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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 97 Research Studies Displayed
Bernard D, Fang Z
AHRQ Author: Bernard D
Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015.
Researchers examined the prevalence of high burdens and barriers to care among adults with heart disease treatment. Using MEPS data, they found that public insurance provides protection against high burdens but not against forgoing or delaying care. They recommended that future research investigate whether, and to what extent, barriers to care are associated with worse health outcomes and higher costs in the long term.
Citation: Bernard D, Fang Z . Financial burdens and barriers to care among nonelderly adults with heart disease: 2010-2015. J Am Heart Assoc 2019 Dec 17;8(24):e008831. doi: 10.1161/jaha.118.008831..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Heart Disease and Health, Cardiovascular Conditions, Access to Care
Greenhawt M, Shaker M
Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction.
The authors sought to identify scenarios in which current early peanut introduction guidelines would be cost-effective. They found that the current screening approach to early peanut introduction could be cost-effective at a particular health utility for an in-clinic reaction, skin prick test sensitivity and specificity, and high baseline peanut allergy prevalence among high-risk infants. However, such conditions are unlikely to be plausible to achieve realistically. They recommend further research to define the health state utility associated with reaction location.
Citation: Greenhawt M, Shaker M . Determining levers of cost-effectiveness for screening infants at high risk for peanut sensitization before early peanut introduction. JAMA Netw Open 2019 Dec 2;2(12):e1918041. doi: 10.1001/jamanetworkopen.2019.18041..
Keywords: Patient-Centered Outcomes Research, Newborns/Infants, Children/Adolescents, Respiratory Conditions, Skin Conditions, Screening, Healthcare Costs, Evidence-Based Practice, Guidelines
Hassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S . Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis. Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Werner RM, Konetzka RT, Qi M
The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs.
The objective of this study was to investigate the impact of Medicare's skilled nursing facility (SNF) copayment policy, with a large increase in the daily copayment rate on the 20th day of a benefit period, on length of stay, patient outcomes, and costs. The investigators concluded that Medicare's SNF copayment policy was associated with shorter lengths of stay and worse patient outcomes, suggesting the copayment policy had unintended and negative effects on patient outcomes.
Citation: Werner RM, Konetzka RT, Qi M . The impact of Medicare copayments for skilled nursing facilities on length of stay, outcomes, and costs. Health Serv Res 2019 Dec;54(6):1184-92. doi: 10.1111/1475-6773.13227..
Keywords: Medicare, Nursing Homes, Payment, Long-Term Care, Healthcare Costs, Elderly, Hospitalization, Hospital Discharge
Subramanian MP, Liu J, Chapman WC
Utilization trends, outcomes, and cost in minimally invasive lobectomy.
The objective of this study was to compare outcomes and hospitalization costs among patients undergoing open, video-assisted thoracoscopic surgery (VATS) and RATS lobectomy. The investigators concluded that minimally invasive approaches were associated to improved clinical outcomes compared with open lobectomy. However, only robotic-assisted lobectomy has had rapid growth in utilization. Despite additional cost, RATS lobectomy appeared to provide a viable minimally invasive alternative for general thoracic procedures.
Citation: Subramanian MP, Liu J, Chapman WC . Utilization trends, outcomes, and cost in minimally invasive lobectomy. Ann Thorac Surg 2019 Dec;108(6):1648-55. doi: 10.1016/j.athoracsur.2019.06.049..
Keywords: Healthcare Cost and Utilization Project (HCUP), Surgery, Healthcare Costs, Healthcare Utilization, Outcomes
Rosa TD, Possin KL, Bernstein A
Variations in costs of a collaborative care model for dementia.
Care coordination programs can improve patient outcomes and decrease healthcare expenditures; however, implementation costs are poorly understood. In this study, the investigators evaluated the direct costs of implementing a collaborative dementia care program. They found that care team navigators caseload was an important driver of service cost. They provide strategies for maximizing caseload without sacrificing quality of care and discuss current barriers to broad implementation that can inform new reimbursement policies.
Citation: Rosa TD, Possin KL, Bernstein A . Variations in costs of a collaborative care model for dementia. J Am Geriatr Soc 2019 Dec;67(12):2628-33. doi: 10.1111/jgs.16076.
