Myeloproliferative neoplasms (MPNs) are associated with substantial healthcare resource use and productivity loss. This retrospective cohort analysis used disability leave and medical claims data to measure direct and indirect healthcare costs associated with MPNs. The analysis included 173 patients with myelofibrosis (MF), 4477 with polycythemia vera (PV), 6061 with essential thrombocythemia (ET), and matched controls (n = 519, n = 13,431, and n = 18,183, respectively). Total healthcare costs were significantly higher for cases versus controls in each cohort (mean cost difference: MF, $67,456; PV, $10,970; ET, $22,279). Cases were more likely than controls to take disability leave and incurred higher disability-related costs. Among subgroups with thrombotic events, direct and indirect costs were higher for cases versus controls. Thrombotic events substantially increased direct costs and disability leave for patients with PV or ET compared with the full PV or ET cohorts. These findings demonstrate increased economic burden for patients with MPNs.

The total economic burden of cancer reflects direct and indirect costs, including productivity loss due to employment change, absenteeism, presenteeism, and premature death of patients and impacts on caregivers. This study estimated the magnitude of employment decrease among employees newly diagnosed with early (non-metastatic) versus late-stage (metastatic) cancer in the US.

The total economic burden of cancer reflects direct and indirect costs, including productivity loss due to employment change, absenteeism, and presenteeism of patients and caregivers. This study estimated the magnitude of employment decrease, work absence (WA), short-term disability (STD), long-term disability (LTD), and associated indirect costs among employees newly diagnosed with metastatic versus non-metastatic cancer in the USA. IBM® MarketScan® Commercial Claims and Encounters and Health and Productivity Management databases were used to identify employees aged 18–64 years and newly diagnosed with any cancer from 2009 to 2019. Proportions of patients with employment decrease, WA, STD, and LTD claims, and number of days missing from work were summarized by metastatic status during the first 12 months after diagnosis and the entire follow-up period. Subgroup analyses were conducted by age (< 50 years, ≥ 50 years) and cancer type (breast, lung, colon, pancreatic, and liver cancer). During the first year after diagnosis, compared to patients without metastases, significantly higher proportions of patients with metastases had employment decrease and STD or LTD claims (p < 0.001). The mean total number of days missing from work for patients with versus without metastases was 33.39 versus 14.91 (ratio = 2.40), 64.05 versus 27.15 (ratio = 2.36), and 105.93 versus 46.29 (ratio = 2.29) days within 3, 6, and 12 months after diagnosis, respectively. Estimates of indirect cost differences between the two groups ranged from $6,877 to $22,283 in the first year. Earlier detection of cancer may reduce productivity loss of patients and indirect costs by initiating treatment before cancer progresses to late stage.

This study aimed to characterize the effects of insomnia treatment adherence on the healthcare utilization and cost burden among insomnia patients with Alzheimer's disease dementia (AD) and comorbid depression, using real-world data.

This study aimed to characterize the incremental healthcare burden of insomnia among patients with Alzheimer's disease dementia (AD) with or without depression using real-world data.

BACKGROUND:Insomnia is associated with worsened clinical outcomes among Alzheimer's disease dementia (AD) patients, increased caregiver burden, and healthcare utilization.OBJECTIVE:This study aimed to characterize the incremental healthcare burden of insomnia in AD using real-world data.METHODS:A retrospective observational study was conducted on AD patients selected from the IBM® MarketScan Commercial and Medicare Supplemental Databases. AD patients with claims-based evidence of insomnia were direct matched to a non-insomnia cohort based on demographic factors. Healthcare utilization and associated costs were assessed for a 12-month follow-up period.RESULTS:A total of 3,500 insomnia AD patients and 9,884 non-insomnia AD patients were analyzed. The insomnia cohort had a higher comorbidity burden at baseline (mean score on Charlson Comorbidity Index 2.5 versus 2.2, p < 0.001) and higher proportions of patients with baseline diagnoses for other conditions including depression: 40%, insomnia cohort versus 25%, non-insomnia (p < 0.001). AD patients with insomnia were more likely to have a claim for inpatient hospitalizations (39.8%versus 32.3%), emergency room services (56.4%versus 48.0%), and skilled-nursing services (42.6%versus 31.9%) (all p < 0.05). Mean total annual healthcare costs during the 12-month follow-up period were significantly higher among AD patients with insomnia as compared to those without. (Mean costs: $37,356 versus $27,990, p < 0.001).CONCLUSION:AD patients with comorbid insomnia are more likely to use higher-cost healthcare services such as inpatient hospitalization, and skilled nursing, and have higher total healthcare costs. This real-world analysis provides evidence that AD disease management should consider proper treatment of comorbid insomnia due to the incremental burden and cost implications.

