Health Outcomes Research in Medicine

Outcomes Research and Comparative Effectiveness

Donald E. Stull — 2012-04-11

Part of the mission of Health Outcomes Research in Medicine is to present evidence from outcomes research to help with decisions about which treatments to pursue and the efficacy of those treatments. In many instances, these decisions may involve comparisons of relative treatment costs in addition to relative treatment efficacy.

Burden of Early-Stage Triple-Negative Breast Cancer in a US Managed Care Plan

Onur Başer, Wenhui Wei, Henry J. Henk, April Teitelbaum, Lin Xie — 2012-03-27

Abstract: Objective: Triple-negative breast cancer (TNBC) is a high-grade breast cancer with an aggressive clinical course. We examined the recurrence rate, health care utilization, and cost of early-stage TNBC in the US managed care setting.Study Design: A retrospective study using linked cancer registry, health care claims, and social administration databases.Methods: This retrospective study used the Impact Intelligence Oncology Management cancer registry, linked to 1999-2009 administrative claims, from a national managed care health plan and also Social Security Administration mortality data. Patients with stage I-III TNBC and non-TNBC were followed from diagnosis to recurrence, disenrollment, or end of observation period. Risk-adjusted recurrence rate, health care utilization, and costs during the follow-up period were compared.Results: A total of 1967 women (403 with TNBC) were included; 289 (14.7%) had local/distant recurrence during the follow-up period. Patients with TNBC were younger (53.68 vs. 56.16 years, P < .0001) and more likely to experience recurrence compared with non-TNBC (21.6% vs. 12.9%, P < .0001; adjusted hazard ratio=2.11, P < .0001). In terms of adjusted annual health care utilization and costs, patients with TNBC had significantly higher numbers of hospitalizations (1.20 vs. 0.90, P=.001); hospitalization days (8.80 vs. 4.97, P < .0001); and emergency department (ED) visits (1.45 vs. 0.95, P=.009). They also had significantly higher inpatient costs (all-cause: $9154 vs. $5501; cancer-related: $5632 vs. $2869; P < .0001 for both); and ED costs (all-cause: $303 vs. $182, P=.003; cancer-related: $240 vs. $138, P=.012).Conclusions: This study demonstrates that, compared with non-TNBC, early-stage TNBC is associated with higher rate of recurrence, resulting in increased health care utilization and costs.

The Impact of End-Stage Renal Disease Transfusion Demand on Blood Utilization and Blood Supply in the United States

2012-03-26

Abstract: Background: Excess supply of blood is required to ensure availability to patients requiring transfusions at the time of need. End-stage renal disease (ESRD) patients undergoing dialysis account for a substantial portion of the demand for transfusions.Objective: The purpose of this analysis was to explore the impact of ESRD transfusion demand on the US blood supply and its margin.Methods: A mathematical model was developed to evaluate the impact on the overall US demand for blood transfusions associated with changes in the mean hemoglobin (Hb) among ESRD patients at Hb levels ranging from 9 to 12g/dL.Results: Our results suggested that, based on ESRD prevalence and blood supply estimates and a mean population Hb of 12g/dL, 27,845 dialysis patients would receive an estimated total of 17,384 units of blood, compared with an estimated 123,503 dialysis patients receiving a total of 288,590 units of blood at a mean population Hb level of 9g/dL. Based on an assumed supply margin of 10%, our model estimated that approximately 21.9% of this margin would be utilized by ESRD patients with a mean population Hb of 9g/dL, compared with 8.7% for mean Hb of 10g/dL, 3.0% for mean Hb of 11g/dL, and 1.3% for mean Hb of 12g/dL.Conclusions: Potential changes in treatment practices for ESRD may shrink the blood margin and limit availability of blood products for other uses, such as for acute injuries and surgical procedures.