Keywords: Dementia, Healthcare Costs, Care Coordination, Elderly, Care Management, Implementation, Teams
Sun EC, Mello MM, Moshfegh J
Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals.
This retrospective analysis used data from the Clinformatics Data Mart database (Optum) to examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals. The investigators found that out-of-network billing appeared to have become common for privately insured patients even when they soughttreatment at in-network hospitals. They indicated that the mean amounts billed appeared to be sufficiently large that they may create financial strain for a substantial proportion of patients.
Citation: Sun EC, Mello MM, Moshfegh J . Assessment of out-of-network billing for privately insured patients receiving care in in-network hospitals. JAMA Intern Med 2019 Nov;179(11):1453-612. doi: 10.1001/jamainternmed.2019.3451..
Keywords: Health Insurance, Healthcare Costs, Payment, Hospitals, Emergency Department
Nguyen JT, Cole AL, Leech AA
Cost-effectiveness of first-line tyrosine kinase inhibitor therapy initiation strategies for chronic myeloid leukemia.
Citation: Nguyen JT, Cole AL, Leech AA . Cost-effectiveness of first-line tyrosine kinase inhibitor therapy initiation strategies for chronic myeloid leukemia. Value Health 2020 Oct;23(10):1292-99. doi: 10.1016/j.jval.2020.05.019..
Keywords: Chronic Conditions, Medication, Healthcare Costs, Treatments, Value
Bayer ND, Hall M, LI Y
Trends in health care use and spending for young children with neurologic impairment.
This retrospective study examined trends in health care use and spending for young children with neurologic impairment (NI) during their first 5 years of life. This study of 13,947 children with NI used data in the multistate IBM Medicaid MarketScan Database from 2009 to 2017. Inpatient service use decreased from 66.8% during the first year down to 5.8% during the fifth year. Emergency department (ED) use decreased more gradually from 67.8% during the first year to 44.4% during the fifth year. Per-member-per-year spending decreased from $83,352 during the first year down to $1944 in the fifth year.
Citation: Bayer ND, Hall M, LI Y . Trends in health care use and spending for young children with neurologic impairment. Pediatrics 2022 Jan;149(1). doi: 10.1542/peds.2021-050905.
Keywords: Children/Adolescents, Healthcare Costs, Healthcare Utilization, Neurological Disorders
Jacobs PD, Selden TM
AHRQ Author: Jacobs PD, Selden TM
Changes in the equity of US health care financing in the period 2005-16.
This study examined changes in how households pay for health care spending in the United States from 2005 to 2016. At the start of the study period, households in the bottom 20% of income paid 26.8% of their income for health care compared to about half that amount for those with income in the top 1 percent. By 2016 the percentages had become about the same across all income levels. This result reflected increases in coverage through Medicaid and the Affordable Care Act Marketplaces.
Citation: Jacobs PD, Selden TM . Changes in the equity of US health care financing in the period 2005-16. Health Aff 2019 Nov;38(11):1791-800. doi: 10.1377/hlthaff.2019.00625..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Health Insurance, Medicare, Policy
Moniz MH, Soliman AB, Kolenic GE
Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women.
Investigators evaluated the association between out-of-pocket costs and long-acting reversible contraceptive (LARC) insertion among commercially insured postpartum women. Using the Clinformatics Data Mart, they found that cost sharing for postpartum LARC is associated with use, suggesting that out-of-pocket costs may impede LARC access for some commercially insured postpartum women. They concluded that reducing out-of-pocket costs for the most effective forms of contraception may increase use.
AHRQ-funded; HS025465; HS023784.
Citation: Moniz MH, Soliman AB, Kolenic GE . Cost sharing and utilization of postpartum intrauterine devices and contraceptive implants among commercially insured women. Womens Health Issues 2019 Nov - Dec;29(6):465-70. doi: 10.1016/j.whi.2019.07.006..
Keywords: Women, Health Insurance, Healthcare Costs, Access to Care
Leeds IL, DiBrito SR, Canner JK
Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease.
