ABSTRACT
BACKGROUND: The impact of migr2D) and cardiovascular disease (CVD) are associated with increased morbidity and mortality in COVID-19 (C-19) patients. However, the economic burden associated with these pre-existing comorbidities is not well understood. OBJECTIVE(S): This study aimed to compare the healthcare resource utilization (HCRU) and costs among C-19 patients with pre-existing T2D + CVD, T2D only, or neither. METHOD(S): This retrospective study used administrative claims in the HealthCore Integrated Research Database from US commercial and Medicare Advantage health plans. Patients with C-19 were identified from March 1, 2020-May 31, 2021, and stratified by presence of T2D and CVD. HCRU and costs were identified during follow-up and presented on a per patient per month (PPPM) basis. Propensity score matching and multivariable analyses were performed to adjust for differences between the three groups. RESULT(S): A total of 321,232 C-19 patients were identified (21,651 T2D + CVD, 28,184 T2D only, and 271,397 neither) with a mean follow-up of 5.4 months. C-19 patients with T2D + CVD were significantly older and had a greater comorbidity burden than those with neither. The unadjusted analysis shows that PPPM costs during follow-up were $14,790, $5,717, and $1,891 for T2D + CVD, T2D only, and neither, respectively, with C-19 related costs contributing 78%, 75%, and 64% of the overall costs. The majority of costs occurred during the first month after C-19 infection. After matching, 6,967 patients were identified for each cohort. Hospitalization occurred in 34.2% (T2D + CVD), 26.0% (T2D only), and 21.2% (neither), with a mean length of stay of 9.5, 9.9, and 8.9 days. Emergency room visits were reported in 28.6%, 24.5% and 20.4%, respectively. In-person physician and telehealth visits followed a similar pattern, with the highest number of visits among C-19 patients with T2D + CVD. Multivariable models show that C-19 patients with T2D + CVD were 59% more likely to be hospitalized, incurring 54% greater costs than those with neither. Patients with T2D only were 28% more likely to be hospitalized with 21% greater costs than those with neither. CONCLUSION(S): C-19 patients with pre-existing T2D + CVD had the greatest economic burden even after accounting for baseline differences between groups. The magnitude of increased HCRU and costs suggests that more aggressive triage and management of C-19 patients with both T2D and CVD may favorably impact economic outcomes.
ABSTRACT
Objectives: In response to the disruption of in-person healthcare visits during the Covid-19 pandemic in the US, public and private payers expanded their coverage and reimbursement for telehealth (TH) services starting March 2020. To account for this new driver of healthcare resource utilization, we created a standardized definition of TH utilization from administrative claims to improve research quality. We used this definition to investigate trends in TH utilization in a large US commercially insured/Medicare Advantage/Supplement population. Methods: Administrative claims from 1/1/2006 to 8/31/2021 from the HealthCore Integrated Research Database® were used to identify TH claims. We defined TH based on outpatient claims containing at least one of the following TH designations (not mutually exclusive): place of service codes, CPT codes, CPT modifiers, and certain Tax IDs from known telehealth providers. Coding patterns and TH utilization over time were evaluated. All analyses were descriptive. Results: Over the 15-year period, 57% of TH claims occurred in 2020 and an additional 39% in 2021 (through August). In 2019/2020/2021, the share of outpatient claims designated as TH was 0.1%/4.8%/4.4%. Utilization was slightly higher among commercially-insured compared to Medicare Advantage/Supplement patients (5.0% vs. 3.9% in 2020). Most TH use was identified via CPT modifier codes (80%), followed by place of service codes (53%). Evaluation & management visits and specialist physician services each accounted for approximately 45% of all TH claims. Approximately 8% of TH claims were for audio-only visits based on submitted codes. Conclusions: We created a standardized algorithm to identify TH using claims data. Consistent with prior reports, TH utilization increased substantially following onset of the Covid-19 pandemic in conjunction with increased coverage and reimbursement for the service. Incorporation of TH utilization via this algorithm is an essential tool for all health economic and outcomes research studies evaluating time periods from 2020 and beyond.