Despite an array of therapeutic options, multiple myeloma (MM) remains an incurable malignancy for most patients. A substantial unmet need exists in the treatment of MM, particularly for patients requiring multiple lines of therapy (LoT). This analysis describes clinical outcomes and treatment patterns among patients with MM initiating their first therapy after treatment with lenalidomide (LEN).

BACKGROUNDEndometriosis is a painful chronic inflammatory disease caused by endometrial tissue implanting and growing outside the uterus, resulting in pelvic pain symptoms and subfertility. Treatment imposes a substantial economic burden on the patient and health care system.OBJECTIVETo evaluate direct health care utilization and costs among women newly diagnosed with endometriosis compared with age-matched controls in a U.S. Medicaid population.METHODSThis retrospective cohort study used deidentified health care claims from the 2007-2015 MarketScan Multi-State Medicaid Database. Women (aged 18-49 years) newly diagnosed with endometriosis (ICD-9-CM 617.xx) during January 2008 through September 2014 were identified (date of first diagnosis = index date). Age-matched women without endometriosis (controls) were selected from the database and assigned index dates matching the distribution for endometriosis patients. Direct health care resource utilization (HCRU) and costs (medical and pharmacy) over the 12-month post-index period (2015 U.S. dollars) were computed by service category (hospitalization, emergency room visits, outpatient services, and prescriptions) and compared between study cohorts using the chi-square test for proportions and t-test for continuous variables.RESULTSThe final sample included 15,615 endometriosis patients and 86,829 matched controls. HCRU during the 12-month post-index follow-up period was significantly higher for endometriosis cases compared with controls in all measured categories. Hospital admissions occurred among 33.1% of cases and 7.2% of controls, and 65.8% of endometriosis patients were admitted for endometriosis-related surgery. Emergency room visits occurred in 71.5% of cases, and 42.2% of controls. Mean (SD) office visits were 10.4 (8.5) for endometriosis patients and 5.1 (6.9) for controls. Endometriosis patients had significantly more prescription claims than controls, 45.9 (42.0) versus 25.1 (39.1). Mean total direct health care costs were $13,670 ($29,843) for cases versus $5,779 ($23,614) for controls. All differences between cases and controls were significant at P < 0.001.CONCLUSIONSHealth care costs and resource utilization in all measured categories were higher among endometriosis cases than controls. The economic burden of endometriosis among patients with Medicaid insurance is substantial, underscoring the unmet medical need for earlier diagnosis and cost-effective treatments.DISCLOSURESThis study was funded by AbbVie and conducted by Truven Health Analytics, an IBM Company. AbbVie participated in developing the study design, data analysis and interpretation, manuscript writing and revisions, and approval for publication. Soliman and Vora are employees of AbbVie and may own AbbVie stock/stock options. Surrey has served in a consulting role on research to AbbVie and is on the speaker bureau for Ferring Laboratories. Bonafede and Nelson are employees of Truven Health Analytics, an IBM Company, which received compensation from AbbVie for the overall conduct of the study and preparation of the manuscript. Agarwal has served in a consulting role on research to AbbVie. Preliminary results of this study were previously presented in a podium session at the 2017 American Society for Reproductive Medicine Scientific Congress and Expo; October 28-November 1, 2017; San Antonio, TX.

