- Email: [email protected]
Mo1092 Cost-Utility Analysis Shows Adalimumab Is Cost-Effective for the Management of Ulcerative Colitis
CDI = C. Difficile Infection; QALY = Quality Adjusted Life Year
Mo1089 Proving Cost Effectiveness Through Implementation of a Nurse-Led Inflammatory Bowel Disease (IBD) Patient Advice Line and Virtual Clinic (CHEAP) Alexandra Sechi, Elise Sawyer, Wa Sang Watson Ng, Susan J. Connor
a
P<.001 using paired t-test.
Background: In the care of patients with inflammatory bowel disease (IBD), a nurse-led IBD patient advice-line (AL) and virtual clinic (VC) is increasingly being recognised as an integral part of the IBD service. The AL is a telephone and email service for patients needing acute advice relating to their IBD. The VC involves the IBD specialist nurse reviewing and triaging patient investigations prior to a collaborative review with the IBD consultant. A subsequent plan of care is made, actioned and communicated to the patient via phone or email. The aims of this prospective audit were to evaluate the outcome of the nurse led AL and VC and to quantify the potential financial implication to the Australian healthcare system. Methods: Data was collected prospectively at Liverpool Hospital, a single tertiary IBD Specialist Referral Centre in Sydney. Each outpatient occasion of service (OOS) was recorded for the AL over a period of 4 months, and for the VC over 6 months. Both periods were completed on 31 October 2015, although data collection is ongoing. An OOS was only included when it resulted in a change to patient management. Each OOS was categorised into: a) General Practitioner consultation (GPC) avoided b) IBD outpatient consultation (OPC) avoided c) Emergency Department (ED) presentation or hospital admission avoided Costs incurred for the AL and VC included both the nursing time required (mean 21 hours per week) and the gastroenterologists' time (mean 3 hours per week). Savings were calculated based on the OOS that avoided GPC, IBD OPC, presentation to ED and admission to hospital. Costs were benchmarked using the Medicare Benefit Schedule (MBS) and Independent Hospital Pricing Authority (IHPA) of Australia and prices expressed in Australian dollars (AUD). Results: Over 4 months, 111 calls were received through the AL. Of these, 34 avoided GPC, 70 avoided IBD OPC, 6 ED presentations were avoided, and there was 1 avoided hospital admission. There were 438 VC OOS over the 6 month period. Of these, 3 avoided GPC, 400 avoided IBD OPC and 34 ED presentations were avoided. There were no unplanned presentations to ED, no unplanned hospitalisations and 1 patient presented to ED upon instruction. Avoidance of GPC, OPC and ED presentations led to a projected annual cost saving of $176 350, with the projected annual costs incurred being $65 289. Thus the projected annual net cost savings were $111 061. Conclusion: Specialised IBD nurse led AL and VC improves IBD patients' access to services, overall care and reduces healthcare costs. This highlights the importance of a proactive multidisciplinary approach in optimising the care of patients with IBD.
