- Email: [email protected]
Effect of Financial Incentives on Health Promotion Participation
A32
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
Data was obtained using pharmacy claims. Drug classes were identified based on the first two digits of the generic product identifier (GPI). The total number of inmates and the total medication fill frequency were collected. In each drug class, the number of the patients and the medication fill frequency with their respective percentages were identified and calculated. The percentage cost for each drug class was also calculated and compared. Results: Medications were classified into twenty different drug classes. During the study period, a total of 44,466 patients were identified with a total medication fill frequency of 1,358,295. A large percentage of patients were on medications for chronic conditions and most patients were on pain/analgesic medications (70.07%). Psychotherapeutic and pain/analgesic medication drug classes were filled most frequently (16.05% and 14.81% respectively). HIV and hepatitis C medications have the highest medication expenditures (43.44% and 14.09% respectively). Conclusions: There is a lack of data concerning medication cost and consumption in the incarcerated population. This study showed that most of the patients in the state correctional facilities were on medications for chronic diseases with neurological conditions as the highest frequency of medication fills. HIV and hepatitis C patients had the highest medication cost expenditures, as expected. The results of this study help us understand the key drivers of high medication cost in this understudied population and possibly lead to the development of appropriate pharmaceutical care management. PHS127 Assessment and Characterization of Gaps in Literature of Resource Utilization and Economic Burden in Inflammatory Myopathies Gala S, Mwamburi M Market Access Solutions LLC, Raritan, NJ, USA
Objectives: Inflammatory myopathies (IM) including polymyositis (PM), dermatomyositis (DM), and inclusion-body myositis (IBM) pose a significant burden on patients and payers. These rare diseases have no approved treatments or clinical guidelines, however their cost burden equals or exceeds that of rheumatoid arthritis and systemic sclerosis. There are significant knowledge gaps on resource utilization and cost burden in IM. We conducted gap assessment to identify and characterize gaps in existing knowledge with respect to the individual myopathies. Methods: We conducted a systematic literature review in PubMed and conference proceedings of American College of Rheumatology (ACR) and International Society for Pharmacoeconomics and Outcomes Research (ISPOR). We limited the search to between 2011 and 2015, to US-based human studies, and published in English language. After screening and identifying eligible studies, we extracted data on resource utilization and costs. We analyzed the data qualitatively to characterize knowledge gaps. Results: Of 232 titles screened, one full-text article and three conference proceedings (2 ACR, 1 ISPOR) qualified for inclusion. Two studies were database analyses and two were survey analyses. Three studies reported resource utilization and cost data for IBM, one study for PM/DM. Resource utilization rates and cost data were available for healthcare visits, therapies (only for PM/DM) and use of aids for each sub-type of IM. Resource utilization for diagnoses, medical therapy, over-the-counter (OTC) medications, and ambulatory care visits for IBM, and for outpatient (OP) visits, home care, physical therapy (PT), OTC medications, and counseling for PM/DM were not reported. Costs pertaining to diagnoses, OP visits, specialist visits, home care, PT, counseling, adverse events, caregiver burden, out-of-pocket burden were not reported for any myopathy. Conclusions: With significant interest in research targeted towards development of new drugs for IM, a comprehensive understanding of resource utilization and associated costs of all components of care is essential for each sub-type of IM. PHS128 Determining the Value of a Health System/School Partnership to Provide School Health and Pediatric Care in School: A Cost-Benefit Analysis Mueller JM1, Johnson S2, Connor K2, Calderon Velazquez G2, Padula WV1 Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2Johns Hopkins University, Baltimore, MD, USA