BACKGROUND:Central precocious puberty (CPP), early onset of puberty caused by the premature activation of the hypothalamic-pituitary-gonadal axis, is a rare disease affecting children of both sexes. There is limited evidence that quantifies the economic burden of CPP.OBJECTIVE:To characterize the health care resource utilization (HRU) and costs among patients with CPP who were treated with gonadotropinreleasing hormone (GnRH) agonists, for those insured commercially and with Medicaid.METHODS:Eligible CPP patients for this retrospective cohort analysis were aged ≤ 12 years; were diagnosed between January 1, 2010, and September 30, 2014; and had at least 1 prescription for an FDA-approved GnRH agonist: leuprolide or histrelin (first prescription = index date). CPP patients had to be continuously enrolled in the MarketScan Commercial or Medicaid Database for at least 12 months before and after the index date. Control patients were randomly selected from all eligible non-CPP patients and N:1 matched on demographic characteristics with up to 20 controls per case. Clinical comorbidities, HRU, and costs were compared between study cohorts. Health care costs were examined via multivariable analysis to adjust for baseline differences between patients and controls. Treatment patterns among CPP patients were also characterized.RESULTS:There were 1,236 CPP patients and 24,206 controls with commercial insurance and 673 CPP patients and 11,965 controls with Medicaid insurance who met the inclusion criteria. Across payers, the mean age of CPP patients ranged from 7.6 years (Medicaid) to 8.5 (commercial), and 80%-87% were female. The mean observed duration (SD) of treatment with any approved GnRH agonist was 1.51 (0.98) years for commercial patients and 1.22 (1.04) for Medicaid patients. The mean age of discontinuation among patients who ceased GnRH agonist treatment ranged from 8.7 to 9.6 years. In the first year post-index, CPP patients had a greater number of unique diagnosis codes, unique medications, and comorbid conditions than controls. They also had significantly higher all-cause and diseasemonitoring related HRU. After adjusting for baseline characteristics, CPP patients with Medicaid insurance spent 6.42 times more ($16,768 [$31,460] vs. $2,610 [$4,897]), and patients with commercial insurance spent 12.25 times more ($19,940 [$20,132] vs. $1,628 [$1,645]) on health care in the year following treatment initiation than matched controls.CONCLUSIONS:Patients with CPP have substantially more comorbidities and greater HRU and costs than their non-CPP peers.DISCLOSURES:All funding for this study was provided by AbbVie, which participated in analysis and interpretation of data, drafting, reviewing, and approving the publication. All authors contributed to the development of the publication and maintained control over the final content. Soliman and Grubb are employed by AbbVie and hold stock in AbbVie. Bonafede and Nelson are employed by IBM Watson Health, which received funding from AbbVie to conduct this study. Klein is a paid consultant of AbbVie but was not compensated for any work on development of this manuscript for publication. Portions of this work were presented at Pediatric Academic Societies (PAS) 2018 Meeting, May 5-8, 2018, in Toronto, Canada, as a poster presentation titled "Examination of Economic Burden Among Commercially Insured Patients with Central Precocious Puberty (CPP)."

