the Indian Health Service (IHS) and Tribal health programs. The authors analyzed fiscal year 2013 IHS/Tribal treatment costs for AI/ANs aged 65 and over with dementia and a matched sample without dementia (n= 1842). Mean total treatment costs for adults with dementia were $5400 higher than for adults without dementia ($13,027 versus $7627). The difference in adjusted total treatment costs was $2943, the majority of which was due to the difference in hospital inpatient costs.
Citation: O'Connell J, Grau L, Goins T . The costs of treating all-cause dementia among American Indians and Alaska native adults who access services through the Indian Health Service and Tribal health programs. Alzheimers Dement 2022 Nov;18(11):2055-66. doi: 10.1002/alz.12603..
Keywords: Dementia, Racial and Ethnic Minorities, Healthcare Costs, Disparities
Williams PH, Gilmartin HM, Leonard C
The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs.
This study’s objective was to examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for Veterans Affairs Healthcare System Rural Transitions Nurse Program (TNP) enrollees compared to controls. Although findings showed no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs, suggesting a shifting of costs from the inpatient to outpatient setting.
Citation: Williams PH, Gilmartin HM, Leonard C . The influence of the Rural Transitions Nurse Program for veterans on healthcare utilization costs. J Gen Intern Med 2022 Nov;37(14):3529-34. doi: 10.1007/s11606-022-07401-y..
Keywords: Rural Health, Veterans, Nursing, Transitions of Care, Healthcare Utilization, Healthcare Costs
Becker 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).
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
Glynn A, Hernandez I, Roberts ET
Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes.
This study’s objective was to estimate the take-up of the Medicare Part D Low-Income Subsidy (LIS) among Medicare beneficiaries with diabetes and examine differences in out-of-pocket costs and prescription drug use between LIS enrollees and LIS-eligible non-enrollees. Data from the Health and Retirement Study linked to Medicare administrative data from 2008 to 2016 was used. The authors first estimated LIS take-up stratified by income (≤100% of the Federal Poverty Level [FPL] and >100% to ≤150% of FPL). Second, to assess the consequences of forgoing the LIS among near-poor beneficiaries (incomes >100% to ≤150% of FPL), they conducted propensity score-weighted regression analyses to compare out-of-pocket costs, prescription drug use, and cost-related medication non-adherence among LIS enrollees and LIS-eligible non-enrollees. Among Medicare beneficiaries with diabetes, 68.1% of those considered near-poor (incomes >100% to ≤150% of FPL) received the LIS, compared to 90.3% of those with incomes ≤100% of FPL. Among near-poor beneficiaries, LIS-eligible non-enrollees incurred higher annual out-of-pocket drug spending ($518], filled 7.3 fewer prescriptions for diabetes, hypertension, and hyperlipidemia drugs, and were 8.9 percentage points more likely to report skipping drugs due to cost. all compared to LIS enrollees.
Citation: Glynn A, Hernandez I, Roberts ET . Consequences of forgoing prescription drug subsidies among low-income Medicare beneficiaries with diabetes. Health Serv Res 2022 Oct;57(5):1136-44. doi: 10.1111/1475-6773.13990..
Keywords: Medication, Diabetes, Chronic Conditions, Low-Income, Medicare, Healthcare Costs
Tisdale RL, Cusick MM, Aluri KZ
Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease.
The purpose of this study was to determine the cost-effectiveness of adding dapagliflozin to standard management of patients with non-diabetic chronic kidney disease (CKD). Findings showed that adding dapagliflozin to standard care improved life expectancy by 2 years, increased discounted quality-adjusted life years, and reduced the total incidence of both kidney failure on kidney replacement therapy (KRT) and average years on KRT over the lifetime of the cohort. Further, dapagliflozin plus standard care was more effective than standard care alone while increasing lifetime costs.
Citation: Tisdale RL, Cusick MM, Aluri KZ . Cost-effectiveness of dapagliflozin for non-diabetic chronic kidney disease. J Gen Intern Med 2022 Oct;37(13):3380-87. doi: 10.1007/s11606-021-07311-5..
Keywords: Kidney Disease and Health, Medication, Chronic Conditions, Healthcare Costs
Chovatiya R, Begolka WS, Thibau IJ
Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among Black individuals in the United States.
The purpose of this study was to explain the categories and impact of out-of-pocket (OOP) healthcare expenses associated with atopic dermatitis (AD) management among black individuals. The researchers administered a voluntary online survey to 113, 502 members of the National Eczema Association. 77.3% of respondents met the participation criteria of being U.S. residents, 18 years of age and older, and self-reporting that they had AD or were the primary caregivers of individuals with AD. The study found that Blacks (74.2%) vs. non-Blacks (63.3%) reported more OOP costs for prescription medications covered (65.1%) and not covered (46.5%), by insurance, emergency room visits (22.1% vs. 11.8%), and outpatient laboratory testing (33.3% vs. 21.8%,). There was a relationship between Black race and increased household financial impact from OOP expenses, and predictors of financial impact included minimally controlled AD, systemic therapy, greater than $200 monthly OOP expenses, and Medicaid. Blacks with Medicaid had greater odds of harmful financial impact than those of black race or with Medicaid alone. The researchers concluded that there is a relationship between Black race increased OOP costs for AD, with significant financial impact to the household.
Citation: Chovatiya R, Begolka WS, Thibau IJ . Financial burden and impact of atopic dermatitis out-of-pocket healthcare expenses among Black individuals in the United States. Arch Dermatol Res 2022 Oct;314(8):739-47. doi: 10.1007/s00403-021-02282-3..
Keywords: Skin Conditions, Healthcare Costs, Racial and Ethnic Minorities