Mo1091 Efficiency of Colonoscopy Screening in an Open GI System in a Safety Net Hospital: A Prevalence Study Raj Shah, Sashidhar Manthravadi, Aditya Gutta, Hima Veeramachaneni, Kirbi Yelorda, Neha Husain, Reem Mustafa Introduction: Missed appointments and longer wait times have been linked to decreased healthcare efficiency and economic strain. The safety net population is especially in need of gastroenterology care and thus working towards a highly efficient system is vital. Methods: We conducted a retrospective study identifying 50-75 year old patients who had an outpatient colonoscopy order placed between 1/1/2012 to 10/16/2015. We assessed the rates of noshow, canceled, rescheduled and completed appointments in a 3 month period based on the patient's first colonoscopy order. We compared the rates of different age groups and different years using Poisson regression. We then calculated the effects of no show rates on healthcare cost using the average cost of colonoscopy per the healthcare blue book in our zip code region. Results: We identified 4,510 patients who met eligibility criteria. Age group to patient distribution were as follows: 50-54: 1,832 (40.6%), 55-59: 1,191 (26.4%), 6064: 882 (19.6%), 65-69: 375 (8.3%), and 70-75: 230 (5.1%). Patient distribution to year were as follows: 2012: 1,161 (25.7%), 2013: 1,246 (29.8%), 2014: 1,246 (27.6%) and mid2015: 757 (16.8%). The 4,510 patients scheduled a total of 6,813 appointments in a 3 month period with 1,791 (26.3%) rescheduled, 1,018 (14.9%) canceled, and 544 (8.0%) no showed appointments. The average number of scheduled, rescheduled, canceled, and no-showed appointments per person was 1.51, 0.40, 0.23, and 0.12, respectively. In regards to no-shows, a minimum of $973,760 was lost per this cohort within the 3 month period. After adjusting for the number of appointments, there was a mean of 38% decrease in no shows per year and 10% increase in rescheduled appointments per year (p= .001). There was a non-linear trend for no-shows and age groups signifying the highest no-show rates in the youngest and oldest patients (p=.001). A sub-group analysis of 50-69 year old patients showed a 5 % decrease in missed appointments per age year (p=.001). A total of 3,246 patients were able to complete at least 1 appointment, thus the failure rate in this cohort to complete the order within the 3 month period was 28%. Discussion: Efforts to increase compliance among the younger and older populations should be undertaken. Albeit, noshow rates are decreasing, the system is still highly inefficient. This data only takes into account the 3 month period after the first order was placed, which likely underestimates the yearly missed appointment rate and time/cost burden with re-ordering and no-shows after the initial period. Efficiency of the current system should be evaluated to further identify barriers to adherence, increase compliance, and improve time and cost effectiveness and overall patient care in safety net hospitals.
Mo1090 The Costs of Care for Patients With Ulcerative Colitis: Effect of Adalimumab on Health Care Resources Utilisation in Clinical Practice From INSPIRADA Simon Travis, Brian G. Feagan, Laurent Peyrin-Biroulet, Remo Panaccione, Silvio Danese, Andreas Lazar, Anne M. Robinson, Joel H. Petersson, Mareiki Bereswill, Martha Skup, Naijun Chen, Song Wang, Roopal B. Thakkar, Jingdong Chao Background: Limited data are available on the effect of adalimumab (ADA) on the use of health care resources and the costs of care in real-world clinical practice. Methods: INSPIRADA was a single-arm, multi-country, open-label study evaluating the effect of ADA on health care resource use and costs of care in patients with UC treated according to usual clinical practice. Patients (18 to 75 years old) with active UC, Physician's Global Assessment (PGA) ‡2 and Short Inflammatory Bowel Disease Questionnaire £45 at Baseline (BL) who failed conventional treatment and who had experienced rectal bleeding within 7 days of BL were enrolled. Patients received 160/80 mg ADA at Week 0/2 followed by 40 mg of ADA every other week at Week 4 through Week 26. Patients who did not respond to ADA by Week 8 (PGA ‡ 2 and did not achieve Simple Clinical Colitis Activity Index response, defined as a decrease of ‡ 2 points compared to BL) were to discontinue ADA. Patients who lost response at or after Week 8 could escalate to 40 mg ADA weekly dosing. Direct costs were medical costs (excluding ADA costs) associated with hospitalisations and outpatient procedures and were standardised using UK National Health Service (NHS) reference costs for all participating countries. Indirect costs were costs associated with work loss resulting
Mo1092 Cost-Utility Analysis Shows Adalimumab Is Cost-Effective for the Management of Ulcerative Colitis Candace L. Beilman, Thanh Nguyen, Victoria Ung, Christopher Ma, Karen Wong, Karen Kroeker, Thomas Lee, Haili Wang, Arto Ohinmaa, Phil Jacobs, Brendan P. Halloran, Richard N. Fedorak Background: Adalimumab (ADA) is effective for the induction and maintenance of remission in patients with moderate to severe ulcerative colitis (UC). Currently, biologic therapies are used in cases where patients fail or are intolerant to conventional medical therapies. If biologic therapies are not available, patients often choose to remain in an unwell state rather than undergo colectomy. Aim: The aim of the study was to evaluate the real-life costeffectiveness of ADA in patients with moderate to severe UC who are refractory to thiopurines
