Healthcare costs among patients with newly diagnosed helicobacter pylori infection in the United States: a linked claims-EHR study

Figures & data

Figure 1. Study cohort construction for the primary analysis and secondary analysis.

HP: Helicobacter pylori; EHR: electronic health record. ^aSerology tests were not included as they are not used to confirm active HP infection

Figure 2. (A) Study design used in primary analysis and (B) study design used to secondary analysis.

Table 1. Unadjusted all-cause healthcare costs and Resource utilization in patients with HP.

	Patients with HP
	N = 60,593
	12 M Baseline Period	12M Follow-up Period
Inpatient
Had an admission (N,%)	3,873 (6.4)	4,908 (8.1)
Number of admissions (Mean, SD)	0.1 (0.3)	0.1 (0.4)
Total hospitalized days (Mean, SD)	0.4 (10.9)	0.6 (12.3)
Length of stay per admission (Mean, SD)	5.5 (40.4)	6.1 (42.6)
Inpatient costs (Mean, SD)	$976 ($7,693)	$1,501 ($14,174)
Emergency Department (ED)
Had an ED visit (N,%)	22,653 (37.4)	21,314 (35.2)
Number of ED visits (Mean, SD)	0.9 (2.4)	0.9 (2.4)
ED visit costs (Mean, SD)	$863 ($8,894)	$849 ($9,081)
Outpatient (OP) Services
Had an OP service (N,%)	59,499 (98.2)	59,301 (97.9)
Number of OP services (Mean, SD)	17.1 (27.3)	19.5 (31.6)
Number of OP services (Median, IQR)^b	10 (14)	11 (17)
OP service costs (Mean, SD)	$12,278 ($65,453)	$14,114 ($70,378)
OP service costs (Median, IQR)^b	$2,998 ($6,891)	$3,658 ($8,280)
Office Visits
Had an office visit (N,%)	59,135 (97.6)	58,953 (97.3)
Number of office visits (Mean, SD)	10.5 (8.4)	11.4 (9.1)
Number of office visits (Median, IQR)^b	8 (9)	9 (10)
Office visit costs (Mean, SD)	$1,185 ($1,993)	$1,322 ($3,280)
Office visit costs (Median, IQR)^b	$661 ($1,065)	$702 ($1,161)
Pharmacy
Had a pharmacy claim (N,%)	55,569 (91.7)	56,875 (93.9)
Number of pharmacy claims (Mean, SD)	38.2 (45.0)	44.5 (48.6)
Number of pharmacy claims (Median, IQR)^b	23 (46)	29 (49)
Pharmacy costs (Mean, SD)	$2,210 ($9,864)	$2,908 ($18,269)
Pharmacy costs (Median, IQR)^b	$301 ($1,314)	$473 ($1,707)
Total
Total costs (Mean, SD)	$17,513 ($69,298)	$23,693 ($78,089)
Total costs (Median, IQR)^b	$5,696 ($11,868)	$6,808 ($14,261)

IQR: interquartile range; SD: standard deviation.

^bIQR = 75th percentile - 25th percentile.

Table 2. Average marginal effects of comorbidities and demographic factors^a on healthcare costs of patients with Helicobacter pylori (HP) infection (descending order).

Parameter	Estimate	95% Confidence Limits		p
End-stage renal disease	$92,988	$86,422	$99,553	<.001
Osteomyelitis	$41,026	$30,111	$51,941	<.001
Any cancer	$25,475	$19,710	$31,241	<.001
Diabetes, type 2	$22,901	$9996	$35,806	<.001
Hematemesis	$19,100	$13,652	$24,549	<.001
Pulmonary heart disease	$18,176	$13,639	$22,712	<.001
Diabetes, type 1	$17,335	$13,240	$21,431	<.001
Liver cirrhosis	$17,287	$12,172	$22,402	<.001
Heart failure	$16,551	$13,299	$19,802	<.001
Gastric cancer	$15,705	$1,509	$29,902	0.03
COPD	$10,496	$8,179	$12,814	<.001
Loss of appetite	$9,875	$5,177	$14,573	<.001
Inflammatory bowel disease	$9,032	$3,852	$14,212	<.001
Penicillin allergy	$8,032	$4,076	$11,988	<.001
Other heart disease	$7,525	$5,539	$9,510	<.001
Peptic ulcer disease	$7,323	$4,679	$9,967	<.001
Vomiting	$7,118	$5,165	$9,072	<.001
Chronic rheumatic heart disease	$7,087	$1,919	$12,254	<.001
Diseases of arteries and veins	$6,778	$4,887	$8,668	<.001
Dementia	$5,351	-$69	$10,772	0.053
Osteoarthritis	$5,125	$3,505	$6,746	<.001
Asthma	$5,034	$3,110	$6,958	<.001
Primary hypertension	$4,447	$2,019	$6,875	<.001
Ischemic heart disease	$4,098	$1,961	$6,234	<.001
Cerebrovascular disease	$3,672	$961	$6,383	0.008
Nausea	$3,631	$1,652	$5,611	<.001
Blood in stool	$3,611	$1,428	$5,794	0.001
Resides in Northeast region	$3,581	$1,792	$5,369	<.001
Depression	$2,962	$1,160	$4,764	0.001
Resides in Midwest region	$2,825	$624	$5,025	0.012
Anxiety	$2,390	$711	$4,068	0.005
Irritable bowel syndrome	$2,254	-$701	$5,209	0.135
Dysphagia	$2,234	$201	$4,267	0.031
Body mass index	$174	$77	$271	<.001
Age	$57	$2	$111	0.042