Marrugo Arnedo C1, Florez tanuz A2, Gomez de la rosa F2, Lopez pajaro K3, Orozco Africano J2, Alvis Guzman N2 1Universidad de Cartagena. Centro de Investigación y Docencia. Hospital Infantil Napoleón Franco Pareja, Cartagena de Indias, Colombia, 2Grupo de investigación en economía de la salud - GIES, Cartagena, Colombia, 3Centro de investigación e Innovación en Salud - CiiSA, Cartagena de Indias, Colombia
Objectives: To estimate the concentration of health care expenditure of a public health insurance company in 2014. Methods: The health expenditure was analyzed by health care services and pathological groups of a Colombian public health insurance company with approximately 1.650.000 members from poor households. The Gini coefficient was used to describe the concentration of health expenditure and interpreted with the Lorenz curve to graph and represent the inequality. Results: The health care expenditure of the insurance company was USD 418 million. From this expenditure, 81% was cover within the Colombian Compulsory Health Plan, whereas the other 19% was not. The pathological groups that concentrated 43,4% of health expenditure were Cardiovascular (14,3%), Cancer (7,8%), Respiratory diseases (7,3%), Urinary diseases (7%) and Trauma (6,9%). Diagnostic, curative and rehabilitative services represented 77,8% of health care expenditure. Inpatient stay was the service with higher cost proportion of the health care expenditure (47%) and outpatient visit the commonly used. Lorenz curve showed that 80% of health care expenditure was concentrated in approximately 25% of members with a Gini coefficient of 0,58. Conclusions: Diagnosis and treatment of chronic non-communicable diseases, concentrated a high proportion of health care expenditures which generate a challenge for resources of health care promotion and preventive services. PHS130 Impact of patient nonadherence to diabetes treatment on complication risks and health care costs Mizobe M, Fukuda H Kyushu University, Fukuoka, Japan
Objectives: To investigate the association between nonadherence to diabetes treatment and the occurrence of diabetes complications. Methods: Our study retrospectively identified adherence and nonadherence to diabetes treatment in patients during the first year of observation after new diagnoses of type 2 diabetes, and compared the occurrence of complications and healthcare expenditure between adherent and nonadherent patients for the second to eighth years. Study participants were insurance enrollees with type 2 diabetes who received healthcare between 2005 and 2013, and who could be tracked for more than 12 months from the initiation of diabetes treatment. We measured occurrence of diabetes-related complications (retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion) and all-cause healthcare expenditure. Cox proportional hazards regression models were used to investigate the effects of nonadherence on complication occurrence. To analyze the effects of nonadherence on the cumulative healthcare expenditure according to the number of elapsed years, we developed a generalized linear model (GLM) with a log-link function and gamma distribution. Results: We identified 1,784 nonadherent patients and 9,547 adherent patients. Cox proportional hazard models showed that the occurrence of microvascular complications was significantly higher in the nonadherent group: the hazard ratios (95% confidence intervals) for retinopathy, nephropathy, and neuropathy were 2.04 (1.57–2.66), 1.91 (1.35–2.72), and 1.83 (1.02–3.27), respectively. However, no significant differences were observed between the adherent and nonadherent groups for the macrovascular complications (ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion). In addition, the nonadherent group had a significantly higher cumulative healthcare expenditure than the adherent group during the second-to-fifth–year period (p = 0.029) and the second-to-sixth–year period (p = 0.009) after treatment initiation. Conclusions: Nonadherence in the first year of diabetes can increase the incidence of complications and result in higher expenditures for patients and payers.