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from absenteeism and disability and were based on the Work Productivity and Activity Impairment questionnaire using average weekly earnings from the 2014 UK Annual Salary Survey of Hours and Earnings (ASHE) for all participating countries. All costs were adjusted to 2014 British pounds. Change (defined as 6 months after onset of ADA vs 6 months before onset of ADA) in resource use (number of hospitalisations, days hospitalised, and use of outpatient services) and costs associated with care were calculated. Results: Data from 461 patients (55% male; mean age 42 years; 84% with no prior exposure to TNF antagonists) were analysed. Significant decreases in all-cause direct costs, UC-related medical costs, UCrelated direct plus indirect costs, and use of health care resources were observed 6 months after initiating ADA therapy compared with 6 months before starting ADA therapy ( Table). Conclusion: ADA therapy significantly reduced use of health care resources and their associated costs as well as costs associated with work loss resulting from absenteeism and disability among patients with moderate to severe UC. Change in Health Care Resource Use and Associated Costs (excluding ADA costs) in 2014 British pounds
AGA Abstracts
or have become corticosteroid dependent. A cost strategy where adalimumab was available compared to one where adalimumab was not available and patients opted for an unwell state was assessed. Methods: A previously established Markov model was used to simulate disease progression of patients with moderate to severe UC in situations where ADA is readily available compared to situations when it is unavailable. Utility scores and transition probabilities between health states were determined by using data from randomized controlled trials and real-life rates published by expert inflammatory bowel disease centers. Healthcare costs were obtained from the Ontario Case Costing Initiative and the Alberta Health Schedule of Medical Benefits. An exploratory analysis examining dose escalation was conducted due to the high rate of patients who undergo dose escalation as a result of loss of response to ADA. Results: The mean induction rate of ADA was 87%, which is contrasted to the 34% of patients who responded to corticosteroids and the 57.0% who remained "unwell" despite treatment. Complications which necessitated the cessation of a treatment occurred in approximately 8% of the patients on ADA and 3% of the patients on chronic corticosteroids. The incremental cost-effectiveness ratios (ICER) for readily available ADA treatment of UC were $39,000 and $58,000 per quality-adjusted life year, compared with ongoing medical therapy in an unwell state, at 5-year and 10-year treatment time horizons, respectively. The exploratory analysis revealed ICERs associated with ADA dose escalation to be $76,000 and $100,000 at 5-year and 10-year treatment time horizons, respectively. Conclusions: Considering real-life patient preferences to avoid colectomy, adalimumab is cost-effective according to a willingness-to-pay threshold of $80,000 per quality-adjusted life year for treatment of moderate to severe ulcerative colitis. Dose escalation will increase these costs. Incremental cost-effectiveness ratios for situations where adalimumab is readily available compared to when it is unavailable
inter quartile range (IQR) were calculated for inpatient hospital costs based on the timing of endoscopy. Hospitalizations associated with costs above the 75th percentile were higher cost admissions and used as dependent variable in the cost analysis. Variables that achieved statistical significance (p <0.05) in the univariate analysis were included in a multivariable logistic regression analysis predicting higher cost admissions. Results We included 6,380 patients with a median age of 29 years, male 57%, Caucasians 42%, and 48% suicidal ingestion. Median cost of caustic injury admission was $4,860 (IQR $3,188-$9,483). Admission costs above $9,483 were considered higher cost admissions. Early endoscope was performed in 5,322 (83%) with median cost of $4,277. However, LaEn was performed in 1058 (17%) with median cost of $10,524 (p<0.001). 19% of EaEn admissions were classified as higher cost compared to 56% among LaEn (p<0.001). On multivariate analysis, LaEn was associated with four-fold increase in the chance of higher cost admission (OR 4.4, 95%CI 3.7-5.2, p <0.001) compared to EaEn. Other significant predictors of higher cost were advanced age, high comorbidity, surgery, and local or systemic complications, Table. Conclusion In this nationwide analysis, late upper endoscopic evaluation was an independent and significant predictor of higher healthcare cost after controlling for the extent of injury and the need for surgery. Despite the current recommendation for EaEn, LaEn occurred in 18% of admissions. More efforts should be directed to improve the adherence rate which may lead to significant healthcare cost savings.
