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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 733 Research Studies Displayed
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
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 / Ethnic Minorities
Kim N, Jacobson M
Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference?
In the United States seniors aged 65 and older have Medicare and almost-universal coverage, and in South Korea all residents have national health insurance. The purpose of this study was to compare catastrophic out-of-pocket medical spending (defined as out-of-pocket medical spending over the past two years that exceeded 50% of household income) among adults 65 and older in the United States with the same senior-aged population in South Korea. The study found that the proportion of participants with catastrophic out-of-pocket medical expenditures was 5.8% in the US and 3.0% in South Korea. The researchers concluded that exposure to that level of expenditures was significantly higher in the US than South Korea, with the difference attributed to unobservable system level factors rather than observable sociodemographic characteristics.
Citation: Kim N, Jacobson M . Comparison of catastrophic out-of-pocket medical expenditure among older adults in the United States and South Korea: what affects the apparent difference? BMC Health Serv Res 2022 Sep 26;22(1):1202. doi: 10.1186/s12913-022-08575-1..
Keywords: Elderly, Healthcare Costs, Access to Care, Low-Income
Donohue JM, Cole ES, James CV
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
This article is a literature review of the Medicaid program focusing on Medicaid eligibility, enrollment, and spending and examined areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. The authors included peer-reviewed articles and reports published between January 2003 and February 2022. Medicaid covered approximately 80.6 million people per month in 2022, representing 16.3% of US health spending. Managed care plans run by states enrolled 69.5% of Medicaid beneficiaries in 2019 and adopted 139 delivery system reforms from 2003 to 2019. Over half (56.4%) of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. The authors felt that additional Medicaid reforms are needed to reduce health disparities by race and ethnicity and to achieve equity in access, quality, and outcomes.
Citation: Donohue JM, Cole ES, James CV . The US Medicaid program: coverage, financing, reforms, and implications for health equity. JAMA 2022 Sep 20;328(11):1085-99. doi: 10.1001/jama.2022.14791..
Keywords: Medicaid, Healthcare Costs, Policy, Health Insurance
Kim KD, Funk RJ, Hou H
Association between care fragmentation and total spending after durable left ventricular device implant: a mediation analysis of health care-associated infections within a national Medicare-Society of Thoracic Surgeons INTERMACS linked dataset.
The purpose of this study was to examine the relationship between care fragmentation and total spending for durable left ventricular assisted device (LVAD) implant, and whether this relationship is mediated by infections. The researchers developed a measure of care fragmentation based on the number of shared medical professionals providing care to 4,987 Medicare beneficiaries undergoing LVAD implantation. The study found that the indirect effect of care fragmentation, through infections, was positive and statistically significant. The researchers concluded that higher care fragmentation associated with durable LVAD implantation is related with a greater incidence of infections and higher Medicare beneficiary payments.
Citation: Kim KD, Funk RJ, Hou H . Association between care fragmentation and total spending after durable left ventricular device implant: a mediation analysis of health care-associated infections within a national Medicare-Society of Thoracic Surgeons INTERMACS linked dataset. Circ Cardiovasc Qual Outcomes 2022 Sep;15(9):e008592. doi: 10.1161/circoutcomes.121.008592..
Keywords: Heart Disease and Health, Cardiovascular Conditions, Healthcare Costs, Healthcare-Associated Infections (HAIs), Medicare, Medical Devices, Healthcare Delivery
Oronce CIA, Arbanas JC, Leng M
Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis.
The purpose of this study was to quantify the amount of aducanumab that is discarded because of vial dose size and calculate the potential Medicare savings that could be created by changing the vial size and drug weight to make dispensing more efficient and reduce the amount of discarded drug. The researchers calculated estimates for the monthly amount of discarded drug for each study participant, and then annualized the estimates. Costs were calculated using the 300 mg vial price, which is the larger of the two vial sizes currently available, and calculations were then made for simulated vials in three combinations (100 and 170 mg; 170 and 250mg; and 80mg, 170, and 300 mg.) Costs for each combination were then calculated. The study found that assuming a 10% drug uptake, the equivalent of between 132,398 and 694,258 vials of aducanumab would be discarded costing Medicare between $115.4 million and $604.9
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
million each year. If the 300 mg/3.0 ml vial was reduced to 100 mg/1.0 ml, Medicare savings would range between $70.9 and $369.0 million per year. The researchers concluded that reducing aducanumab vial size could decrease wasteful spending from discarded vials by over 60%.
Citation: Oronce CIA, Arbanas JC, Leng M . Estimated wasteful spending on aducanumab dispensing in the U.S. Medicare population: a cross-sectional analysis. J Am Geriatr Soc 2022 Sep;70(9):2714-18. doi: 10.1111/jgs.17891..