Abstract Aims: To compare treatment duration, healthcare resource utilization (HRU), and direct healthcare costs between patients with central precocious puberty (CPP) treated with leuprolide or histrelin, and between patients with Medicaid or commercial insurance. This information is important as it affects treatment choice and outcomes. Materials and methods: This retrospective cohort study identified commercial and Medicaid-insured CPP patients ≤12-years-old who were diagnosed between 1 January 2010 and 30 September 2014 and had ≥1 prescription for leuprolide or histrelin (first prescription = index date). Treatment patterns were measured for the duration of available data; whereas, all-cause and disease-monitoring HRU and all-cause costs were compared between treatment groups for the year following treatment initiation. Multivariable analysis was used to adjust healthcare costs for differences in baseline patient characteristics. Results: A total of 1,177 commercially-insured (907 leuprolide and 270 histrelin) and 658 Medicaid-insured (613 leuprolide and 45 histrelin) patients were identified. Mean age at treatment initiation ranged from 7.5–8.5-years-old, 11.1–20.5% of patients were male, and the mean treatment duration was over one year. Commercially-insured patients treated with histrelin used more services in general than those treated with leuprolide but had fewer office visits. Healthcare service utilization was similar between Medicaid-insured treatment groups. In both payer populations, costs were similar. Limitations: The number of Medicaid-insured patients who received a histrelin implant was low, and this may make the findings more sensitive to influence by outliers. Conclusions: Mean overall healthcare costs were similar between CPP patients treated with leuprolide and those treated with histrelin. Medicaid patients generally received less testing and were less likely to receive specialist care. Patients treated with histrelin had fewer office visits but also had a shorter overall treatment.

To address the ongoing discussion related to the costs of diagnosing vaginitis the study compared the impact of diagnoses using nucleic acid amplified testing (NAAT) with direct DNA probe (DP). Real-world outcomes using commercial medical claims data compared the diagnostic and therapeutic costs among vaginitis patients between a general population of women and women with diabetes.

The prevalence of endometriosis and the need for treatment in the USA has led to the need to explore the contemporary cost burden associated with the disease. This retrospective cohort study compared direct and indirect healthcare costs in patients with endometriosis to a control group without endometriosis.

To evaluate the direct healthcare utilization and costs among women with newly-diagnosed endometriosis compared to age-matched controls in a Medicaid population. Retrospective cohort study using a deidentified administrative claims database. Women aged between 18-49 years with claims for endometriosis diagnosis (ICD-9-CM 617.xx) from the Truven Health MarketScan® Multi-State Medicaid Database during January 2008 and September 2014, were identified (date of first diagnosis = index date). Age-matched women without endometriosis (controls) were selected from the database and assigned index dates matching the distribution of endometriosis patients index dates. Women with continuous enrollment for 12 months pre- and post-index, and no evidence of endometriosis pre-index were included. Annual direct healthcare utilization and costs (medical and pharmacy costs) over the 12-months post-index period (2015 US$) were computed and compared between the study cohorts using chi-square for proportions and t-tests for continuous variables. Final sample included 15,615 endometriosis patients (mean age 33.9) and 86,829 matched controls (mean age 34.0). During 12-month post-index, patients exhibited higher utilization rates and incurred significantly higher costs across all categories than matched controls (table; P<0.0001 for all comparisons). Approximately 66% of endometriosis patients had at least one endometriosis-related surgery. Pharmacy costs accounted for 15.3% of total healthcare costs among endometriosis patients and 22.2% among controls. Endometriosis-related costs accounted for an average of $3,069 (22.4%) of total healthcare costs among endometriosis patients. Endometriosis places a significant economic and resource burden among women with Medicaid coverage. Costs and resource utilization in all measured categories were higher among patients than controls.Tabled 1Endometriosis Patients (N=15,615)Controls (N=86,829)Difference of Mean CostsPer Patient Costs Mean (standard deviation)Total healthcare costs$13,670 (29,843)$5,780 (23,614)$7,890- Inpatient admissions$5,785 (25,550)$1,689 (17,842)$4,096- Emergency room$819 (1,985)$270 (914)$549- Outpatient visits$606 (675)$277 (592)$329- Outpatient pharmacy$2,096 (6,173)$1,281 (5,140)$815Healthcare utilization% (number of patients with indicated care)Inpatient admissions33.1% (5,168)7.2% (6,219)Emergency room71.5% (11,164)42.2% (36,624)Outpatient visits- OB/GYN outpatient visits96.8% (15,121)28.5% (4,443)71.6% (62,194)8.2% (7,097)Outpatient pharmacy99.2% (15,492)75.7% (65,685) Open table in a new tab

