Dataset Information

Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States.

ABSTRACT:

Importance

Despite the increasing incidence of chronic cutaneous ulcers (CCUs), limited information exists regarding their incremental economic burden.

Objective

To provide nationally representative estimates regarding the incremental health care cost of CCUs, controlling for comorbidities and sociodemographic characteristics.

Design, setting, and participants

This retrospective analysis used 9 years of longitudinal data from the Medical Expenditure Panel Survey (MEPS; January 1, 2007, through December 31, 2015). Patients with CCUs were identified using Agency for Healthcare Research and Quality-produced software that included several codes from the International Classification of Disease, 9th Revision Clinical Modification, for chronic ulcers of the skin. A cross-validated 2-part generalized linear model estimated the adjusted incremental expenditure for individuals with CCUs while controlling for comorbidities and sociodemographic covariates. Data were analyzed from July 1 through September 1, 2018.

Main outcomes and measures

Incremental cost of CCUs, total cost of care, and expenditures associated with inpatient care, outpatient care, prescription medications, emergency department visits, and home health care.

Results

A total of 288 698 patients (52.4% female; mean [SD] age, 38.2 [22.4] years) were included, of whom 1786 had CCUs and 286?912 did not. Patients with CCUs were more likely to be female (1078 [60.4%]), non-Hispanic (1388 [77.7%]), previously or currently married (1440 [80.6%]), and covered by Medicaid/Medicare (852 [47.7%]) and had a lower income (954 [53.4%]) when compared with patients without CCUs (P?Conclusions and relevanceResults of this study suggest that chronic cutaneous ulcers are associated with substantial incremental increases in annual health care expenditure. Expenses for patients with CCUs are increasing, particularly with regard to outpatient cost of care and prescription medication expenditure. As health care costs rise, investigators must identify strategies to prevent and treat CCUs.

SUBMITTER: Tripathi R

PROVIDER: S-EPMC6563532 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States.

Tripathi Raghav R Knusel Konrad D KD Ezaldein Harib H HH Honaker Jeremy S JS Bordeaux Jeremy S JS Scott Jeffrey F JF

JAMA dermatology 20190601 6

<h4>Importance</h4>Despite the increasing incidence of chronic cutaneous ulcers (CCUs), limited information exists regarding their incremental economic burden.<h4>Objective</h4>To provide nationally representative estimates regarding the incremental health care cost of CCUs, controlling for comorbidities and sociodemographic characteristics.<h4>Design, setting, and participants</h4>This retrospective analysis used 9 years of longitudinal data from the Medical Expenditure Panel Survey (MEPS; Janu ...[more]

PMID: 30892572

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Project description:The present health economic evaluation in Afghanistan aims to support public health decision makers and health care managers to allocate resources efficiently to appropriate treatments for cutaneous leishmaniasis (CL) elicited by Leishmania tropica or Leishmania major.A decision tree was used to analyse the cost and the effectiveness of two wound care regimens versus intra-lesional antimony in CL patients in Afghanistan. Costs were collected from a societal perspective. Effectiveness was measured in wound free days. The incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (NMB) were calculated. The model was parameterized with baseline parameters, sensitivity ranges, and parameter distributions. Finally, the model was simulated and results were evaluated with deterministic and probability sensitivity analyses. Final outcomes were the efficiency of the regimens and a budget impact analysis in the context of Afghanistan.Average costs per patients were US$ 11 (SE?=?0.016) (Group I: Intra-dermal Sodium Stibogluconate [IL SSG]), US$ 16 (SE?=?7.58) (Group II: Electro-thermo-debridement [ETD]?+?Moist wound treatment [MWT]) and US$ 25 (SE?=?0.48) (Group III: MWT) in patients with a single chronic CL ulcer. From a societal perspective the budget impact analysis shows that the regimens' drug costs are lower than indirect disease cost. Average effectiveness in wound free days are 177 (SE?=?0.36) in Group II, 147 (SE?=?0.33) in Group III, and 129 (SE?=?0.27) in Group I. The ICER of Group II versus Group I was US$ 0.09 and Group III versus Group I US$ 0.77, which is very cost-effective with a willingness-to-pay threshold of US$ 2 per wound free day. Within a Monte-Carlo probabilistic sensitivity analysis Group II was cost-effective in 80% of the cases starting at a willingness-to-pay of 80 cent per wound free day.Group II provided the most cost-effective treatment. The non-treatment alternative is not an option in the management of chronic CL ulcers. MWT of Group III should at least be practiced. The cost-effectiveness of Group III depends on the number of dressings necessary until complete wound closure.

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Dataset Information

Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States.

Importance

Objective

Design, setting, and participants

Main outcomes and measures

Results

Publications

Incremental Health Care Expenditure of Chronic Cutaneous Ulcers in the United States.

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