Keywords: Medicare, Healthcare Costs, Medication
Encinosa W, Lane K, Cornelio N
AHRQ Author: Encinosa W
How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act.
This article discusses the 2022 No Surprises Act whose goal was to prevent patients from receiving unexpected emergency department (ED) out-of-network physician bills and restrict out-of-network co-payments to in-network co-payment levels. Similar state bans were examined to determine whether the large reduction in out-of-pocket payments under bans will have an unintended consequence of an increase in ED visits and spending. The authors examined 16 million nonelderly, fully funded, privately insured health maintenance organization (HMO) enrollees between 2007 and 2018 from 15 states with balance billing bans for HMO ED visits and 16 states without bans as the control group. They found that the bans reduced spending per visit by 14% but spurred a demand response with an increase of 3 percentage points in ED visits which wiped away the cost savings. The authors predict that the federal ban will result in $5.1 billion in savings but 3.5 million more ED visits at $4.2 billion in extra spending per year, largely negating expected savings.
AHRQ-authored; AHRQ-funded; HS027698.
Citation: Encinosa W, Lane K, Cornelio N . How state surprise billing protections increased ED visits, 2007-2018: potential implications for the No Surprises Act. Am J Manag Care 2022 Sep;28(9):e333-e38. doi: 10.37765/ajmc.2022.89226..
Keywords: Healthcare Costs, Emergency Department, Policy, Healthcare Utilization
Robinson LA, Eber MR, Hammitt JK
Valuing COVID-19 morbidity risk reductions.
The authors described and implemented an approach for approximating the value of averting nonfatal illnesses or injuries and applied it to COVID-19 in the United States. They estimated gains from averting COVID-19 morbidity of about 0.01 quality-adjusted life year (QALY) per mild case averted, 0.02 QALY per severe case, and 3.15 QALYs per critical case. They indicated that these gains translate into monetary values of about $5,300 per mild case, $11,000 per severe case, and $1.8 million per critical case.
Citation: Robinson LA, Eber MR, Hammitt JK . Valuing COVID-19 morbidity risk reductions. J Benefit Cost Anal 2022 Summer;13(2):247-68. doi: 10.1017/bca.2022.11.
Keywords: COVID-19, Risk, Healthcare Costs
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.
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.
Keywords: Palliative Care, Cancer, Quality of Life, Healthcare Costs
Pickens G, Smith MW, McDermott KW
Trends in treatment costs of U.S. emergency department visits.
In recent years, emergency department (ED) spending has been increasing more than in other areas of health care. Few studies have focused on changes in ED treatment costs. The purpose of this study was to analyze recent increases in emergency department treatment costs to highlight possibilities for reducing the growth of overall hospital costs. The researchers used data from the Healthcare Cost and Utilization Project (HCUP) and applied Cost-to-Charge Ratios for ED Files to the HCUP Nationwide Emergency Department Sample for 2012 through 2019. The study found that ED treatment costs experienced a 5.4% annual growth rate, increasing from $54 billion to $88 billion, with higher treatment cost per visit responsible for 4.4 of those percentage points. The researchers concluded that the study provides valuable information for decision- and policy-makers by bringing attention to components of the healthcare delivery system with the highest increasing costs as well as trends in overall ED costs.
AHRQ-authored; AHRQ-funded; 290201800001C.
Citation: Pickens G, Smith MW, McDermott KW . Trends in treatment costs of U.S. emergency department visits. Am J Emerg Med 2022 Aug;58:89-94. doi: 10.1016/j.ajem.2022.05.035..
Keywords: Healthcare Cost and Utilization Project (HCUP), Healthcare Costs, Emergency Department
Mohr NM, Schuette AR, Ullrich F
An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study.
The purpose of this study will be to assess the impact of provider-focused video telehealth in rural hospital emergency departments (ED) on costs and long-term outcomes for patients with sepsis. Using Medicare administrative claims, the researchers will compare telehealth-subscribing hospitals and control hospitals to assess the differences in total health care expenditures, category-specific costs, length of stay, readmissions, and mortality. The researchers intend for the study results to demonstrate the association between telehealth utilization and sepsis care total expenditures.
Citation: Mohr NM, Schuette AR, Ullrich F . An economic and health outcome evaluation of telehealth in rural sepsis care: a comparative effectiveness study. J Comp Eff Res 2022 Jul;11(10):703-16. doi: 10.2217/cer-2022-0019..
Keywords: Telehealth, Health Information Technology (HIT), Sepsis, Rural Health, Healthcare Costs
Haque W, Ahmadzada M, Janumpally S
Adherence to a federal hospital price transparency rule and associated financial and marketplace factors.
