Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

Preussler, Jaime M.; Mau, Lih Wen; Majhail, Navneet S.; Meyer, Christa; Denzen, Ellen M.; Edsall, Kristen C.; Farnia, Stephanie; Silver, Alicia; Saber, Wael; Burns, Linda J.; Vanness, David J.

doi:10.1016/j.bbmt.2016.05.005

Cited by 22 publications

(14 citation statements)

References 34 publications

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“…20 Given these limitations, caution must be exercised in interpreting any results as comparative between chemotherapy alone and alloHCT. Notably, administrative claims data are generally unable to provide detailed clinical data, such as performance status, cytogenetic and molecular profiles, remission status, response to induction therapy, and level of HLA-match, all of which are known to influence both treatment selection and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Our goal was to select patients who underwent initial treatment of chemotherapy alone or alloHCT for AML with curative intent, excluding patients whose treatment was for recurrent disease, secondary AML or for blood disorders other than AML. 20 Patients with total first year post-diagnosis costs below extreme value thresholds based on gamma distributions fitted to observed costs were independently reviewed for eligibility by clinician co-authors (LB, NM, WS).…”

Section: Methodsmentioning

confidence: 99%

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Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation

Preussler

Meyer

Mau

et al. 2017

Biology of Blood and Marrow Transplantation

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The primary aim of this study was to describe healthcare costs and utilization during the first year after a diagnosis of acute myeloid leukemia (AML) for privately insured non-Medicare patients in the United States (US) aged 50-64 years who were treated with either chemotherapy or chemotherapy and allogeneic hematopoietic cell transplantation (alloHCT). MarketScan (Truven Health Analytics) adjudicated total payments for inpatient, outpatient and prescription drug claims from 2007-2011 were used to estimate costs from the health system perspective. Stabilized inverse propensity score weights were constructed using logistic regression to account for differential selection of alloHCT over chemotherapy. Weighted generalized linear models (GLM) adjusted costs and utilization (hospitalizations, inpatient days and outpatient visit-days) for differences in age, sex, diagnosis year, region, insurance plan type, Elixhauser Comorbidity Index (ECI) and 60-day pre-diagnosis costs. Because mortality data were not available, models could not be adjusted for survival times. Among 29,915 patients with a primary diagnosis of AML, a total of 985 patients met inclusion criteria (774 [79%] receiving chemotherapy alone and 211 [21%] alloHCT). Adjusted mean one-year costs were $280,788 for chemotherapy and $544,178 for alloHCT. Patients receiving chemotherapy alone had a mean of 4 hospitalizations, 52.9 inpatient days and 52.4 outpatient visits in the year following AML diagnosis; patients receiving alloHCT had 5 hospitalizations, 92.5 inpatient days and 74.5 outpatient visits. Treating AML in the first year after diagnosis incurs substantial health care costs and utilization with chemotherapy alone and with alloHCT. Our analysis informs health care providers, policy makers and payers so they can better understand treatment costs and utilization for privately-insured patients age 50-64 with AML.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation

Preussler

Meyer

Mau

et al. 2017

Biology of Blood and Marrow Transplantation

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“…Based on a report from the Agency for Healthcare Research and Quality, HCT was among the top 10 procedures with the most rapid increase in hospital costs in the United States, even though it is a relatively uncommon procedure [7]. A number of studies have shown the utility of using administrative claims databases to examine costs and resource utilization in patients with hematologic malignancies undergoing HCT [6][7][8][9]. A study using 2007 to 2009 administrative claims data reported median costs incurred in the first 100 days posttransplantation of $99,899 in auto-HCT recipients and $203,026 in allo-HCT recipients [6].…”