Mo1094 Project Sonar: Validating a Cost Normalization Methodology in a CommunityBased Registry Lawrence Kosinski, Michael Sorensen, Joel V. Brill, Pamela Landsman - Blumberg, Robin Turpin, Charles Baum Background Project Sonar, a community-based registry and disease management program developed to improve clinical and economic outcomes in Inflammatory Bowel Disease, uses a cloud-based platform combining health-related quality of life (HRQoL) information with clinical data delivered through electronic medical record derived Clinical Decision Support tools. These data fields are then combined with payer provided-claims data obtained from the Intensive Medical Home with Blue Cross Blue Shield Illinois database. The objective of this project was to develop and validate a Normalization Methodology to mitigate the variation of cost data between actual payments made vs a normalized payment structure derived from Medicare Payment information. Methods The study population included 185 patients from Project Sonar who have been continuously enrolled in this registry since December 1, 2014. Full claims data are available on this cohort from January 1, 2014 to September 30, 2015. The verification and validation project consisted of the following steps: (1) Physician Services were normalized using CPT Code Payments based on the 2015 Prospective Payment System. (2) Inpatient Hospital Payments were normalized using Medicare DRG Payments as reference. The DRG Payment was calculated using a base rate derived as the sum of the Operating Base Payment and the Capital Base Payment. The base rate was then multiplied by the DRG Weight derived from the Medicare Severity Diagnosis-Related Groups Relative Weighting Factors. (3) Diagnostic Payments were normalized using the 2015 Clinical Diagnostic Laboratory Fee Schedule. (4) Infusable Biologics Payments were normalized using office based payment rates to minimize the site of service differential. Crohn's specific claims were determined using the 555 category of ICD-9 Codes plus additional codes that were specific for Crohn's-related symptoms. The study period was December 1, 2014 through September 30, 2015. This was compared against a similar period of January 1, 2014 through Oct 31, 2014. Results Payments for Crohn's-related services vary markedly according to the site of service - i.e. where the infusion is performed; overall, there is an 18% difference in cost. Biologics are specifically an issue based upon site of service. There is a difference of $85/unit if infused in office vs $158/unit if infused in a HOPD. Conclusion Project Sonar represents a unique opportunity to manage care using the AGA Crohn's Care Pathway and analyze the results on payments. For meaningful comparison, it is essential that payments are normalized against Medicare Payments in order to mitigate the site of service differential in payment reporting. The Normalization Methodology presented has broad applicability for those seeking to analyze complex realworld clinical practice data and cost. Study funded by Takeda Pharmaceuticals U.S.A., Inc.
Markov model simulating the progression of a cohort of patients with moderate to severe ulcerative colitis, who are corticosteroid-dependent or refractory to thiopurines, in situations where adalimumab is readily available compared to situations when it is unavailable
Mo1093 Early Upper Endoscopic Evaluation Can Reduce the Cost of Admission for Caustic Substance Ingestion, a National Analysis From the United States Tony S. Brar, Ali Abbas, Andreas G. Zori, David S. Estores Background Caustic ingestion is a serious medical problem with devastating short- and longterm consequences. Early (within 24-48 hours) endoscopic evaluation is recommended to evaluate the extent of injury. There has been no nationwide study evaluating the healthcare cost impact of these hospitalizations and the predictors of costly admissions. Methods The Nationwide Inpatient Sample (NIS) database 2003-2011 was used to identify all-age, nonreferral, urgent/emergent admissions with E-ICD9 codes indicating caustic ingestion. Those who had upper endoscopic evaluation identified by ICD9 codes were included. Information about demographics, hospital characteristics, timing of upper endoscopy (early endoscopy or EaEn <48 hours since admission, and late endoscopy LaEn = or > 48 hours), comorbidities (summarized using Charlson Comorbidity Index), local complications (bleeding, perforation, fistula), systemic complications (shock, sepsis, acute renal failure) and undergoing surgery were abstracted. Hospital-related charges for each admission were converted to the organizational cost per case of providing care using the NIS database. Costs were adjusted to 2015 U.S. Dollars using data from the U.S. Bureau of Labor Statistics. Weighted medians and
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Mo1089 Proving Cost Effectiveness Through Implementation of a Nurse-Led Inflammatory Bowel Disease (IBD) Patient Advice Line and Virtual Clinic (CHEAP) Alexandra Sechi, Elise Sawyer, Wa Sang Watson Ng, Susan J. Connor
a
P<.001 using paired t-test.