1Johns
Objectives: The Rales Health Center at KIPP Baltimore (RHC), is a high service school-based health center (SBHC) that provides a full range of pediatric services. The objective of this study was to analyze the cost-benefit of the RHC to a previous traditional school health model (standard care). Methods: The cost-benefit of RHC was analyzed from the societal (community) perspective using a decision tree model previously described by Guo et al (2010). As a high service SBHC, RHC employs 1 Medical Assistant, 1 Nurse Practitioner (NP), 1.75 Registered Nurses (RN) and 0.6 Pediatricians. This was compared to standard care, which included 1 RN, 1 Medical Assistant and 0.2 NPs. We assumed that the SBHC could handle greater throughput of student health issues related to asthma, decreased prescription costs, and reduced parental resources invested in health care in terms of missed time at work, as well as improve student attendance. Costs of employment were measured in 2015 $U.S. using data from the U.S. Bureau for Labor and Statistics, and overhead was also monetized. Benefits were measured in various terms. The willingness-topay threshold from the societal perspective was assumed as $0 due to anticipated budget constraints of a school board, and was used to calculate Net Monetary Benefit (NMB). Univariate and multivariate sensitivity analyses were conducted. Results: The cost to operate RHC was estimated at $363,726 compared to standard care cost of $116,201 (incremental cost = $247,525). Total monetized incremental benefits of RHC were estimated in the range of $343,792-$471,901. The NMB for RHC was $96,267-$224,376, which is largely cost-beneficial to a community. Conclusions: The RHC SBHC model provides excellent value to the community and prevents overutilization of health services. Communities should consider adoption of similar SBHCs in school settings to reduce costs and improve school attendance. PHS129 The Concentration of Health Care Expenditure of a Colombian Public Health Insurance Company
PHS131 Effect of Financial Incentives on Health Promotion Participation Navratil-Strawn J Optum, Minneapolis, MN, USA
Objectives: Many employers provide health management/promotion incentives to improve program participation. The objective of this study was to assess the impact financial incentives have on health assessment (HA) and biometric screenings participation. Methods: Data from commercial customers with incentives (N= 145) were compared to groups without incentives (N= 302). Propensity score matching and multivariate regression models were used to control for differences in client characteristics. Results: Incentive groups had higher participation rates for HA (37.0% vs. 15.9%) and biometrics (18.4% vs. 6.1%). HA participation increased from 26.2% to 36.3% with benefit plan richness (e.g. more health promotion product offerings) for incentive plans compared to only 9.1% and 17.0% for the non-incentive cohorts. Biometric participation was also higher for incentives customers with greater health promotion offerings then the non-incentives group. Conclusions: Health assessment and biometric participation was higher for customers offering more health promotional products and incentives to employees then the nonincentives cohort. PHS132 Final Year Medical Students’ Perception Towards Generic Medicines in Southeast Yemen AL-Tamimi SK1, Hassali MA1, Shafie AA1, Alrasheedy AA2 Sains Malaysia, Penang, Malaysia, 2Qassim University, Buraidah, Saudi Arabia
1Universiti
Objectives: 1) to evaluate the knowledge and perception of final year medical students about generic medicines. 2) To explore factors could affect final-year medical students’ future prescribing practice. Methods: All final year medical students from two governmental universities (n= 322) were invited to participate
VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 1 - A 3 1 8
Data was obtained using pharmacy claims. Drug classes were identified based on the first two digits of the generic product identifier (GPI). The total number of inmates and the total medication fill frequency were collected. In each drug class, the number of the patients and the medication fill frequency with their respective percentages were identified and calculated. The percentage cost for each drug class was also calculated and compared. Results: Medications were classified into twenty different drug classes. During the study period, a total of 44,466 patients were identified with a total medication fill frequency of 1,358,295. A large percentage of patients were on medications for chronic conditions and most patients were on pain/analgesic medications (70.07%). Psychotherapeutic and pain/analgesic medication drug classes were filled most frequently (16.05% and 14.81% respectively). HIV and hepatitis C medications have the highest medication expenditures (43.44% and 14.09% respectively). Conclusions: There is a lack of data concerning medication cost and consumption in the incarcerated population. This study showed that most of the patients in the state correctional facilities were on medications for chronic diseases with neurological conditions as the highest frequency of medication fills. HIV and hepatitis C patients had the highest medication cost expenditures, as expected. The results of this study help us understand the key drivers of high medication cost in this understudied population and possibly lead to the development of appropriate pharmaceutical care management. PHS127 Assessment and Characterization of Gaps in Literature of Resource Utilization and Economic Burden in Inflammatory Myopathies Gala S, Mwamburi M Market Access Solutions LLC, Raritan, NJ, USA
