Innovative assessment of inpatient and pulmonary drug costs for children with cystic fibrosis

Abstract

This study provides more accurate longitudinal estimates of CF care costs throughout childhood and shows that increasing age, pancreatic insufficiency, use of dornase, and hospitalizations are key determinants of cost. These estimates can be included in evaluations of the cost-effectiveness of new, highly expensive treatments being introduced for any CF population. Pediatr Pulmonol. 2016;51:1295-1303. © 2016 Wiley Periodicals, Inc.

A Latent Class Approach to Modeling Trajectories of Health Care Cost in Pediatric Cystic Fibrosis

“…As the goal of this study is to illustrate a new approach to prediction of longitudinal costs, we reduce model complexity and consider only 2 risk factors in addition to age that have been shown to affect pediatric CF costs. 13 We use the determination at birth of whether a child is pancreatic insufficient (PI), a digestive condition common among CF children that manifests in poor nutritional outcomes. The presence of diminished lung function (DLF) is measured by the Wisconsin Chest X-ray exam at approximately 5 years of age as either severe or not severe.…”

“…14,15 Costly hospitalizations are common among children with CF and are a key factor strongly associated with the overall cost of care. 13,15 However, many children with CF have few or no hospitalizations regardless of observed characteristics and led us to create a new variable where children are classified into cost utilization groups (low, medium, and high) that depend on their frequency of hospitalizations.…”

“…11,12 Using the direct medical costs of a pediatric population from birth to age 17, prior work showed that the children had varying levels of severity of CF and large variation in costs of treatment. 13 Clinically, CF is a progressive disease, where a child's general health decreases and whose annual costs increase over time. After controlling for known demographics, genotype severity, and other disease factors believed to contribute to costs, there remained substantial variation in cost outcomes due to differences in disease severity and treatments among the children.…”

Cystic fibrosis year in review 2016

“…Annual cost, assessed via hospital billing and medical records for 73 patients in the Wisconsin newborn screening trial followed from birth to 18 years of age, was estimated to be $24 768. However, in a high‐utilization class, the average annual cost was $58 938 . The costs broke down into the following categories: outpatient medications (53%), hospitalizations (32%), and outpatient therapy (15%), with drug costs almost equally split between pulmonary (48%) and non‐pulmonary (52%).…”

Quantitative chest computerized tomography and FEV1equally identify pulmonary exacerbation risk in children with cystic fibrosis

“…Chest CT scores are also predictive of the frequency of future pulmonary exacerbations up to 10 years later . This predictive ability is important because pulmonary exacerbations are valuable clinical endpoints associated with lower quality of life, increased healthcare costs, more rapid progression of lung disease, and increased mortality . Patients at high risk could be treated with additional CF therapies that have been shown to reduce the frequency of pulmonary exacerbations, and efforts could be made to increase adherence to CF therapies, as better adherence is associated with lower rates of pulmonary exacerbations .…”