Background: In the care of patients with inflammatory bowel disease (IBD), a nurse-led IBD patient advice-line (AL) and virtual clinic (VC) is increasingly being recognised as an integral part of the IBD service. The AL is a telephone and email service for patients needing acute advice relating to their IBD. The VC involves the IBD specialist nurse reviewing and triaging patient investigations prior to a collaborative review with the IBD consultant. A subsequent plan of care is made, actioned and communicated to the patient via phone or email. The aims of this prospective audit were to evaluate the outcome of the nurse led AL and VC and to quantify the potential financial implication to the Australian healthcare system. Methods: Data was collected prospectively at Liverpool Hospital, a single tertiary IBD Specialist Referral Centre in Sydney. Each outpatient occasion of service (OOS) was recorded for the AL over a period of 4 months, and for the VC over 6 months. Both periods were completed on 31 October 2015, although data collection is ongoing. An OOS was only included when it resulted in a change to patient management. Each OOS was categorised into: a) General Practitioner consultation (GPC) avoided b) IBD outpatient consultation (OPC) avoided c) Emergency Department (ED) presentation or hospital admission avoided Costs incurred for the AL and VC included both the nursing time required (mean 21 hours per week) and the gastroenterologists' time (mean 3 hours per week). Savings were calculated based on the OOS that avoided GPC, IBD OPC, presentation to ED and admission to hospital. Costs were benchmarked using the Medicare Benefit Schedule (MBS) and Independent Hospital Pricing Authority (IHPA) of Australia and prices expressed in Australian dollars (AUD). Results: Over 4 months, 111 calls were received through the AL. Of these, 34 avoided GPC, 70 avoided IBD OPC, 6 ED presentations were avoided, and there was 1 avoided hospital admission. There were 438 VC OOS over the 6 month period. Of these, 3 avoided GPC, 400 avoided IBD OPC and 34 ED presentations were avoided. There were no unplanned presentations to ED, no unplanned hospitalisations and 1 patient presented to ED upon instruction. Avoidance of GPC, OPC and ED presentations led to a projected annual cost saving of $176 350, with the projected annual costs incurred being $65 289. Thus the projected annual net cost savings were $111 061. Conclusion: Specialised IBD nurse led AL and VC improves IBD patients' access to services, overall care and reduces healthcare costs. This highlights the importance of a proactive multidisciplinary approach in optimising the care of patients with IBD.
Mo1091 Efficiency of Colonoscopy Screening in an Open GI System in a Safety Net Hospital: A Prevalence Study Raj Shah, Sashidhar Manthravadi, Aditya Gutta, Hima Veeramachaneni, Kirbi Yelorda, Neha Husain, Reem Mustafa Introduction: Missed appointments and longer wait times have been linked to decreased healthcare efficiency and economic strain. The safety net population is especially in need of gastroenterology care and thus working towards a highly efficient system is vital. Methods: We conducted a retrospective study identifying 50-75 year old patients who had an outpatient colonoscopy order placed between 1/1/2012 to 10/16/2015. We assessed the rates of noshow, canceled, rescheduled and completed appointments in a 3 month period based on the patient's first colonoscopy order. We compared the rates of different age groups and different years using Poisson regression. We then calculated the effects of no show rates on healthcare cost using the average cost of colonoscopy per the healthcare blue book in our zip code region. Results: We identified 4,510 patients who met eligibility criteria. Age group to patient distribution were as follows: 50-54: 1,832 (40.6%), 55-59: 1,191 (26.4%), 6064: 882 (19.6%), 65-69: 375 (8.3%), and 70-75: 230 (5.1%). Patient distribution to year were as follows: 2012: 1,161 (25.7%), 2013: 1,246 (29.8%), 2014: 1,246 (27.6%) and mid2015: 757 (16.8%). The 4,510 patients scheduled a total of 6,813 appointments in a 3 month period with 1,791 (26.3%) rescheduled, 1,018 (14.9%) canceled, and 544 (8.0%) no showed appointments. The average number of scheduled, rescheduled, canceled, and no-showed appointments per person was 1.51, 0.40, 0.23, and 0.12, respectively. In regards to no-shows, a minimum