ABSTRACT
<b>BACKGROUND:</b> The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report for the management of chronic obstructive pulmonary disease (COPD) focuses on reducing existing symptoms, decreasing the risk of future exacerbations, and improving health status by recommending specific drug therapy based on exacerbation risk and symptoms. However, disparities exist between evidence-based recommendations and clinical practice. Research that quantifies the real-world effect of COPD regimen alignment with the GOLD recommendations on clinical and economic outcomes is needed. <b>OBJECTIVE:</b> To compare COPD-related health care resource utilization (HRU) and costs, as well as exacerbation rates, among patients with COPD on maintenance therapy based on 2017 GOLD treatment recommendation compliance status per GOLD ABCD risk group classification in a U.S. commercially insured/Medicare Advantage population. <b>METHODS:</b> This retrospective cohort study utilized administrative claims data in the HealthCore Integrated Research Database. The COPD population was identified using a previously validated claims-based predictive model. Among this population, patients with >= 1 claim for a COPD maintenance medication (earliest maintenance fill-date = index date) between January 1, 2014, and March 31, 2017, were identified. Patients were required to be aged >= 40 years, have >= 12 months of pre-index and >= 30 days of post-index health plan enrollment, with no diagnosis for asthma, cystic fibrosis, and/or lung cancer at any time from January 1, 2013, to March 31, 2018. Patients were categorized into exacerbation risk/symptomatology groups according to the 2017 GOLD ABCD assessment recommendations and were then classified into treatment-compliance status based on their maintenance therapy. Multivariable analyses were conducted to examine post-index COPD-related HRU, costs, and exacerbations by compliance status. <b>RESULTS:</b> The primary analytical study sample included 38,382 patients in the GOLD A/B group and 6,525 in the GOLD C/D group. Patients were further categorized into GOLD A (n = 19,345), B (n = 19,037), C (n = 1,865), and D (n = 4,670). GOLD-compliant regimens were observed in 32.9% of patients in the GOLD A/B group and in 58.9% of patients in the GOLD C/D group. Inhaled corticosteroid-containing regimens were the most commonly observed noncompliant regimen. Patients on compliant regimens had significantly fewer COPD-related inpatient and emergency department visits and therefore had significantly lower COPD-related medical costs in both the GOLD A/B and C/D cohorts. Similar results were observed for individual GOLD cohorts B, C, and D. These savings were offset by increased pharmacy expenditures. Being on GOLD guideline-compliant regimens significantly reduced the risk of exacerbation by 8% (hazard ratio [HR] = 0.92;P < 0.0001) in the GOLD A/B cohort and by 12% (HR = 0.88;P = 0.0005) in the GOLD C/D cohort, and was also associated with a significantly reduced exacerbation rate in the GOLD A/B (rate ratio [RR] = 0.93;P < 0.0001) and GOLD C/D (RR = 0.93;P = 0.0129) groups. <b>CONCLUSIONS:</b> This study suggests a continuing trend of high prevalence of suboptimal prescriber compliance to GOLD treatment recommendations. Treatment regimens compliant with GOLD recommendations were associated with improvement in exacerbations, reduced COPD-related HRU, and COPD-related medical cost offsets. <b>DISCLOSURES:</b> This study was funded by Boehringer Ingelheim Pharmaceuticals, Inc. (BIPI). BIPI was given the opportunity to review the manuscript for medical and scientific accuracy as well as intellectual property considerations. Palli and Shaikh are employees of BIPI. Willey is an employee of HealthCore, which was contracted by BIPI to conduct this study. Zhou was an employee of HealthCore at the time of study execution. Data were presented in part during an AMCP webinar (recording not made public) held in lieu of the Spring 2020 AMCP conference, which was canceled due to the COVID-19 pandemic.