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Abstract
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, disease-related 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 disease-related 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.
Acknowledgments
The authors would like to acknowledge Dr Sarah Birch and Sue Williamson (Rx Communications, Mold, UK) for medical writing assistance with the preparation of this manuscript, funded by Eli Lilly and Company.
Abbreviations
5-ASA, 5-aminosalicylic acid; DMARD, disease-modifying anti-rheumatic drug; DRG, diagnosis-related group; ER, emergency room; HCPCS, Healthcare Common Procedure Coding System; HCRU, healthcare resource utilization; HIV, human immunodeficiency virus; ICD, International Classification of Diseases; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus; UC, ulcerative colitis; US, United States.
Author Contributions
Krista M Schroeder was involved in the design and interpretation of the data for the work, Steve Gelwicks was involved in the design of the work and the analysis of the data. April N Naegeli and Pam C Heaton were involved in the interpretation of the data for the work. All authors contributed sufficiently to the work and provided critical revision of the manuscript for important intellectual content. All authors give their approval of the manuscript to be submitted and published in ClinicoEconomics and Outcomes Research, and agree to be accountable for all aspects of the work.
Disclosure
Krista M Schroeder and April N Naegeli are employees of and own stock in Eli Lilly and Company. Steve Gelwicks was an employee of Eli Lilly and Company at the time the study was conducted and is a minor stockholder of Eli Lilly and Company. Pamela C Heaton reports grants from Eli Lilly and Company, during the conduct of the study and outside the submitted work. The authors report no other conflicts of interest in this work.