This research letter describes a study that evaluated adherence to the federal Hospital Price Transparency Rule 6 to 9 months after the final rule effective date (January 1, 2021). The rule’s aim is to increase health price transparency and facilitation patient price shopping online. Hospitals were required to post 5 price types: gross charges, discounted prices, payer-specific negotiated prices, minimum and maximum prices in a machine-readable file, and a separate accessible display or price estimator for at least 300 shoppable items. The authors used the Herfindahl-Hirschman Index (HHI) to measure inpatient hospital market concentration. The data was collected for 185 of 929 core-based statistical areas from 2019. HHI is divided into the following categories: unconcentrated, moderately concentrated, or highly or very concentrated. Results showed that out of 5239 total hospitals, 729 (13.9%) had an adherent machine-readable file but no shoppable display, 1542 (29.4%) had an adherent shoppable display but no machine-readable file, and 300 (5.7%) had both. The most adherent hospitals tended to be acute care hospitals with lesser revenue per patient-day, within unconcentrated health care markets, and in urban areas.
Citation: Haque W, Ahmadzada M, Janumpally S . Adherence to a federal hospital price transparency rule and associated financial and marketplace factors. JAMA 2022 Jun 7;327(21):2143-45. doi: 10.1001/jama.2022.5363..
Keywords: Policy, Hospitals, 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.
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
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA . Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016. JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care
Luo Q, Moghtaderi A, Markus A
Financial impacts of the Medicaid expansion on community health centers.
This study’s objective was to determine the impact of Medicaid expansion on community health centers. The authors combined data from the Uniform Data System, IRS nonprofit tax returns, and county-level characteristics from the Census Bureau. Their final dataset included 5841 center-year observations. They found a $2.08 million relative increase in Medicaid revenues, offset by a $0.44 million decrease in total grants among community health centers in expansion states compared with centers in non-expansion states. They found a large but not statistically significant $0.98 million relative increase in total expenditures among expansion state centers. Uncompensated care for health centers in expansion states decreased by $1.19 million relative to their counterparts in non-expansion states.
Citation: Luo Q, Moghtaderi A, Markus A . Financial impacts of the Medicaid expansion on community health centers. Health Serv Res 2022 Jun;57(3):634-43. doi: 10.1111/1475-6773.13897..
Keywords: Medicaid, Community-Based Practice, Healthcare Costs
Anderson KE, Polsky D, Dy S
Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare.
The purpose of this study was to compare Medicare Advantage (MA) coverage with traditional Medicare (TM) coverage as it relates to whether MA is associated with greater efficiency of prescribing Part B drugs. The authors sampled 20% of all 2016 outpatient and carrier TM claims and MA encounter records and Master Beneficiary Summary File data and analyzed whether MA enrollees more often received the low-cost Part B drug compared to TM enrollees. Four clinical scenarios were evaluated where multiple, similarly effective drugs exist: (1) anti-VEGF agents to treat macular degeneration, (2) bone resorption inhibitors for osteoporosis, (3) bone resorption inhibitors for malignant neoplasms, and (4) intravenous iron for iron deficiency anemia. The researchers estimated spending differences if TM prescribing aligned with MA prescribing and evaluated whether differences between MA and TM prescribing patterns were due to differences in the hospitals and provider practices who treat MA and TM enrollees or differences in how those hospitals and provider practices engage with their MA vs TM patients. The researchers found that more MA enrollees received the low-cost drug vs. TM enrollees in all 4 clinical scenarios, and that if TM prescribing matched that of ME prescribing, there would be a spending savings of 6% to 20% for each of the 4 scenarios. The study concluded that in 4 clinical scenarios in which similarly or equally effective treatment options exist, MA enrollees were more likely than TM enrollees to receive low-cost Part B drugs.
Citation: Anderson KE, Polsky D, Dy S . Prescribing of low- versus high-cost Part B drugs in Medicare Advantage and traditional Medicare. Health Serv Res 2022 Jun;57(3):537-47. doi: 10.1111/1475-6773.13912..
Keywords: Medication, Medicare, Healthcare Costs
De Roo AC, Shubeck SP SP, Cain-Nielsen AH
Cost consequences of age and comorbidity in accelerated postoperative discharge after colectomy.
The initial cost benefits of reductions in post-surgery duration of stay could be weakened by an increase in post-acute care or readmissions for those patients, especially for older adults and/ or those with comorbidities. The study objective was to assess whether thea hospitals with faster post-surgery discharge accumulate larger total episode savings and/or experience larger payments post-discharge. The researchers conducted a retrospective cross-sectional study utilizing national data from the July 2012 to June 2015 Medicare Provider Analysis and Review files focused on 88,860 Medicare beneficiaries undergoing elective colectomy procedures. The primary outcome measure was the average total episode payment among the different age and comorbidity categories, further stratified by duration of hospital stay. The study found that average total episode payments were lower in the shortest versus longest duration-of-stay hospitals across all age and comorbidity strata. Post-discharge payments were similar among duration-of-stay hospitals by age but greater among high comorbidity. The researchers note a study limitation that the post-acute care use data may be influenced by factors at the patient level, such as patient preference and the availability of caregivers, and concluded that the hospitals with the shortest duration of post-surgical stays had lower total episode payments and no related increase in post-acute care payments even in older adults and/ or those with comorbidities.
