The economic impact of acute coronary syndrome on length of stay: an analysis using the Healthcare Cost and Utilization Project (HCUP) databases.

OBJECTIVE: To assess the economic impact of initial and repeat hospitalizations associated with acute coronary syndrome (ACS) over 1 year (2009). DESIGN AND METHODS: National- and state-level data on length of stay (LOS) and related charges for ACS-associated hospital admissions were assessed using two Healthcare Utilization Project databases. The first, the Nationwide Inpatient Sample (NIS), provided clinical and resource use information from ∼8 million hospital stays, representing a 20% stratified sample of ∼40 million annual hospital stays in the US in 2009. The second, the State Inpatient Databases, provided 100% of inpatient data from nine states that included both patient age and linked information on multiple patient admissions within the same calendar year. For patients with repeat admissions, the LOS, primary diagnosis, and total charges between the first and subsequent admissions were evaluated. All patients≥18 years of age with at least one diagnosis of ACS, defined using the International Classification of Diseases, 9th Revision, were included (code 410.xx [except 410.x2], 411.1x and 411.8x). Variables evaluated for each discharge included demographics, cardiovascular events and procedures, LOS, discharge status, and total charges. RESULTS: The NIS reported 1,437,735 discharges for ACS in 2009. In this dataset, mean LOS for an initial ACS event was 5.56 days. Patients>65 years of age had the highest numbers of admissions; this group also had the most comorbidities. Approximately 40% of ACS patients with data on repeat visits had more than one admission, >70% of these within 2 months of the primary discharge. Mean charges were $71,336 for the first admission and $53,290 for the second admission. CONCLUSION: Despite a variety of new therapies to prevent ACS, it remains a common condition. Better therapies are called for if the clinical and cost burden of ACS is to be alleviated.

A physician-focused intervention to reduce potentially inappropriate medication prescribing in older people: a 3-year, Italian, prospective, proof-of-concept study.

BACKGROUND: Potentially inappropriate medications (PIMs) are a preventable cause of negative clinical and economic consequences in older people. A range of educational interventions have attempted to address this in the past and have produced mixed results. OBJECTIVE: The objective of this study was to assess the effect of a physician-focused, multi-factorial, quality-improvement intervention on PIM prescribing in older patients in primary care. METHODS: This 3-year, multi-phase, prospective, proof-of-concept project introduced in 2007 was aimed at engaging all 303 general practitioners (GPs) in the Local Health Authority (LHA) of Parma, Italy, to positively influence the quality of prescribing to the entire older outpatient population (those aged at least 65 years) served by these physicians. The intervention focused on increasing GPs' awareness of prescribing for older people and included three key elements: (1) initial dissemination of a developed list of PIMs to always be avoided, along with a list of alternative drugs; (2) annual reviews of PIM incidence data; and (3) educational sessions on PIMs via academic detailing and case study reviews. Quarterly incidence rates of PIM exposure were calculated among all Parma LHA older outpatients who had received a prescription for any medication from their GP in a given quarter. The intervention was assessed by evaluating the changes in these rates between the study baseline (2007 fourth quarter [Q4]) and the end of the study (post-intervention: 2009 Q4). To reduce bias and confounding from background influences that may have acted to reduce PIM incidence rates independent of the intervention, these rate changes were also compared with those drawn from a similar neighbouring LHA over the same time period. RESULTS: Quarterly PIM exposure incidence rates among the older Parma LHA patients declined 31.4 % (7.8 % baseline to 5.3 % post-intervention), compared with 21.6 % in the comparator LHA (7.7 % to 6.1 %). The reduction in rates was significantly greater in the Parma LHA (p < 0.001), where the intervention resulted in 608 older patients (12.4 % of expected) being spared PIM exposure during 2009 Q4. PIM exposure rate reductions for NSAIDs and digoxin were each significantly greater in the Parma LHA than in the comparator LHA. CONCLUSIONS: By reaching out to GPs and maintaining contact with them, this quality intervention appears to have positively impacted physicians' awareness and prescribing behaviour, which led to significant reductions in PIM exposures and likely translated to significant population health benefits among their older patients. Similar interventions tailored to target specific PIMs or focus on certain subpopulations of GPs may further improve prescribing quality among older people.

An economic model to value companion diagnostics in non-small-cell lung cancer.

AIM: An economic model was used to evaluate the potential economic impact and cost-effectiveness of companion diagnostic testing for patients with non-small-cell lung cancer (NSCLC). MATERIALS & METHODS: A decision analysis model examined alternative patient management strategies for patients with advanced NSCLC who were not amenable to surgical treatment. A review of the literature provided the variables used to develop a timely base case and sensitivity analysis. A potential future scenario was also modeled. The model includes three options: conventional treatment (CT), new treatment (NT) and companion diagnostic (CD) strategy. RESULTS: In the base case analysis based upon current data, the cost per life-year saved for CT, NT option and CD was US$43,367, US$47,394 and US$47,779, respectively. The cost per life-year saved for CT, NT option and CD in a potential future scenario with more expensive, effective targeted therapy was US$47,748, US$69,255 and US$66,369, respectively. CONCLUSION: In the future scenario, CDs have an incremental cost-effectiveness of US$56,829 per life-year saved when compared with NT as a first-line treatment. This is one demonstration of how CDs may be a cost-effective option for the treatment of patients with advanced NSCLC when the NT is extremely expensive but the outcome is significantly improved.

Alzheimer's disease: new therapies and the role of biomarkers.

Biomarkers have shown promise for identifying people at high risk for Alzheimer's disease. Therapies that address presymptomatic disease are already in development, and MCOs should start thinking about coverage for them.