This goal of this study was to assess the cost-effectiveness of extended prophylaxis in patients with Crohn's disease after abdominal surgery. A decision tree model was used to assess cost-effectiveness and cost-per-case averted with extended-duration venous thromboembolism prophylaxis following abdominal surgery. Results showed that extended prophylaxis in patients with Crohn's disease postoperatively is not cost-effective when the cumulative incidence of posthospital thrombosis remains less than 4.9%. These findings are driven by the low absolute risk of thrombosis in this population and the considerable cost of universal treatment.
Citation: Leeds IL, DiBrito SR, Canner JK . Cost-benefit limitations of extended, outpatient venous thromboembolism prophylaxis following surgery for Crohn's disease. Dis Colon Rectum 2019 Nov;62(11):1371-80. doi: 10.1097/dcr.0000000000001461..
Keywords: Prevention, Digestive Disease and Health, Surgery, Value, Healthcare Costs, Adverse Events, Patient Safety, Blood Clots, Decision Making, Medication
Howard R, Thompson M, Fan Z
Costs associated with modifiable risk factors in ventral and incisional hernia repair.
The authors sought to identify the attributable association of modifiable risk factors for adverse outcomes after ventral and incisional hernia repair (VIHR) on outcomes and episode-of-care payments. They found that, in this cross-sectional study, modifiable risk factors, such as obesity, insulin-dependent diabetes, and unhealthy alcohol use, were associated with adverse outcomes after VIHR. These factors were significantly associated with increased health care spending; therefore, preoperative optimization may improve outcomes and decrease episode-of-care costs.
Citation: Howard R, Thompson M, Fan Z . Costs associated with modifiable risk factors in ventral and incisional hernia repair. JAMA Netw Open 2019 Nov;2(11):e1916330. doi: 10.1001/jamanetworkopen.2019.16330..
Keywords: Surgery, Risk, Healthcare Costs
McClellan C, Fingar KR, Ali MM
AHRQ Author: McClellan C
Price elasticity of demand for buprenorphine/naloxone prescriptions.
In this study, using the IBM MarketScan(R) Commercial Claims and Encounters Database for individuals with employer-sponsored private health insurance coverage, the researchers examined the relationship between cost sharing and the number of buprenorphine/naloxone prescription fills using enrollee-level longitudinal fixed effects models.
Citation: McClellan C, Fingar KR, Ali MM . Price elasticity of demand for buprenorphine/naloxone prescriptions. J Subst Abuse Treat 2019 Nov;106:4-11. doi: 10.1016/j.jsat.2019.08.001..
Keywords: Medication, Healthcare Costs, Health Insurance
Adams DR, Williams NJ, Becker-Haimes EM
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
In this study, the investigators prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. The investigators expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. They found that, controlling for covariates, financial strain predicted therapist turnover but not for therapists who participated in an EBP training initiative.
Citation: Adams DR, Williams NJ, Becker-Haimes EM . Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices. Adm Policy Ment Health 2019 Nov;46(6):713-23. doi: 10.1007/s10488-019-00949-8..
Keywords: Healthcare Costs, Evidence-Based Practice, Behavioral Health, Provider, Provider: Clinician, Training, Workforce
Boudreaux M, Gangopadhyaya A, Long SK
AHRQ Author: Karaca Z
Using data from the Healthcare Cost and Utilization Project for state health policy research.
Investigators describe the opportunities and challenges of using HCUP data to conduct state health policy research and to provide empirical examples of what can go wrong when using the national HCUP data inappropriately. Analyzing cesarean delivery rates, discharges per capita, and discharges by the payer, they found that state-level estimates are volatile and often provide misleading policy conclusions. They conclude that the Nationwide Inpatient Sample should not be used for state-level research and specified that AHRQ provides resources to assist analysts with state-specific studies using State Inpatient Database files.
Citation: Boudreaux M, Gangopadhyaya A, Long SK . Using data from the Healthcare Cost and Utilization Project for state health policy research. Med Care 2019 Nov;57(11):855-60. doi: 10.1097/mlr.0000000000001196..
Keywords: Healthcare Cost and Utilization Project (HCUP), Policy, Health Services Research (HSR), Healthcare Costs, Data, Research Methodologies
Chhabra KR, Nuliyalu U, Dimick JB
Who will be the costliest patients? Using recent claims to predict expensive surgical episodes.