Citation: De Roo AC, Shubeck SP SP, Cain-Nielsen AH . Cost consequences of age and comorbidity in accelerated postoperative discharge after colectomy. Dis Colon Rectum 2022 May;65(5):758-66. doi: 10.1097/dcr.0000000000002020..
Keywords: Healthcare Costs, Surgery
Jiang S, Mathias PC, Hendrix N
Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis.
This paper describes a cost-effectiveness model that was constructed to assess the clinical and economic value of a clinical decision support (CDS) alert program that provides pharmacogenomic (PGx) testing results compared to no alert program in acute coronary syndrome (ACS) and atrial fibrillation (AF) from a health system perspective. The authors projected that 20% of 500,000 health-system members between the ages of 55 and 65 received PGx testing for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) annually. Clinical events, costs, and quality-adjusted life years (QALYs) were calculated for CYP2C19 (ACS-clopidogrel) and CYP2C9, CYP4F2 and VKORC1 (AF-warfarin) testing outcomes annually. Clinical events, costs, and quality-adjusted life years (QALYs) over 20 years were calculated with an annual discount rate of 3%. A total of 3169 alerts would be fired. The CDS alert program was predicted to help avoid 16 major clinical events and 6 deaths for ACS; and 2 clinical events and 0.9 deaths for AF. The incremental cost-effectiveness ratio was measured as $39,477/QALY, which would make the alert program cost-effective.
Citation: Jiang S, Mathias PC, Hendrix N . Implementation of pharmacogenomic clinical decision support for health systems: a cost-utility analysis. Pharmacogenomics J 2022 May;22(3):188-97. doi: 10.1038/s41397-022-00275-7..
Keywords: Clinical Decision Support (CDS), Healthcare Costs, Health Systems, Health Information Technology (HIT)
McCleskey SG, Shek L, Grein J
Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review.
This systematic review looked at economic evaluations of quality improvement (QI) interventions to reduce rates of catheter-associated urinary tract infections (CAUTIs). A literature review was conducted for conference abstracts and studies from January 2000 to October 2020. Dual reviewers assessed study design, effectiveness, costs and study quality for eligibility. The reviewers performed a cost-consequence analysis from the hospital perspective, estimating the incidence rate ratio and increment net cost/savings per hospital over 3 years for each eligible study. Fifteen unique economic evaluations were eligible, and 12 studies were amenable to standardization. QI interventions were associated with a 43% decline in infections and wide ranges of net costs relative to usual care.
Citation: McCleskey SG, Shek L, Grein J . Economic evaluation of quality improvement interventions to prevent catheter-associated urinary tract infections in the hospital setting: a systematic review. BMJ Qual Saf 2022 Apr;31(4):308-21. doi: 10.1136/bmjqs-2021-013839..
Keywords: Quality Improvement, Quality of Care, Urinary Tract Infection (UTI), Healthcare-Associated Infections (HAIs), Hospitals, Healthcare Costs
Grennan M, Kim GH, McConnell KJ
Hospital management practices and medical device costs.
The authors sought to determine whether the variation in prices paid for cardiac medical devices was associated with management practices in cardiac units. Unit prices on management practice scores and other hospital characteristics were regressed for the 11 top-spending cardiac device categories. The authors found that better management practices were associated with lower device prices. They noted that this modest magnitude was similar to other events expected to lower input prices, such as transparency in the form of benchmarking information and hospital mergers.
Citation: Grennan M, Kim GH, McConnell KJ . Hospital management practices and medical device costs. Health Serv Res 2022 Apr;57(2):227-36. doi: 10.1111/1475-6773.13898..
Keywords: Medical Devices, Hospitals, Healthcare Costs
Meiselbach MK, Eisenberg MD, Bai G
Labor market concentration and worker contributions to health insurance premiums.
This study’s objective was to examine if labor market concentration was associated with higher worker contributions to health plan premiums. The authors combined publicly available data from the Census to calculate labor market concentration and the Medical Expenditure Panel Survey Insurance/Employer Component to determine premium contributions from 2010 to 2016 for metropolitan areas. They found that higher labor market concentration was associated with higher worker contributions to health plan premiums, lower take-home income, and no change in employer contributions to premiums consistent with their hypothesis.
Citation: Meiselbach MK, Eisenberg MD, Bai G . Labor market concentration and worker contributions to health insurance premiums. Med Care Res Rev 2022 Apr;79(2):198-206. doi: 10.1177/10775587211012992..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Healthcare Costs