Objective: To compare direct and indirect costs between endometriosis patients who underwent endometriosis-related surgery (surgery cohort) and those who have not received surgery (no-surgery cohort).Design: Retrospective cohort study.Setting: Not applicable.Patient(s): Endometriosis patients (aged 18-49 years) with (n = 124,530) or without (n = 37,106) a claim for endometriosis-related surgery were identified from the Truven Health MarketScan Commercial and Health and Productivity Management databases for 2006-2014.Intervention(s): Not applicable.Main Outcome Measure(s): Primary outcomes were healthcare utilization during 12-month pre- and post-index periods, annual direct (healthcare) and indirect (absenteeism and short-and long-term disability) costs during the 12-month post-index period (in 2014 US dollars). Indirect costs were assessed for patients with available productivity data.Result(s): Patients in the surgery cohort had significantly higher healthcare resource utilization during the post-index period and had mean annual total adjusted post-index direct costs approximately three times the costs among patients in the no-surgery cohort ($19,203 [SD $7,133] vs. $ 6,365 [SD $2,364]; average incremental annual direct cost = $12,838). The mean cost of surgery ($7,268 [SD $7,975]) was the single largest contributor to incremental annual direct cost. Mean estimated annual total indirect costs were $8,843 (surgery cohort) vs. $5,603 (no-surgery cohort); average incremental annual indirect cost = $3,240.Conclusion(s): Endometriosis patients who underwent surgery, compared with endometriosis patients who did not, incurred significantly higher direct costs due to healthcare utilization and indirect costs due to absenteeism or short-term disability. Regardless of the surgery type, the cost of index surgery contributed substantially to the total healthcare expenditure. (C) 2017 by American Society for Reproductive Medicine.

Study Objective: To describe healthcare resource utilization and costs among commercially insured women with newly diagnosed abnormal uterine bleeding (AUB).

A previous cohort study indicated that atazanavir (ATV), a protease inhibitor used for HIV treatment, is not associated with an increased risk of cardiovascular (CV) events. The objective of this study was to compare the risk of CV events among antiretroviral-naïve patients initiating ATV-containing versus ATV-free ARV regimens.

To describe time to treatment among commercially insured women with newly diagnosed abnormal uterine bleeding (AUB).

A proportion of days covered (PDC) threshold of ≥80% is commonly used to classify patients as adherent to a medication; however, the relationship between adherence and outcomes may be more complex than a binary classification. This study examined the functional form of the relationship between adherence to glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy and medical healthcare costs among U.S. patients with type 2 diabetes (T2D). This retrospective cohort study used a large US administrative claims database. Patients were included if they had T2D, were GLP-1RA–naïve, initiated GLP-1RA therapy from 2/1/2012–10/1/2012 (date of initiation=index), were aged ≥18 years at index, and had continuous enrollment for 12 months before (baseline) to 12 months after index (follow-up). The PDC for the initiated GLP-1RA was calculated over follow-up and patients were partitioned into PDC deciles, thus allowing examination of non-linear relationships between the PDC and medical costs (inpatient + outpatient medical, excludes pharmacy). Multivariable regressions examined the association between PDC deciles and medical costs, adjusting for confounders. Study sample included 17,275 patients. In multivariable analyses, the association between PDC deciles and overall medical costs suggested that costs decreased non-linearly with increasing adherence deciles (using PDC decile 1 [D1, lowest adherence] as reference, cost ratios were: D2=1.12, P=0.191; D3=0.82, P=0.005; D4=1.01, P=0.884; D5=0.91, P=0.188; D6=0.87, P=0.042; D7=0.80, P=0.001; D8=0.70, P<0.001; D9=0.64, P=<0.001; D10=0.66, P<0.001). Similar results were observed for diabetes-specific (medical claims with a diagnosis of T2D) medical costs (PDC D1 as reference: D2=1.05, P=0.663; D3=0.71, P<0.001; D4=0.96, P=0.710; D5=0.82, P=0.033; D6=0.88, P=0.277; D7=0.77, P=0.011; D8=0.65, P<0.001; D9=0.57, P<0.001; D10=0.62, P<0.001). In U.S. patients with T2D newly initiating GLP-1RA therapy, the relationship between the PDC and medical healthcare costs was non-linear but the costs generally decreased with increasing PDC; this relationship was particularly evident at decile 7 and higher.

