Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids.

BACKGROUND: To estimate the potential cost savings by following the current Global Initiative for Chronic Obstructive Lung Disease (GOLD) guideline recommendations in patients being treated for chronic obstructive pulmonary disease (COPD) with the combination of long-acting ß(2)-agonist (LABA), long-acting muscarinic antagonist (LAMA) or inhaled corticosteroids (ICS). METHODS: The Geisinger Health System (GHS) database was utilized to identify subjects between January 1, 2004 to March 12, 2007. The index date was based on the first prescription of a LAMA plus LABA, LAMA plus LABA/ICS, or LABA plus ICS. Patients were included in the study if they: had a COPD diagnosis; had data representative of treatment 12 months prior to and 12 months post index date; were 40 years of age or over; had no prior diagnosis for asthma; and had pulmonary function test (PFT) data. We examined the baseline characteristics of these patients along with their healthcare resource utilization. Based on PFT data within 30 days of the index date, a subgroup was classified as adhering or non-adhering to GOLD guidelines. RESULTS: A total of 364 subjects could be classified as adhering or non-adherent to current GOLD guidelines based on their PFT results. The adherent subgroup received COPD medications consistent with current GOLD guidelines. Of the LAMA plus LABA cohort, 25 patients adhered and 39 patients were non-adherent to current GOLD guidelines. In the cohort of LABA plus ICS, 74 patients were adherent and 180 patients non-adherent to current GOLD guidelines. In the cohort of LAMA plus LABA/ICS, 21 patients were adherent and 25 patients non-adherent to current GOLD guidelines. GOLD adherence was associated with mean total cost of all services savings of $5,889 for LAMA plus LABA, $3,330 for LABA + ICS, and $10,217 for LAMA plus LABA/ICS cohorts. CONCLUSION: Staging of COPD with a PFT and adherence to current GOLD guidelines was associated with lower costs in subjects with moderate to severe COPD. Appropriate use of LAMA plus LABA, LABA plus ICS, and LAMA plus LABA/ICS has economic as well as clinical benefits for patients and payers.

Economic burden and absenteeism from influenza-like illness in healthy households with children (5-17 years) in the US.

BACKGROUND: School children (5-17 years) function as vectors in influenza epidemics. The objective of this study was to quantify the burden of influenza-like illness (ILI) on US healthy households with school-aged children. METHODS: The Medical Expenditure Panel Survey database of 1996-2002 was queried to compare annual total medical expenses and absenteeism incurred by otherwise healthy households with school-aged children that reported experiencing ILI to similar households that did not experience ILI. RESULTS: We identified 12,850 healthy households with at least one school-aged child. Households reporting one or more ILI episodes incurred $281.47 higher total annual medical expenses than those without an ILI. Employed members in households with ILI lost an average of 1.12 more workdays from their illness compared to those in the households without ILI. Furthermore, households with ILI in which all members were employed and medically insured lost an additional 0.89 workdays due to caring for other ill household members. School children in households with ILI missed 1.91 more school days annually and 4.87 more school days if the household had three or more students. The total annual additional cost to a household experiencing ILI, including medical expenses and productivity losses was $538.75 for fully employed and insured households and $424.83 if one or more members were unemployed or uninsured. CONCLUSIONS: ILI increase economic burden among households with school-aged children and lead to more school and workdays lost. Initiatives to vaccinate school-aged children should be explored.

Antibiotic prescribing rates in the US ambulatory care setting for patients diagnosed with influenza, 1997-2001.

To document the rate and cost of antibiotic prescribing for patients diagnosed only with influenza during US ambulatory care visits. Federal survey data for 1997-2001 were used to estimate outpatient trends for all patients and healthy people age 5-49 years. Cost estimates were based on Medicare payments and Red Book average wholesale prices in 2003. Antibiotic prescribing for influenza is widespread; 38% of visits led to an antibiotic prescription of which one-third were for broad spectrum antibiotics. Inappropriate antibiotics cost dollar 18.5 million annually and may contribute to resistance. Increased vaccination rates and viral testing could reduce these trends.

Recent trends in severe respiratory syncytial virus (RSV) among US infants, 1997 to 2000.

OBJECTIVES: To provide current estimates of the incidence, associated risk factors, and costs of severe respiratory syncytial virus (RSV) infections among infants in the United States, defined as emergency department (ED) visits, hospitalization, and death. STUDY DESIGN: Retrospective analysis of National Hospital Ambulatory Medical Care Survey data 1997 to 2000; National Hospital Discharge Survey data 1997 to 2000; Perinatal Mortality Linked Files 1998 to 1999. The Hospital Cost Utilization Inpatient Sample data 1997 to 2000 were used to estimate hospitalization costs, and the 2001 Medicare fee schedule was used to estimate ED visit costs. Census data were used for population estimates. Between 1997 and 2000, there were 718,008 ED visits by infants with lower respiratory infection diagnoses during the RSV season (22.8/1000), and 29% were admitted. Costs of ED visits were approximately 202 million US dollars. RSV bronchiolitis was the leading cause of infant hospitalization annually. Total hospital charges for RSV-coded primary diagnoses during the 4 years were more than 2.6 billion US dollars. An estimated 390 RSV-associated postneonatal deaths occurred in 1999. Low birth weight and prematurity significantly increased RSV-associated mortality rates. CONCLUSIONS: RSV is a major cause of infant morbidity and mortality. Severe RSV is highest among infants of black mothers and Medicaid-insured infants. Prematurity and low birth weight significantly increase RSV mortality rates.