of $973,760 was lost per this cohort within the 3 month period. After adjusting for the number of appointments, there was a mean of 38% decrease in no shows per year and 10% increase in rescheduled appointments per year (p= .001). There was a non-linear trend for no-shows and age groups signifying the highest no-show rates in the youngest and oldest patients (p=.001). A sub-group analysis of 50-69 year old patients showed a 5 % decrease in missed appointments per age year (p=.001). A total of 3,246 patients were able to complete at least 1 appointment, thus the failure rate in this cohort to complete the order within the 3 month period was 28%. Discussion: Efforts to increase compliance among the younger and older populations should be undertaken. Albeit, noshow rates are decreasing, the system is still highly inefficient. This data only takes into account the 3 month period after the first order was placed, which likely underestimates the yearly missed appointment rate and time/cost burden with re-ordering and no-shows after the initial period. Efficiency of the current system should be evaluated to further identify barriers to adherence, increase compliance, and improve time and cost effectiveness and overall patient care in safety net hospitals.
Mo1090 The Costs of Care for Patients With Ulcerative Colitis: Effect of Adalimumab on Health Care Resources Utilisation in Clinical Practice From INSPIRADA Simon Travis, Brian G. Feagan, Laurent Peyrin-Biroulet, Remo Panaccione, Silvio Danese, Andreas Lazar, Anne M. Robinson, Joel H. Petersson, Mareiki Bereswill, Martha Skup, Naijun Chen, Song Wang, Roopal B. Thakkar, Jingdong Chao Background: Limited data are available on the effect of adalimumab (ADA) on the use of health care resources and the costs of care in real-world clinical practice. Methods: INSPIRADA was a single-arm, multi-country, open-label study evaluating the effect of ADA on health care resource use and costs of care in patients with UC treated according to usual clinical practice. Patients (18 to 75 years old) with active UC, Physician's Global Assessment (PGA) ‡2 and Short Inflammatory Bowel Disease Questionnaire £45 at Baseline (BL) who failed conventional treatment and who had experienced rectal bleeding within 7 days of BL were enrolled. Patients received 160/80 mg ADA at Week 0/2 followed by 40 mg of ADA every other week at Week 4 through Week 26. Patients who did not respond to ADA by Week 8 (PGA ‡ 2 and did not achieve Simple Clinical Colitis Activity Index response, defined as a decrease of ‡ 2 points compared to BL) were to discontinue ADA. Patients who lost response at or after Week 8 could escalate to 40 mg ADA weekly dosing. Direct costs were medical costs (excluding ADA costs) associated with hospitalisations and outpatient procedures and were standardised using UK National Health Service (NHS) reference costs for all participating countries. Indirect costs were costs associated with work loss resulting
Mo1092 Cost-Utility Analysis Shows Adalimumab Is Cost-Effective for the Management of Ulcerative Colitis Candace L. Beilman, Thanh Nguyen, Victoria Ung, Christopher Ma, Karen Wong, Karen Kroeker, Thomas Lee, Haili Wang, Arto Ohinmaa, Phil Jacobs, Brendan P. Halloran, Richard N. Fedorak Background: Adalimumab (ADA) is effective for the induction and maintenance of remission in patients with moderate to severe ulcerative colitis (UC). Currently, biologic therapies are used in cases where patients fail or are intolerant to conventional medical therapies. If biologic therapies are not available, patients often choose to remain in an unwell state rather than undergo colectomy. Aim: The aim of the study was to evaluate the real-life costeffectiveness of ADA in patients with moderate to severe UC who are refractory to thiopurines