To describe incremental direct and indirect costs among endometriosis patients who undergo endometriosis-related surgical procedures. Retrospective cohort study of a deidentified administrative claims database. Truven Health MarketScan Commercial and Health and Productivity Management Databases were used to identify women aged 18-49 undergoing hysterectomy, oophorectomy, laparotomy or laparoscopy (index event) with an endometriosis diagnosis (ICD-9-CM 617.xx) on the day of surgery January 2006 and June 2014. Non-surgery controls had ≥2 endometriosis diagnoses (second dx = index event). Surgery patients had at least 12 months of continuous enrollment pre- and post-index, and no endometriosis-related surgery pre-index. Main study outcomes were the costs of surgeries defined as all costs on the day of surgery (for outpatient procedures) or during the same admission (for inpatient procedures), and the direct and indirect costs in the 12-months post-index date in 2014 US$. Indirect costs were assessed on a subset of patients with available data. The sample included 124,530 surgery and 37,106 non-surgery patients. Pre-index healthcare costs were lower for the surgery cohort ($6,840 vs. $8,247, p<.001). Surgery cost was highest for oophorectomy, followed by hysterectomy, laparotomy and laparoscopy (table). Direct and indirect costs were significantly higher for surgery patients. Total healthcare, endometriosis-related, and indirect costs due to short-term disability were highest among oophorectomy patients while indirect costs due to absence were highest among hysterectomy patients. Pharmacy costs were 9% and 24%of total healthcare costs among surgery and non-surgery patients, respectively. Multivariable regression-adjusted estimated total annual indirect costs were $8,843 for surgery patients and $5,603 for non-surgery controls (p<.001). Among endometriosis patients, endometriosis-related surgery was associated with higher 12-month incremental direct and indirect costs.Tabled 1Mean 12-month costs in 2014 $ (SD)(Total N = 161,636)No surgerySurgery (overall)HysterectomyLaparoscopyLaparotomyOopherectomyTotal healthcare(medical + pharmacy)$7,013(18,038)$18,881(17,708)$19,854(19,304)$17,133(16,470)$21,031(25,122)$23,813(25,511)Outpatient pharmacy$1,696(4,879)$1,736(3,881)$1,565(3,766)$1,949(3,934)$1,755(4,722)$1,752)(3,677)Endometriosis-related*$275(1,558)$8,417(8.943)$8,652(9,053)$7,678(7,835)$10,589(11,588)$12,878(16,379)Costs of qualifying surgeryNA$7,225(7,975)$9,955(8,659)$3,422(3,936)$8,592(10,085)$11,962(10,304)Indirect: Absence(N = 1,927)$4,781(3,335)$6,238(4,745)$6,936(4,720)$5,235(4,355)$6,305(6,611)$6,616(5,845)Indirect: Short-term disability(N = 11,931)$597(2,639)$2,379(3,457)$3,274(3,646)$1,249(2,872)$1,903(2,641)$3,630(3,921)All surgical group costs (surgery overall, hysterectomy, laparoscopy, laparotomy and oophorectomy) were significantly higher than the No Surgery cohort (all p<0.001), except for pharmacy costs which were not significantly different between the surgery overall and the no surgery group. Additionally, pharmacy costs were significantly lower among the hysterectomy cohort (p<0.001), and higher among the laparoscopy cohort (p<0.001 compared to the no surgery group)* Endometriosis-related healthcare costs includes costs of all medical claims with a diagnosis indicating endometriosis as well as prescription claims for endometriosis-related drugs Open table in a new tab