Objectives: Inflammatory myopathies (IM) including polymyositis (PM), dermatomyositis (DM), and inclusion-body myositis (IBM) pose a significant burden on patients and payers. These rare diseases have no approved treatments or clinical guidelines, however their cost burden equals or exceeds that of rheumatoid arthritis and systemic sclerosis. There are significant knowledge gaps on resource utilization and cost burden in IM. We conducted gap assessment to identify and characterize gaps in existing knowledge with respect to the individual myopathies. Methods: We conducted a systematic literature review in PubMed and conference proceedings of American College of Rheumatology (ACR) and International Society for Pharmacoeconomics and Outcomes Research (ISPOR). We limited the search to between 2011 and 2015, to US-based human studies, and published in English language. After screening and identifying eligible studies, we extracted data on resource utilization and costs. We analyzed the data qualitatively to characterize knowledge gaps. Results: Of 232 titles screened, one full-text article and three conference proceedings (2 ACR, 1 ISPOR) qualified for inclusion. Two studies were database analyses and two were survey analyses. Three studies reported resource utilization and cost data for IBM, one study for PM/DM. Resource utilization rates and cost data were available for healthcare visits, therapies (only for PM/DM) and use of aids for each sub-type of IM. Resource utilization for diagnoses, medical therapy, over-the-counter (OTC) medications, and ambulatory care visits for IBM, and for outpatient (OP) visits, home care, physical therapy (PT), OTC medications, and counseling for PM/DM were not reported. Costs pertaining to diagnoses, OP visits, specialist visits, home care, PT, counseling, adverse events, caregiver burden, out-of-pocket burden were not reported for any myopathy. Conclusions: With significant interest in research targeted towards development of new drugs for IM, a comprehensive understanding of resource utilization and associated costs of all components of care is essential for each sub-type of IM. PHS128 Determining the Value of a Health System/School Partnership to Provide School Health and Pediatric Care in School: A Cost-Benefit Analysis Mueller JM1, Johnson S2, Connor K2, Calderon Velazquez G2, Padula WV1 Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 2Johns Hopkins University, Baltimore, MD, USA
Marrugo Arnedo C1, Florez tanuz A2, Gomez de la rosa F2, Lopez pajaro K3, Orozco Africano J2, Alvis Guzman N2 1Universidad de Cartagena. Centro de Investigación y Docencia. Hospital Infantil Napoleón Franco Pareja, Cartagena de Indias, Colombia, 2Grupo de investigación en economía de la salud - GIES, Cartagena, Colombia, 3Centro de investigación e Innovación en Salud - CiiSA, Cartagena de Indias, Colombia
Objectives: To estimate the concentration of health care expenditure of a public health insurance company in 2014. Methods: The health expenditure was analyzed by health care services and pathological groups of a Colombian public health insurance company with approximately 1.650.000 members from poor households. The Gini coefficient was used to describe the concentration of health expenditure and interpreted with the Lorenz curve to graph and represent the inequality. Results: The health care expenditure of the insurance company was USD 418 million. From this expenditure, 81% was cover within the Colombian Compulsory Health Plan, whereas the other 19% was not. The pathological groups that concentrated 43,4% of health expenditure were Cardiovascular (14,3%), Cancer (7,8%), Respiratory diseases (7,3%), Urinary diseases (7%) and Trauma (6,9%). Diagnostic, curative and rehabilitative services represented 77,8% of health care expenditure. Inpatient stay was the service with higher cost proportion of the health care expenditure (47%) and outpatient visit the commonly used. Lorenz curve showed that 80% of health care expenditure was concentrated in approximately 25% of members with a Gini coefficient of 0,58. Conclusions: Diagnosis and treatment of chronic non-communicable diseases, concentrated a high proportion of health care expenditures which generate a challenge for resources of health care promotion and preventive services. PHS130 Impact of patient nonadherence to diabetes treatment on complication risks and health care costs Mizobe M, Fukuda H Kyushu University, Fukuoka, Japan
Objectives: To investigate the association between nonadherence to diabetes treatment and the occurrence of diabetes complications. Methods: Our study retrospectively identified adherence and nonadherence to diabetes treatment in patients during the first year of observation after new diagnoses of type 2 diabetes, and compared the occurrence of complications and healthcare expenditure between adherent and nonadherent patients for the second to eighth years. Study participants were insurance enrollees with type 2 diabetes who received healthcare between 2005 and 2013, and who could be tracked for more than 12 months from the initiation of diabetes treatment. We measured occurrence of diabetes-related complications (retinopathy, nephropathy, neuropathy, ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion) and all-cause healthcare expenditure. Cox proportional hazards regression models were used to investigate the effects of nonadherence on complication occurrence. To analyze the effects of nonadherence on the cumulative healthcare expenditure according to the number of elapsed years, we developed a generalized linear model (GLM) with a log-link function and gamma distribution. Results: We identified 1,784 nonadherent patients and 9,547 adherent patients. Cox proportional hazard models showed that the occurrence of microvascular complications was significantly higher in the nonadherent group: the hazard ratios (95% confidence intervals) for retinopathy, nephropathy, and neuropathy were 2.04 (1.57–2.66), 1.91 (1.35–2.72), and 1.83 (1.02–3.27), respectively. However, no significant differences were observed between the adherent and nonadherent groups for the macrovascular complications (ischemic heart disease, cerebrovascular disease, and chronic arterial occlusion). In addition, the nonadherent group had a significantly higher cumulative healthcare expenditure than the adherent group during the second-to-fifth–year period (p = 0.029) and the second-to-sixth–year period (p = 0.009) after treatment initiation. Conclusions: Nonadherence in the first year of diabetes can increase the incidence of complications and result in higher expenditures for patients and payers.