Time and out-of-pocket costs associated with respiratory syncytial virus hospitalization of infants.

OBJECTIVE: The objective of this study was to quantify time spent plus out-of-pocket costs associated with confirmed respiratory syncytial virus (RSV) hospitalization of infants not prophylaxed against RSV. METHODS: A prospective survey was carried out at multiple tertiary care hospitals in the United States. PATIENTS: The patients consisted of a consecutive sample of infants <12 months, born between 33 and 35 weeks of gestation. One site also enrolled full-term infants hospitalized with confirmed RSV. Daily patient census identified eligible patients. Consenting caregivers of eligible subjects (n=84, 1 refusal) were interviewed on discharge day and by telephone approximately 30 days following discharge regarding time and out-of-pocket costs due to RSV. RESULTS: Total average out of pocket expenses were 643.69 US dollars (range 21-16,867 US dollars; SD 2,403 US dollars) for premature and 214.42 US dollars (range 6-827 US dollars; SD 218 US dollars) (P=.0158) for full-term subjects. Total average economic burden per admission was 4517.07 US dollars for premature and 2135.30 US dollars for full-term infants, including the value of lost productivity but excluding inpatient hospital and physician bills and lost income. Premature infants (n=48) had longer hospital stays (mean 6.9 days; SD 7.5 vs. 3.4 days; SD 2.6 days) (P=.001) with an associated mean total time spent by up to 5 adults of 281.7 hours (range 25-2819.7 hours; SD 465.8 hours) versus a mean of 139.7 hours (range 31.8-561.3 hours; SD 118.1 hours) for term infants (P=.109). Time and out-of-pocket costs continued after discharge. CONCLUSIONS: RSV hospitalization of infants is associated with substantial, previously unmeasured time and monetary losses. These losses continued following discharge. The economic burden on families and society appears heavier for infants born at 33 to 35 weeks of gestation than for full-term infants.

Respiratory syncytial virus-coded pediatric hospitalizations, 1997 to 1999.

BACKGROUND: The recent number and rate of infant hospitalizations with a respiratory syncytial virus (RSV)-coded diagnosis have not been published. METHODS: Retrospective data analysis. National Hospital Discharge Survey data for 1997 to 1999 were analyzed for discharges of infants < 1 year old with an RSV-coded diagnosis (ICD-9-CM 466.11, 480.1, 079.6). Hospitalization rates were estimated with annual midyear Census data. RESULTS: RSV bronchiolitis was the leading primary diagnosis annually for all infants hospitalized for any reason. Between 1997 and 1999, 297 684 RSV-coded discharges of infants with an RSV-coded diagnosis occurred. The associated hospitalization rate was 25.2 per 1000 infants. RSV-coded discharges peaked in February. CONCLUSION: RSV bronchiolitis was the leading cause of hospital admissions of infants younger than age 1 year for any reason between 1997 and 1999.

A method for identifying the financial burden of hospitalized infants on families.

OBJECTIVES: To describe a method for measuring the direct and indirect costs to families of infants hospitalized with respiratory syncytial virus (RSV). METHODS: After pretesting and revising a questionnaire, a prospective survey was conducted in multiple tertiary-care hospitals with pediatric intensive care units. Eligible patients were infants less than 12 months old who had not received RSV prophylaxis and were hospitalized with a confirmed RSV infection. All English- and Spanish-speaking caregivers of eligible subjects were asked to participate in a face-to-face, structured interview on the day of hospital discharge regarding hospitalization-related direct and indirect costs. Thirty days later, caregivers were re-interviewed by telephone about their RSV-related costs during the elapsed month. The survey was initiated in February 2000 and continued through April 2001. RESULTS: In addition to the infants' parents, numerous adults visited 55% of hospitalized infants. In 17% of cases, nonparents missed work to visit the child. Volunteers watched siblings of 26% of the infants. Relying only on closed-ended questions about parents' costs during the hospitalization would have missed important information about child-care volunteers and types of expenses. Follow-up interviews revealed that RSV-related out-of-pocket expenses and missed work continued during the month following discharge. CONCLUSIONS: Survey instruments should be pretested with potentially eligible subjects. Open-ended questions are needed, because all costs cannot be anticipated. Respondents should be probed for details. This method revealed certain time and financial burdens during and after hospitalization that had not been previously reported in the literature.