Predictors of High-cost Patients With Noninfectious Inflammatory Eye Diseases

Abstract

Purpose: Noninfectious inflammatory eye diseases (NIIEDs), such as uveitis, is a general term used to describe a complex mix of acute, chronic, allergic, and inflammatory disorders. Prior literature has established that, in addition to severe clinical burden, NIIEDs is associated with significant economic burden for US payers; however, no literature provides a current estimate of the economic burden associated with patients with high-cost NIIEDs. This study aimed to better understand the cost and resource use distribution and predictors of patients with high-cost NIIEDs.Methods: This retrospective cohort study selected adult patients with NIIEDs from a large US administrative claims database between 2006 and 2015. Among the included patients, total all-cause health care costs were calculated for a randomly selected 12-month period. Patients in the top 20% of total all-cause health care costs were identified as high-cost patients; the remaining patients were identified as lower-cost patients. Patient demographic characteristics, clinical characteristics, cost, and health care resource utilization (HRU) were compared. Logistic regression models were used to determine characteristics associated with high-cost patients.Findings: Patients with NIIEDs (n ¼ 14,879) were categorized into 2976 high-cost and 11,903 lowercost patients. High-cost patients with NIIEDs were significantly more likely to experience blindness, cataract, cystoid macular degeneration, retinal detachment, and visual disturbances during the follow-up period than the lower-cost patients (all P < 0.05). The high-cost patients accounted for~7 7% of the total all-cause health care spend. Highcost patients incurred an average annual total health care cost of $59,873, and the top 1 percentile incurred $349,967 during the follow-up period. Hospitalization was a key cost driver among the high-cost patients, accounting for 50% of the total cost among the top 1 percentile of patients. High-cost patients were more likely to have specific autoimmune diseases, inpatient admission, and use of biologic and immunosuppressant agents.Implications: A small segment of patients with NIIEDs consumed most resources. This study identified several predictors based on patient characteristics and HRU that may help inform the profile of patients with NIIEDs with the highest health care needs. As such, patients with a given profile can be selected for targeted interventions by clinicians to potentially help improve quality of care and to reduce costs.

Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients

“…These groups include all patients with significant economic and clinical burdens. Consistent with our analyses, other scholars have found that hospitalization accounted for almost all total spending among HC patients ( Meyers et al, 2014 ; Rice et al, 2017 ; Nelson et al, 2019 ). Almost all of our HC patients were hospitalized at least once during 12-month follow-up, whereas Meyers and colleagues showed a lower (but explainable) figure because our study population was aged >65 years.…”

“…Another concordant comorbidity more likely to be recorded in T2DM patients was hyperuricemia/gout (OR 2.49,95% CI,. As reported recently, there appears to be a three-way association between hyperuricemia, T2DM, and hypertension (Mortada, 2017). Moreover, hyperuricemia has emerged as an independent risk factor in T2DM development and hypertension through several postulated mechanisms (Kuwabara et al, 2017).…”

“…The hospitalization cost included the cost of all-cause hospitalization incurred in each group. In accordance with recent studies ( Meyers et al, 2014 ; Wammes et al, 2018 ; Nelson et al, 2019 ), primary care visits were proxied using prescriptions. Therefore, each prescription is counted as a visit.…”

Impacto psicosocial y económico de la uveítis en México

“…Causa el 10-15 % de la ceguera mundial 1,2,5 y es la tercera causa de ceguera prevenible en el mundo. 6 Adicionalmente, el 25-50 % de los pacientes tendrán una enfermedad sistémica asociada. 2 Existen cuestionarios de calidad de vida relacionada con la visión y han encontrado que la función visual y el estado de general de salud es peor que en las personas sanas.…”

“…8 Al presentarse en edades productivas causa un impacto socioeconómico importante. 6 Este depende de múltiples factores, como la causa y duración de la enfermedad, comorbilidades, el ingreso del paciente/ familia o el apoyo gubernamental. 2 Hasta ahora carecemos de información sobre el efecto psicosocial y económico que experimentan los pacientes diagnosticados con uveítis en México.…”