Markers of iron deficiency in patients with polycythemia vera receiving ruxolitinib or best available therapy.

Polycythemia vera (PV) is characterized by erythropoiesis and JAK2-activating mutations, with increased risks of morbidity and mortality. Most patients with PV are iron deficient, and treatment often includes hematocrit control with phlebotomy, which may exacerbate iron deficiency-associated complications. The phase 3 RESPONSE trial evaluated the JAK1/JAK2 inhibitor ruxolitinib (n=110) versus best available therapy (BAT; n=112) in patients with PV who were hydroxyurea-resistant/intolerant. Ruxolitinib was superior to BAT for hematocrit control, reduction in splenomegaly, and blood count normalization. This exploratory analysis, the first to evaluate iron status in a prospective study of patients with PV, investigated ruxolitinib effects on 7 serum iron markers and iron deficiency-related patient-reported outcomes (PRO). Among patients with evidence of baseline iron deficiency, ruxolitinib was associated with normalization of iron marker levels, compared with lesser improvement with BAT. Iron levels remained stable in ruxolitinib patients with normal iron levels at baseline. Regardless of baseline iron status, treatment with ruxolitinib was associated with improvements in concentration problems, cognitive function, dizziness, fatigue, headaches, and inactivity, although improvements were generally greater among patients with baseline iron deficiency. The improvements in iron deficiency markers and PROs observed with ruxolitinib are suggestive of clinical benefits that warrant further exploration.

Hidden costs associated with venous thromboembolism: impact of lost productivity on employers and employees.

OBJECTIVE: To determine productivity loss and indirect costs with deep vein thrombosis (DVT) and pulmonary embolism (PE). METHODS: Medical and pharmacy claims with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed from the Integrated Benefits Institute's Health and Productivity Benchmarking (IBI-HPB) database (STD and LTD claims) and IMS LifeLink™ data (medical and pharmacy claims), which were indirectly linked using a weighting approach matching from IBI-HPB patients' demographic distribution. RESULTS: A total of 5442 DVT and 6199 PE claims were identified. Employees with DVT lost 57 STD and 440 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7414 and $58181, respectively. Employees with PE lost 56 STD and 364 LTD days per disability incident. The average per claim productivity loss from STD and LTD was $7605 and $48,751, respectively. CONCLUSIONS: Deep vein thrombosis and PE impose substantial economic burdens.

The economic burden of acute coronary syndromes for employees and their dependents: medical and productivity costs.

OBJECTIVE: To determine the total burden of illness, including direct and indirect costs for employees and their dependents with acute coronary syndrome (ACS). METHODS: Medical and pharmacy claims along with short-term disability (STD) and long-term disability (LTD) claims from 2007 to 2010 were analyzed using two data sets: Integrated Benefits Institute's Health and Productivity Benchmarking Database (STD and LTD claims) and IMS LifeLink™ Health Plan Data (medical and pharmacy claims). RESULTS: Employees with ACS lost 60.2 ± 0.29 STD and 397.9 ± 8.09 LTD days per disability incident. For employers, the estimated average per claim productivity loss from STD and LTD was $7943 ± 39.7 and $52,473 ± 1114, respectively. Total annual ACS health care costs per employee were $8170 ± 106, with $7545 ± 104 for annual medical costs. Hospitalizations accounted for 75% of total annual ACS health care costs. CONCLUSIONS: ACS imposes a substantial economic burden on employees, employers, and society.

Work absences and expenditures for employees with autoimmune inflammatory diseases.

OBJECTIVE: Economic burden was compared for employees with autoimmune inflammatory diseases (AutoIDs) who received anti-tumor necrosis factor (TNF) α agents, those who did not, and those with no AutoID. METHODS: Retrospective claims data analysis (2000-2006). Propensity analysis created two groups: (1) adult AutoID patients with anti-TNFα therapy (AutoID/anti-TNFα) matched to those with no anti-TNFα therapy (AutoID/non-anti-TNFα), and (2) non-AutoID patients (control) matched to all AutoID patients (AutoID). Indirect, direct, and total expenditures after controlling for various covariates were compared using regression analysis. RESULTS: Total direct and total expenditures were, respectively, $13,187 and $13,373 higher for AutoID/anti-TNFα group (n = 689) versus AutoID/non-anti-TNFα group (n = 2699). Indirect expenditures were not statistically different between the groups. AutoID- (n = 12,612) and control-group (n = 48,895) differences showed similar trends. CONCLUSIONS: These results provide useful information to employers about the cost burden associated with AutoIDs.

Reducing total health burden from 2001 to 2009: an employer counter-trend success story and its implications for health care reform.

OBJECTIVES: To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs. METHODS: Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001-2002 to 2008-2009. RESULTS: Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred. CONCLUSIONS: Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.

The self-reported health and productivity burden of autoimmune disorders at a major self-insured employer.

OBJECTIVES: Examine the self-reported health and productivity burden of three autoimmune disorders: rheumatoid arthritis, psoriasis, and inflammatory bowel disease. METHODS: A 2009 representative survey of a major employer's US workforce, with two approaches for disease identification: (1) self-report and (2) self-report replicated by claims-based International Classification of Diseases, 9th Revision (ICD-9), codes. RESULTS: Self-reported prevalence: rheumatoid arthritis, 4.2%; psoriasis, 3.0%; inflammatory bowel disease, 1.2%. Psoriasis and inflammatory bowel disease replicated rheumatoid arthritis' pattern of health and productivity effects though not as strongly. The three autoimmune disorders combined significantly affected health at all severity levels. They also significantly affected productivity at higher severity but not at no symptom/lower severity levels. CONCLUSIONS: When employees with autoimmune disorders with lower severity/no symptoms do not progress to higher severity, their work performance remains on par with healthy employees. Autoimmune disorders' high impact/low prevalence offers much promise for lowering costs through benefit design.

How to align evidence-based benefit design with the employer bottom-line: a case study.

OBJECTIVE: To illustrate how to use evidence-based benefit design (EBD) by presenting the case study of a major manufacturer. METHOD: Key components of the company's measurement and management approach to EBD are introduced. Descriptive results on the direct and indirect cost and utilization trends of the company's US active workforce during 2002 to 2008 are presented. RESULTS: From 1999 to 2002 aggregated to 2008, health care costs dropped sharply, with 2006, 2008, and projected 2009 reporting decreases even as annualized increases in national expenditures approximated 10%. Annualized rates for hospitalizations, office visits, and prescriptions showed corresponding decreases from 2004 to 2008. From 2002 to 2008, workers' compensation/disability and absenteeism costs decreased 38% and 46%, respectively. CONCLUSIONS: These results support the company's direction in health benefit design although further confirmation is needed. Ongoing quality improvement processes are discussed, as are implications for implementing EBD.

Evidence-based benefit design: toward a sustainable health care future for employers.

Health care costs for employers are rising much faster than inflation. The common approach to health benefit design of increasing cost sharing has failed to contain costs. Some employers, however, have been successful at mitigating the cost trend or actually reducing health care costs. These employers have in common a dedication to data analysis, a search for cost drivers, and a willingness to adjust their approach to health benefit design to address these cost drivers. This approach has much in common with the movement in clinical practice toward evidence-based medicine. We propose that employers adopt a similar approach toward health benefits termed evidence-based benefit design, which is based on a health and productivity framework focused on direct and indirect costs. Evidence-based benefit design incorporates the relevant literature and employer-specific data that are integrated and regularly analyzed.