Section: Introductionmentioning

confidence: 99%

Real-World Economic Burden Associated with Transplantation-Related Complications

Perales

Bonafede

Cai

et al. 2017

Biology of Blood and Marrow Transplantation

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Approximately 20,000 hematopoietic cell transplantation (HCT) procedures are performed annually in the United States. Real-world data on the costs associated with post-transplantation complications are limited. Patients with hematologic malignancies aged ≥18 years undergoing autologous HCT (auto-HCT) or allogeneic HCT (allo-HCT) between January 1, 2011, and June 30, 2014, were identified in the Truven Health MarketScan Research Databases. Patients were required to have 12 months of continuous medical and pharmacy enrollment before and after HCT; patients who experience inpatient death within 12 months post-HCT were also included. Patients with previous HCT were excluded. Potential HCT-related complications were identified if they had a medical claim with a diagnosis code for relapse; infection; cardiovascular, renal, neurologic, pulmonary, hepatic, or gastrointestinal disease; secondary malignancy; thrombotic microangiopathy; or posterior reversible encephalopathy syndrome within 1 year post-HCT. Healthcare costs attributable to these complications were evaluated by comparing total costs in HCT recipients with complications and those without complications. The MarketScan Research Databases were further linked to the Social Security Administration's Master Death File to obtain patient death events in a subset of patients. A total of 2672 HCT recipients were included in the analysis. The mean ± SD age of recipients was 54.5 ± 11.6 years, and the majority of recipients (63.6%) underwent auto-HCT. Complications were identified in 81% of auto-HCT recipients and in 95.5% of allo-HCT recipients. Most complications occurred within 180 days post-HCT. Compared with Auto-HCT recipients without complications, those with complications incurred $51,475 higher adjusted total costs (P < .01). Compared with allo-HCT recipients without complications, those with complications incurred $181,473 higher adjusted total costs (P < .01). Among the patients with mortality data, auto-HCT recipients with complications had a higher mortality rate (13.4% vs 5.7%, P < .01) and a lower probability of survival (P < .01) compared with those without complications. In allo-HCT recipients, however, the mortality rate and probability of survival were not significantly different between those with complications and those without complications. HCT recipients with complications were associated with considerable economic burden in terms of direct healthcare costs in a commercially insured population, and in the case of auto-HCT, a higher mortality rate was observed in those with complications.

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“…1,2 Given that administrative insurance claims are generated at every interaction an individual has with the healthcare system, large closed administrative insurance claims databases, such as IBM ® MarketScan ® Research Databases, provide a good source of information for the investigation of scenarios, including healthcare delivery, benefits, harms and cost, for large populations. 3,4 However, although claims data are frequently used for research, such usage was not their original intended purpose: 5 The purpose of administrative claims is billing and reimbursement of medical care. Therefore, complexities exist when using diagnosis codes to attribute cost to a disease.…”

Section: Introductionmentioning

confidence: 99%

<p>Comparison Of Methods To Estimate Disease-Related Cost And Healthcare Resource Utilization For Autoimmune Diseases In Administrative Claims Databases</p>

Schroeder¹,

Gelwicks²,

Naegeli³

et al. 2019

CEOR

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Background: Establishing disease-related cost and/or healthcare resource utilization (HCRU) is an important aspect of health outcomes research, particularly when considering the cost offset of novel treatments. However, few studies have compared methodologies used to assess disease-related cost/HCRU. Methods: Data from the United States IBM ® MarketScan ® Research Databases were used to compare four different methods of calculating disease-related cost and HCRU in patients with rheumatoid arthritis (RA). The analysis was repeated, in part, for patients with ulcerative colitis (UC) to explore the generalizability of findings to a second autoimmune disease. Four methods of disease-related cost/HCRU attribution were selected following a literature search for potential methods: Method 1, claim-wide cost/HCRU attribution based on claim-listed diagnosis codes and a predetermined disease-related medication list (pharmacy claims only); Method 2, line-item cost/HCRU attribution based on procedures/medications more likely to occur in disease cases than in matched controls at two likelihood ratio cutoffs (1.5× and 3.5×); Method 3, diseaserelated cost/HCRU calculated as the difference in total average cost/HCRU between cases and matched controls; Method 4, line-item cost/HCRU attribution based on clinician manual determination of procedures/medications related to the disease. Results and conclusion: Overall, 24,373 patients with RA and 9665 with UC were included. Average total cost during 2015 was $US28,750 per patient with RA and $US20,480 per patient with UC. Disease-related cost and HCRU for RA calculated using Method 4 were most closely approximated by Methods 1 and 2 (3.5×), with Method 2 (3.5×) the closest approximation. However, in certain research scenarios, the simplest method compared in this analysis, Method 1, may provide an adequate approximation of diseaserelated cost and HCRU. Although Method 4 was not executed in the UC analysis because of its labor-intensive nature, similar patterns of disease-related cost and HCRU were observed for Methods 1-3 in patients with UC and RA.

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Administrative Claims Data for Economic Analyses in Hematopoietic Cell Transplantation: Challenges and Opportunities

Cited by 22 publications

References 34 publications

Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation

Healthcare Costs and Utilization for Patients Age 50 to 64 Years with Acute Myeloid Leukemia Treated with Chemotherapy or with Chemotherapy and Allogeneic Hematopoietic Cell Transplantation

Real-World Economic Burden Associated with Transplantation-Related Complications

<p>Comparison Of Methods To Estimate Disease-Related Cost And Healthcare Resource Utilization For Autoimmune Diseases In Administrative Claims Databases</p>

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