COPD, Chronic obstructive pulmonary disease.

^aidentified as significant in the stepwise regression and included in the generalized linear model.

Table 3. Average marginal effects of Covariates on healthcare costs of patients above and below the median Predicted cost^a.

	Low Cost Group	High Cost Group	Difference
Diabetes, type 2	$3968	$10,708	$6740
Other heart disease	$210	$2,349	$2,139
COPD	$25	$2,080	$2,054
Diseases of arteries and veins	$313	$2,192	$1,879
End-stage renal disease	$0	$1,863	$1,863
Primary hypertension	$1,551	$3,317	$1,766
Heart failure	$1	$1,684	$1,683
Osteoarthritis	$409	$2,021	$1,612
Vomiting	$312	$1,694	$1,381
Asthma	$236	$1,212	$975
Diabetes, type 1	$53	$985	$932
Ischemic heart disease	$108	$1,000	$892
Pulmonary heart disease	$1	$798	$797
Any cancer	$0	$765	$765
Peptic ulcer disease	$124	$875	$750
Body mass index	$4,394	$5,080	$686
Depression	$283	$919	$636
Liver cirrhosis	$0	$559	$559
Hematemesis	$0	$559	$559
Age	$2,826	$3,323	$497
Anxiety	$357	$815	$458
Nausea	$251	$689	$438
Cerebrovascular disease	$52	$449	$397
Penicillin allergy	$23	$419	$397
Blood in stool	$184	$537	$353
Loss of appetite	$20	$362	$343
Osteomyelitis	$0	$290	$290
Inflammatory bowel disease	$26	$256	$230
Chronic rheumatic heart disease	$8	$225	$216
Dysphagia	$164	$346	$181
Resides in Northeast region	$783	$961	$179
Dementia	$9	$152	$143
Resides in Midwest region	$272	$363	$91
Irritable bowel syndrome	$73	$153	$81
Gastric cancer	$0	$76	$76

COPD, Chronic obstructive pulmonary disease ^aHigh/low cost patient split defined as having predicted cost above/below the median predicted cost.

Table 4. Marginal effects of reduction in Helicobacter pylori (HP)-related costs associated with HP eradication.

Parameter	Estimate	95% Confidence Limits		p
Age	-$1	-$3	$1	0.291
Sex	-$2	-$70	$66	0.955
BMI	-$3	-$8	$2	0.173
Geographic region of residence
Northeast	$189	$46	$333	<.001
Midwest	-$33	-$190	$123	0.678
South	-$43	-$172	$87	0.518
West	$6	-$126	$139	0.925
Clinical conditions post-eradication testing
Peptic ulcer disease	$2181	$1715	$2647	<.001
Gastric polyp	$1585	$809	$2362	<.001
Functional dyspepsia	$714	$477	$952	<.001
Gastritis	$626	$474	$778	<.001
Atrophic gastritis	$570	$190	$950	0.003
Esophagitis	$213	-$28	$453	0.083
Dyspepsia	$187	$18	$357	0.031
Gastroesophageal reflux disease (GERD)	$150	-$2	$301	0.054
Idiopathic thrombocytopenic purpura (ITP)	$105	-$1,391	$1,602	0.890
Successfully eradicated HP after first-line	-$38	-$165	$90	0.563
Interaction terms
Peptic ulcer disease x eradicated	-$1,770	-$2,290	-$1,249	<.001
Gastric polyp x eradicated	-$524	-$1,370	$321	0.224
Atrophic gastritis x eradicated	-$518	-$978	-$58	0.027
Functional dyspepsia x eradicated	-$494	-$780	-$208	<.001
Gastritis x eradicated	-$352	-$528	-$176	<.001
ITP x eradicated	-$202	-$2,320	$1,916	0.851
GERD x eradicated	-$91	-$262	$81	0.299
Esophagitis x eradicated	-$84	-$366	$198	0.559
Dyspepsia x eradicated	-$5	-$201	$190	0.957

Data availability statement

The data that support the findings of this study are available from Veradigm and Komodo Health but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Veradigm and Komodo Health.