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from absenteeism and disability and were based on the Work Productivity and Activity Impairment questionnaire using average weekly earnings from the 2014 UK Annual Salary Survey of Hours and Earnings (ASHE) for all participating countries. All costs were adjusted to 2014 British pounds. Change (defined as 6 months after onset of ADA vs 6 months before onset of ADA) in resource use (number of hospitalisations, days hospitalised, and use of outpatient services) and costs associated with care were calculated. Results: Data from 461 patients (55% male; mean age 42 years; 84% with no prior exposure to TNF antagonists) were analysed. Significant decreases in all-cause direct costs, UC-related medical costs, UCrelated direct plus indirect costs, and use of health care resources were observed 6 months after initiating ADA therapy compared with 6 months before starting ADA therapy ( Table). Conclusion: ADA therapy significantly reduced use of health care resources and their associated costs as well as costs associated with work loss resulting from absenteeism and disability among patients with moderate to severe UC. Change in Health Care Resource Use and Associated Costs (excluding ADA costs) in 2014 British pounds
AGA Abstracts
or have become corticosteroid dependent. A cost strategy where adalimumab was available compared to one where adalimumab was not available and patients opted for an unwell state was assessed. Methods: A previously established Markov model was used to simulate disease progression of patients with moderate to severe UC in situations where ADA is readily available compared to situations when it is unavailable. Utility scores and transition probabilities between health states were determined by using data from randomized controlled trials and real-life rates published by expert inflammatory bowel disease centers. Healthcare costs were obtained from the Ontario Case Costing Initiative and the Alberta Health Schedule of Medical Benefits. An exploratory analysis examining dose escalation was conducted due to the high rate of patients who undergo dose escalation as a result of loss of response to ADA. Results: The mean induction rate of ADA was 87%, which is contrasted to the 34% of patients who responded to corticosteroids and the 57.0% who remained "unwell" despite treatment. Complications which necessitated the cessation of a treatment occurred in approximately 8% of the patients on ADA and 3% of the patients on chronic corticosteroids. The incremental cost-effectiveness ratios (ICER) for readily available ADA treatment of UC were $39,000 and $58,000 per quality-adjusted life year, compared with ongoing medical therapy in an unwell state, at 5-year and 10-year treatment time horizons, respectively. The exploratory analysis revealed ICERs associated with ADA dose escalation to be $76,000 and $100,000 at 5-year and 10-year treatment time horizons, respectively. Conclusions: Considering real-life patient preferences to avoid colectomy, adalimumab is cost-effective according to a willingness-to-pay threshold of $80,000 per quality-adjusted life year for treatment of moderate to severe ulcerative colitis. Dose escalation will increase these costs. Incremental cost-effectiveness ratios for situations where adalimumab is readily available compared to when it is unavailable
inter quartile range (IQR) were calculated for inpatient hospital costs based on the timing of endoscopy. Hospitalizations associated with costs above the 75th percentile were higher cost admissions and used as dependent variable in the cost analysis. Variables that achieved statistical significance (p <0.05) in the univariate analysis were included in a multivariable logistic regression analysis predicting higher cost admissions. Results We included 6,380 patients with a median age of 29 years, male 57%, Caucasians 42%, and 48% suicidal ingestion. Median cost of caustic injury admission was $4,860 (IQR $3,188-$9,483). Admission costs above $9,483 were considered higher cost admissions. Early endoscope was performed in 5,322 (83%) with median cost of $4,277. However, LaEn was performed in 1058 (17%) with median cost of $10,524 (p<0.001). 19% of EaEn admissions were classified as higher cost compared to 56% among LaEn (p<0.001). On multivariate analysis, LaEn was associated with four-fold increase in the chance of higher cost admission (OR 4.4, 95%CI 3.7-5.2, p <0.001) compared to EaEn. Other significant predictors of higher cost were advanced age, high comorbidity, surgery, and local or systemic complications, Table. Conclusion In this nationwide analysis, late upper endoscopic evaluation was an independent and significant predictor of higher healthcare cost after controlling for the extent of injury and the need for surgery. Despite the current recommendation for EaEn, LaEn occurred in 18% of admissions. More efforts should be directed to improve the adherence rate which may lead to significant healthcare cost savings.
