Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities

Asaria, Miqdad; Grasic, Katja; Walker, Simon

doi:10.1007/s40273-015-0358-8

Cited by 17 publications

(12 citation statements)

References 14 publications

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“…However, it is still challenging to understand the methods used, and to implement them in research 19 . Because this is a new and evolving area, the primary aim of this study was to describe our methods for incorporating costs into CPRD and HES data, including characterizing important challenges in the implementation.…”

Section: Introductionmentioning

confidence: 99%

Methods for estimating costs in patients with hyperlipidemia experiencing their first cardiovascular event in the United Kingdom

Danese¹,

Gleeson²,

Griffiths

et al. 2017

Journal of Medical Economics

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Aims: Methods for integrating external costs into clinical databases are not well-characterized. The purpose of this research was to describe and implement methods for estimating the cost of hospitalizations, prescriptions, and general practitioner and specialist visits used to manage hyperlipidemia patients experiencing cardiovascular (CV) events in the United Kingdom (UK). Methods: This study was a retrospective cohort study using the Clinical Practice Research Datalink and Hospital Episode Statistics data. Costs were incorporated based on reference costs from the National Health Service, and labor costs from the Personal Social Services Research Unit. The study population included patients seen by general practitioners in the UK from 2006-2012. Patients 18 years were selected at the time of their first CV-related hospitalization defined as myocardial infarction, ischemic stroke, heart failure, transient ischemic attack, unstable angina, or revascularization. To be included, patients must have received 2 lipid-lowering therapies. Outcome measures included healthcare utilization and direct medical costs for hospitalizations, medications, general practitioner visits, and specialist visits during the 6-month acute period, starting with the CV hospitalization, and during the subsequent 30-month long-term period. Results: There were 24,093 patients with a CV hospitalization included in the cohort. This study identified and costed 69,240 hospitalizations, 673,069 GP visits, 32,942 specialist visits, and 2,572,792 prescriptions, representing 855 unique drug and dose combinations. The mean acute period and mean annualized long-term period costs (2014£) were £4,060 and £1,433 for hospitalizations, £377 and £518 for GP visits, £59 and £103 for specialist visits, and £98 and £209 for medications. Conclusions: Hospital costs represent the largest portion of acute and long-term costs in this population. Detailed costing using utilization data is feasible and representative of UK clinical practice, but is labor intensive. The availability of a standardized coding system in the UK drug costing data would greatly facilitate drug costing. ARTICLE HISTORY

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Section: Introductionmentioning

confidence: 99%

Methods for estimating costs in patients with hyperlipidemia experiencing their first cardiovascular event in the United Kingdom

Danese¹,

Gleeson²,

Griffiths

et al. 2017

Journal of Medical Economics

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“…Also, because information about patients’ secondary care contacts must be manually entered at the practice, this information may be incomplete in primary care datasets [13]. Using linked datasets has been recommended by previous studies to best assess and evaluate the care pathway and resource use of patient groups [42, 43], but the use of linked datasets comes with its own technical and analytical challenges [44]. However, it is worth noting that a subset of English practices (reportedly 75%, representing 58% of all UK CPRD practices) have consented to participate in the CPRD linkage scheme, which includes linkage with HES data [13].…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluations Alongside Efficient Study Designs Using Large Observational Datasets: the PLEASANT Trial Case Study

et al. 2017

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BackgroundLarge observational datasets such as Clinical Practice Research Datalink (CPRD) provide opportunities to conduct clinical studies and economic evaluations with efficient designs.ObjectivesOur objectives were to report the economic evaluation methodology for a cluster randomised controlled trial (RCT) of a UK NHS-delivered public health intervention for children with asthma that was evaluated using CPRD and describe the impact of this methodology on results.MethodsCPRD identified eligible patients using predefined asthma diagnostic codes and captured 1-year pre- and post-intervention healthcare contacts (August 2012 to July 2014). Quality-adjusted life-years (QALYs) 4 months post-intervention were estimated by assigning utility values to exacerbation-related contacts; a systematic review identified these utility values because preference-based outcome measures were not collected. Bootstrapped costs were evaluated 12 months post-intervention, both with 1-year regression-based baseline adjustment (BA) and without BA (observed).ResultsOf 12,179 patients recruited, 8190 (intervention 3641; control 4549) were evaluated in the primary analysis, which included patients who received the protocol-defined intervention and for whom CPRD data were available. The intervention’s per-patient incremental QALY loss was 0.00017 (bias-corrected and accelerated 95% confidence intervals [BCa 95% CI] –0.00051 to 0.00018) and cost savings were £14.74 (observed; BCa 95% CI –75.86 to 45.19) or £36.07 (BA; BCa 95% CI –77.11 to 9.67), respectively. The probability of cost savings was much higher when accounting for BA versus observed costs due to baseline cost differences between trial arms (96.3 vs. 67.3%, respectively).ConclusionEconomic evaluations using data from a large observational database without any primary data collection is feasible, informative and potentially efficient.Clinical Trials Registration Number: ISRCTN03000938.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-016-0484-y) contains supplementary material, which is available to authorized users.

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“…Having data available, adopting and using EHR in a widespread manner and being able to study bigger cohorts through time linking data from various sources is most important to promoting equity, cost-effectiveness Asaria, Grasic, et al 2016;Beresniak et al 2016) and identifying determinants of where to act (Fehr et al 2014), improving clinical care, preventing disease, and promoting health (Hansell and Aylin 2003;Mendes Ribeiro et al 2015; OECD-Organisation for Economic Co-operation and Development 2017). This is especially pertinent considering the evolution of the burden of chronic non-communicable disease such as cerebrocardiovascular disease.…”

Section: Challenges Of Big Data and Complexity In Methods But Simplicmentioning

confidence: 99%

Picturing inequities for health impact assessment: linked electronic records, mortality and regional disparities in Portugal

Bacelar–Nicolau

Rodrigues

Fernandes

et al. 2017

Impact Assessment and Project Appraisal

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Using Linked Electronic Health Records to Estimate Healthcare Costs: Key Challenges and Opportunities

Cited by 17 publications

References 14 publications

Methods for estimating costs in patients with hyperlipidemia experiencing their first cardiovascular event in the United Kingdom

Methods for estimating costs in patients with hyperlipidemia experiencing their first cardiovascular event in the United Kingdom

Economic Evaluations Alongside Efficient Study Designs Using Large Observational Datasets: the PLEASANT Trial Case Study

Picturing inequities for health impact assessment: linked electronic records, mortality and regional disparities in Portugal

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