1Johns
Objectives: The Rales Health Center at KIPP Baltimore (RHC), is a high service school-based health center (SBHC) that provides a full range of pediatric services. The objective of this study was to analyze the cost-benefit of the RHC to a previous traditional school health model (standard care). Methods: The cost-benefit of RHC was analyzed from the societal (community) perspective using a decision tree model previously described by Guo et al (2010). As a high service SBHC, RHC employs 1 Medical Assistant, 1 Nurse Practitioner (NP), 1.75 Registered Nurses (RN) and 0.6 Pediatricians. This was compared to standard care, which included 1 RN, 1 Medical Assistant and 0.2 NPs. We assumed that the SBHC could handle greater throughput of student health issues related to asthma, decreased prescription costs, and reduced parental resources invested in health care in terms of missed time at work, as well as improve student attendance. Costs of employment were measured in 2015 $U.S. using data from the U.S. Bureau for Labor and Statistics, and overhead was also monetized. Benefits were measured in various terms. The willingness-topay threshold from the societal perspective was assumed as $0 due to anticipated budget constraints of a school board, and was used to calculate Net Monetary Benefit (NMB). Univariate and multivariate sensitivity analyses were conducted. Results: The cost to operate RHC was estimated at $363,726 compared to standard care cost of $116,201 (incremental cost = $247,525). Total monetized incremental benefits of RHC were estimated in the range of $343,792-$471,901. The NMB for RHC was $96,267-$224,376, which is largely cost-beneficial to a community. Conclusions: The RHC SBHC model provides excellent value to the community and prevents overutilization of health services. Communities should consider adoption of similar SBHCs in school settings to reduce costs and improve school attendance. PHS129 The Concentration of Health Care Expenditure of a Colombian Public Health Insurance Company
PHS131 Effect of Financial Incentives on Health Promotion Participation Navratil-Strawn J Optum, Minneapolis, MN, USA
Objectives: Many employers provide health management/promotion incentives to improve program participation. The objective of this study was to assess the impact financial incentives have on health assessment (HA) and biometric screenings participation. Methods: Data from commercial customers with incentives (N= 145) were compared to groups without incentives (N= 302). Propensity score matching and multivariate regression models were used to control for differences in client characteristics. Results: Incentive groups had higher participation rates for HA (37.0% vs. 15.9%) and biometrics (18.4% vs. 6.1%). HA participation increased from 26.2% to 36.3% with benefit plan richness (e.g. more health promotion product offerings) for incentive plans compared to only 9.1% and 17.0% for the non-incentive cohorts. Biometric participation was also higher for incentives customers with greater health promotion offerings then the non-incentives group. Conclusions: Health assessment and biometric participation was higher for customers offering more health promotional products and incentives to employees then the nonincentives cohort. PHS132 Final Year Medical Students’ Perception Towards Generic Medicines in Southeast Yemen AL-Tamimi SK1, Hassali MA1, Shafie AA1, Alrasheedy AA2 Sains Malaysia, Penang, Malaysia, 2Qassim University, Buraidah, Saudi Arabia
1Universiti
Objectives: 1) to evaluate the knowledge and perception of final year medical students about generic medicines. 2) To explore factors could affect final-year medical students’ future prescribing practice. Methods: All final year medical students from two governmental universities (n= 322) were invited to participate