Mo1094 Project Sonar: Validating a Cost Normalization Methodology in a CommunityBased Registry Lawrence Kosinski, Michael Sorensen, Joel V. Brill, Pamela Landsman - Blumberg, Robin Turpin, Charles Baum Background Project Sonar, a community-based registry and disease management program developed to improve clinical and economic outcomes in Inflammatory Bowel Disease, uses a cloud-based platform combining health-related quality of life (HRQoL) information with clinical data delivered through electronic medical record derived Clinical Decision Support tools. These data fields are then combined with payer provided-claims data obtained from the Intensive Medical Home with Blue Cross Blue Shield Illinois database. The objective of this project was to develop and validate a Normalization Methodology to mitigate the variation of cost data between actual payments made vs a normalized payment structure derived from Medicare Payment information. Methods The study population included 185 patients from Project Sonar who have been continuously enrolled in this registry since December 1, 2014. Full claims data are available on this cohort from January 1, 2014 to September 30, 2015. The verification and validation project consisted of the following steps: (1) Physician Services were normalized using CPT Code Payments based on the 2015 Prospective Payment System. (2) Inpatient Hospital Payments were normalized using Medicare DRG Payments as reference. The DRG Payment was calculated using a base rate derived as the sum of the Operating Base Payment and the Capital Base Payment. The base rate was then multiplied by the DRG Weight derived from the Medicare Severity Diagnosis-Related Groups Relative Weighting Factors. (3) Diagnostic Payments were normalized using the 2015 Clinical Diagnostic Laboratory Fee Schedule. (4) Infusable Biologics Payments were normalized using office based payment rates to minimize the site of service differential. Crohn's specific claims were determined using the 555 category of ICD-9 Codes plus additional codes that were specific for Crohn's-related symptoms. The study period was December 1, 2014 through September 30, 2015. This was compared against a similar period of January 1, 2014 through Oct 31, 2014. Results Payments for Crohn's-related services vary markedly according to the site of service - i.e. where the infusion is performed; overall, there is an 18% difference in cost. Biologics are specifically an issue based upon site of service. There is a difference of $85/unit if infused in office vs $158/unit if infused in a HOPD. Conclusion Project Sonar represents a unique opportunity to manage care using the AGA Crohn's Care Pathway and analyze the results on payments. For meaningful comparison, it is essential that payments are normalized against Medicare Payments in order to mitigate the site of service differential in payment reporting. The Normalization Methodology presented has broad applicability for those seeking to analyze complex realworld clinical practice data and cost. Study funded by Takeda Pharmaceuticals U.S.A., Inc.
Markov model simulating the progression of a cohort of patients with moderate to severe ulcerative colitis, who are corticosteroid-dependent or refractory to thiopurines, in situations where adalimumab is readily available compared to situations when it is unavailable
Mo1093 Early Upper Endoscopic Evaluation Can Reduce the Cost of Admission for Caustic Substance Ingestion, a National Analysis From the United States Tony S. Brar, Ali Abbas, Andreas G. Zori, David S. Estores Background Caustic ingestion is a serious medical problem with devastating short- and longterm consequences. Early (within 24-48 hours) endoscopic evaluation is recommended to evaluate the extent of injury. There has been no nationwide study evaluating the healthcare cost impact of these hospitalizations and the predictors of costly admissions. Methods The Nationwide Inpatient Sample (NIS) database 2003-2011 was used to identify all-age, nonreferral, urgent/emergent admissions with E-ICD9 codes indicating caustic ingestion. Those who had upper endoscopic evaluation identified by ICD9 codes were included. Information about demographics, hospital characteristics, timing of upper endoscopy (early endoscopy or EaEn <48 hours since admission, and late endoscopy LaEn = or > 48 hours), comorbidities (summarized using Charlson Comorbidity Index), local complications (bleeding, perforation, fistula), systemic complications (shock, sepsis, acute renal failure) and undergoing surgery were abstracted. Hospital-related charges for each admission were converted to the organizational cost per case of providing care using the NIS database. Costs were adjusted to 2015 U.S. Dollars using data from the U.S. Bureau of Labor Statistics. Weighted medians and
AGA Abstracts
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