Researchers studied the effects of surgeon and hospital characteristics on surgical expenditures using Medicare claims data. They found that a significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data and recommended adjusting for patient factors to facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.
AHRQ-funded; HS024763; HS000053.
Citation: Chhabra KR, Nuliyalu U, Dimick JB . Who will be the costliest patients? Using recent claims to predict expensive surgical episodes. Med Care 2019 Nov;57(11):869-74. doi: 10.1097/mlr.0000000000001204..
Keywords: Healthcare Costs, Surgery, Medicare
Childers CP, Maggard-Gibbons M, Nuckols T
A comparison of costs: how California teaching hospitals achieved slower growth than nonteaching hospitals in operating room costs from 2005 to 2014.
This study compared risk-adjusted operating room costs between California teaching and nonteaching hospitals using financial statements from fiscal years 2005-2014. Findings showed that California teaching hospitals had lower operating room costs per minute than nonteaching hospitals because of relative labor productivity gains and slower indirect cost growth. Implications for patients and nonteaching hospitals warrant evaluation.
Citation: Childers CP, Maggard-Gibbons M, Nuckols T . A comparison of costs: how California teaching hospitals achieved slower growth than nonteaching hospitals in operating room costs from 2005 to 2014. Acad Med 2019 Oct;94(10):1539-45. doi: 10.1097/acm.0000000000002844..
Keywords: Healthcare Costs, Hospitals, Surgery
Childers CP, Hofer IS, Cheng DS
Evaluating surgeons on intraoperative disposable supply costs: details matter.
Cost report cards have demonstrated variation in intraoperative supply costs and may allow comparisons between surgeons. However, cost data are complex and, if not properly vetted, may be inaccurate. In this study, a retrospective assessment of intraoperative supply costs for consecutive laparoscopic cholecystectomies (2013-2017) at a 4-facility academic center was performed. The investigators concluded that evaluating surgeons based on intraoperative supply costs was sensitive to analytic methods.
Citation: Childers CP, Hofer IS, Cheng DS . Evaluating surgeons on intraoperative disposable supply costs: details matter. J Gastrointest Surg 2019 Oct;23(10):2054-62. doi: 10.1007/s11605-018-3889-4..
Keywords: Healthcare Costs, Provider, Provider: Physician, Surgery
Shaker M, Wallace D, Golden DBK
Simulation of health and economic benefits of extended observation of resolved anaphylaxis.
The objective of this study was to characterize the cost-effectiveness of short vs prolonged medical observation times after resolved anaphylaxis. The authors suggested that the study indicated prolonged medical observation (6-24 hours) for resolved anaphylaxis may not be cost-effective for patients at low risk for biphasic anaphylaxis; however, in particular clinical circumstances of low observation costs, high postdischarge risk of biphasic anaphylaxis, or large incremental fatality risk reduction associated with extended observation, longer medical observation could be justified.
Citation: Shaker M, Wallace D, Golden DBK . Simulation of health and economic benefits of extended observation of resolved anaphylaxis. JAMA Netw Open 2019 Oct 2;2(10):e1913951. doi: 10.1001/jamanetworkopen.2019.13951..
Keywords: Healthcare Costs, Value, Patient-Centered Outcomes Research
McGinn T, Cohen S, Khan S
The high cost of low value care.
The main focus of this study was bridging the "evidence gap" between frontline decision-making in health care and the actual evidence, with the hope of reducing unnecessary diagnostic testing and treatments. From their work in pulmonary embolism (PE) and over ordering of computed tomography pulmonary angiography, the investigators integrated the highly validated Wells' criteria into the electronic health record at two of their major academic tertiary hospitals.
Citation: McGinn T, Cohen S, Khan S . The high cost of low value care. Trans Am Clin Climatol Assoc 2019;130:60-70..
Keywords: Value, Healthcare Costs, Evidence-Based Practice, Patient-Centered Outcomes Research, Decision Making, Comparative Effectiveness
Sukul D, Ryan AM, Yan P
Cardiologist participation in accountable care organizations and changes in spending and quality for Medicare patients with cardiovascular disease.