Cost-effectiveness of Treating Chronic Anemia with Epoetin Alfa among Hemodialysis Patients in the United States

2012-03-26

Abstract: Objectives: The objectives of this analysis were to assess health and economic consequences of targeting hemoglobin (Hb) levels around 10-11g/dL relative to 9-10g/dL using an economic model and to explore the impact of different assumptions on cost-effectiveness.Study Design: Clinical and economic impact of treating anemia in the US hemodialysis population to target Hb levels of 10-11g/dL and 9-10g/dL was assessed using a Markov model. A sensitivity analysis assessed the effects of varying assumptions on the model.Results: Our cost-effectiveness analysis suggests that maintaining Hb 10-11g/dL would result in average reductions of 0.51 hospitalizations and increases of 0.09 quality-adjusted life years per patient, with hospitalization cost offsets of $15,340 over 5 years when compared with Hb of 9-10g/dL. Over the lifetime of the patient, cost-effectiveness improved with hospitalization cost offsets of $21,450 and increases of 0.12 quality-adjusted life years. Sensitivity analysis of individual parameters showed that mortality, hospitalization, health preference, and time horizon of the model had the most influence on cost-effectiveness.Conclusions: Our analysis suggests that epoetin alfa use targeting Hb levels of 10-11g/dL relative to 9-10g/dL may result in better patient outcomes and lower costs. The sensitivity analysis highlighted how assumptions affected cost-effectiveness conclusions; the appropriateness of these assumptions will remain uncertain until new research in today’s dialysis population examining the effects of targeting to lower Hb levels is conducted.

Health Care Utilization and Associated Costs of Hepatitis A in Adults in a US Commercially Insured Population

Debra F. Eisenberg, Stuart J. Burstin, Christy Fang, Derek A. Misurski — 2012-03-26

Abstract: Objective: To examine the impact of acute hepatitis A on health care utilization and cost in a commercially insured population.Study Design: This observational, retrospective cohort study used medical and pharmacy claims data from January 1, 2004 through October 31, 2009. A matched control group consisted of patients without hepatitis A during the study period. Descriptive statistics were used to assess differences between hepatitis A patients (cases) and controls.Results: The case and control groups each contained 2331 patients. In the 12-month post-index period, 482 (20.7%) cases and 193 (8.3%; P < .0001) controls had inpatient (INP) hospitalizations (adjusted mean estimated costs [AMEC] $4433 and $1244 [P < .0001], respectively). Emergency department (ED) services occurred in 382 (16.4%) cases, versus 277 (11.9%; P < .0001) controls (AMEC $225 and $132 [P < .0001], respectively). The mean number of outpatient services (OUT) for cases was 21.5 (±22.1) versus 14.7 (±18.2) for controls, with AMEC $4132 and $2092, respectively. The mean number of physician visits was 9.1 (±9.9) and 5.5 (±7.4) for each group, respectively [AMEC $1025 vs. $577; P < .0001]. There were 20.13 (±24.1) and 19.37 (±24.5) pharmacy claims, with AMEC $1565 and $1115 (P < .0001), in cases and controls, respectively. Adjusted mean total estimated associated costs were $11,479 and $5323 (P < .0001), respectively. Multivariate regression results demonstrated that patients with hepatitis A have higher total medical costs even after adjusting for age, sex, comorbidities, pre-index cost, and hepatitis A vaccination.Conclusions: Patients with hepatitis A had significantly higher health care resource utilization and costs during the 1-year post-index period, compared with controls.

Racial Differences in Perinatal Depression among HIV-infected Women

2012-03-26

Abstract: Background: Perinatal depression may further complicate the health of women with human immunodeficiency virus (HIV) infection. Diagnosis and subsequent treatment of depressive symptoms may significantly improve the health of mother and newborn.Objective: We sought to examine the association between race and perinatal depression among a sample of low-income women with HIV infection.Methods: This retrospective cohort study used data from a multi-state Medicaid administrative claims database to study HIV-infected perinatal women between 2003 and 2007. Multivariate regression analysis was used to study the objective.Results: The overall prevalence of perinatal depression in the sample (n=650) was 27.8%. Black women had significantly lower odds of experiencing perinatal depression (odds ratio 0.328; 95% confidence interval 0.225-0.479) compared with non-black women. Non-black women showed significantly higher comorbidity severity scores than black women (0.356 vs. 0.220, P =.035).Conclusions: This study found that non-black women may be more vulnerable to perinatal depression. Improved health care provider vigilance for depressive symptoms among low-income, HIV-infected women of all races during the perinatal period is warranted.