Despite widespread adoption of Medicare accountable care organizations (ACOs), healthcare spending reductions have been modest. This may relate to variable participation in ACOs by specialist physicians, who disproportionately drive spending. In this study, the investigators analyzed national Medicare data to examine whether specialist participation in Medicare ACOs was associated with changes in healthcare spending and clinical quality.
AHRQ-funded; HS024728; HS025615; HS024525.
Citation: Sukul D, Ryan AM, Yan P . Cardiologist participation in accountable care organizations and changes in spending and quality for Medicare patients with cardiovascular disease. Circ Cardiovasc Qual Outcomes 2019 Sep;12(9):e005438. doi: 10.1161/circoutcomes.118.005438..
Keywords: Cardiovascular Conditions, Healthcare Costs, Heart Disease and Health, Medicare, Quality of Care
Shaker M, Greenhawt M
Cost-effectiveness of stock epinephrine autoinjectors on commercial aircraft.
This study examined the cost-effectiveness of commercial airlines stocking epinephrine autoinjectors on every plane versus the standard emergency kit epinephrine ampules. The study assumed the autoinjectors reduced fatality risk by 10%. They used a Markov movule with microsimulation over an 80-year time horizon and concluded that it was cost-effective with a low annual cost per passenger-at-risk of 8 cents.
Citation: Shaker M, Greenhawt M . Cost-effectiveness of stock epinephrine autoinjectors on commercial aircraft. J Allergy Clin Immunol Pract 2019 Sep - Oct;7(7):2270-76. doi: 10.1016/j.jaip.2019.04.029..
Keywords: Value, Healthcare Costs, Medication
Drouin O, Sharifi M, Gerber M
Parents' willingness to pay for pediatric weight management programs.
This study examined parents’ interested in continuing and willingness to pay (WTP) for 2 pediatric weight management programs after their childrens’ participation. Participants were parents of 2- to 12-year-old children with a body mass index equal to or greater than the 85th percentile who participated in the Connect for Health trial. One group received enhanced primary care (EPC) and the other group EPC plus individualized coaching (EPC+C). After 1 year, they assessed parents’ self-reported WTP for a similar program and the maximum amount they would pay. Of 638 parents polled, 85% were interested in continuing and 38% of them were willing to pay. The median amount they were willing to pay was $25/month. Parents of Hispanic/Latino children versus white ethnicity and those reporting a higher satisfaction with the program more most likely to endorse WTP. Parents of children getting EPC+C were also more willing to pay.
AHRQ-funded; HS024332; HS022986.
Citation: Drouin O, Sharifi M, Gerber M . Parents' willingness to pay for pediatric weight management programs. Acad Pediatr 2019 Sep - Oct;19(7):764-72. doi: 10.1016/j.acap.2019.05.124..
Keywords: Children/Adolescents, Obesity: Weight Management, Obesity, Healthcare Costs, Caregiving, Primary Care, Primary Care: Models of Care
Ganguli I, Lupo C, Mainor AJ
Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries.
This study examined the use and outcomes of preoperative electrocardiogram (EKG) for cataract surgery recipients on Medicare. The outcomes measured were cascade events if the EKG results were problematic. The study compared 110,183 cataract surgery recipients with 97,775 non-surgery participants (63.1% female). For the recipient group, 12,408 (11.3%) received a preoperative EKG (65.6% of them were female). Of those, 1978 (15.9%) had at least 1 potential cascade event. Additional tests, treatments, and cardiology visits added an additional estimated $35 million in addition to the $3.2 million spent on preoperative EKGs. Preoperative EKG recipients who were older, had more chronic conditions, lived in more cardiologist-dense areas, or had their EKG performed by a cardiac specialist rather than a primary care physician were more likely to experience a cascade event.
Citation: Ganguli I, Lupo C, Mainor AJ . Prevalence and cost of care cascades after low-value preoperative electrocardiogram for cataract surgery in fee-for-service Medicare beneficiaries. JAMA Intern Med 2019 Sep;179(9):1157-308. doi: 10.1001/jamainternmed.2019.1739..
Keywords: Healthcare Costs, Medicare, Healthcare Utilization, Value, Surgery, Elderly