COMPARISON OF HEALTHCARE USE AND COSTS OF ADULT PATIENTS WITH PURE - - PowerPoint PPT Presentation

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COMPARISON OF HEALTHCARE USE AND COSTS OF ADULT PATIENTS WITH PURE - - PowerPoint PPT Presentation

Apr 26, 2023 332 likes •584 views

COMPARISON OF HEALTHCARE USE AND COSTS OF ADULT PATIENTS WITH PURE OBSESSIVE-COMPULSIVE DISORDER VERSUS PURE DEPRESSION: NINE-YEAR CLAIMS ANALYSIS OF FLORIDA MEDICAID ENROLLEES C. Hankin 1 ; L.M. Koran 2 ; L. Culpepper 3 ; J.

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1 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

COMPARISON OF HEALTHCARE USE AND COSTS OF ADULT PATIENTS WITH “PURE OBSESSIVE-COMPULSIVE DISORDER” VERSUS “PURE DEPRESSION”: NINE-YEAR CLAIMS ANALYSIS OF FLORIDA MEDICAID ENROLLEES

  • C. Hankin1; L.M. Koran2; L. Culpepper3; J. Knispel4; D. Dougherty5; E. Hollander6;

D.V. Sheehan7; J. Dunn8; A. Levin9; D.W. Black10; A. Bronstone1; S. Wang1

1BioMedEcon, LLC, Moss Beach, CA; 2Stanford University, Stanford, CA; 3Boston University,

Boston, MA; 4Humana, Singer Island, FL; 5Massachusetts General Hospital, Boston, MA; 6Mount Sinai School of Medicine, New York, NY; 7University of South Florida, Tampa, FL; 8SelectHealth, Inc., Salt Lake City, UT; 9Health Plus, Bronx, NY; 10University of Iowa, Iowa City, IA Research Funded by Jazz Pharmaceuticals, Inc.

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2 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

BACKGROUND: OBSESSIVE-COMPULSIVE DISORDER (OCD)

  • Anxiety disorder characterized by
  • Recurrent, unwanted thoughts (obsessions) and/or
  • Repetitive behaviors (compulsions)
  • U.S. estimated prevalence 2%
  • Many studies document higher use of outpatient medical services

among depressed patients

  • Anecdotal reports among patients with OCD
  • Healthcare (medical and psychiatric) costs?
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3 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

OBJECTIVE

  • Compare healthcare use and costs of newly-

diagnosed1 patients with “pure OCD”2 (P-OCD) to matched3 sample of newly-diagnosed patients with “pure depression”(P-D)4

1. Newly-diagnosed: No OCD (or depression) diagnosis 2 years preceding 1st (index) diagnosis 2. Pure OCD: no pre-existing or comorbid bipolar disorder, psychoses, or depression 3. Matched: sex, race/ethnicity, medical illness severity (Charlson index), age/year at index diagnosis 4. Pure Depression: no pre-existing or comorbid bipolar disorder, psychoses, or OCD)

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4 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

METHODS: FLORIDA MEDICAID DATASET

  • Florida Medicaid: > 5 million enrollees
  • Computerized claims records
  • Demographics
  • ICD-9 (diagnoses)
  • CPT (procedures)
  • NDC (drugs)
  • Information patient de-identified and HIPAA compliant
  • BioMedEcon obtained 9 years of data (1997-2006)
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5 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

RESULTS: MEDIAN OVERALL 2-YEAR HEALTHCARE COSTS

$0 $15,000 $30,000 Overall Healthcare Costs Overall Medical Costs Overall Psychiatric Costs

Median Healthcare Costs ($)

p<0.0001 p<0.0001 p<0.0001 $3,390 $24,799 $7,056 $25,666 $7,832 $943

P-OCD P-D

Overall Healthcare Costs Were Significantly Higher in Patients with P-OCD versus P-D

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6 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

RESULTS: MEDIAN OVERALL 2-YEAR HEALTHCARE COSTS

$0 $15,000 $30,000 Overall Healthcare Costs Overall Medical Costs Overall Psychiatric Costs

Median Healthcare Costs ($)

p<0.0001 p<0.0001 p<0.0001 $3,390 $24,799 $7,056 $25,666 $7,832 $943

Overall Healthcare Costs Were Significantly Higher in Patients with P-OCD versus P-D

P-OCD P-D

Medical and Psychiatric) Costs were Significantly Higher in Patients with P-OCD vs P-D

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7 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

Summary of Results

Total Costs Medical Costs Psychiatric Costs Overall Healthcare Costs Inpatient Costs NS NS

  • Outpatient Costs

NS Pharmacy Costs NS

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8 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

MEDIAN 2-YEAR INPATIENT COSTS

$0 $5,000 $10,000

All Inpatient Costs Medical Inpatient Costs

$8,932 $5,791 $8,932 $5,791

P-OCD P-D

Median Inpatient Costs ($)

not significant

Total Inpatient Costs Were Not Significantly Different Between Groups

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9 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

$0 $5,000 $10,000

All Inpatient Costs Medical Inpatient Costs

$8,932 $5,791 $8,932 $5,791

P-OCD P-D

Median Inpatient Costs ($)

not significant

Total Inpatient Costs Were Not Significantly Different Between Groups

MEDIAN 2-YEAR INPATIENT COSTS

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10 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

Summary of Results

Total Costs Medical Costs Psychiatric Costs Overall Healthcare Costs Inpatient Costs NS NS

  • Outpatient Costs

NS Pharmacy Costs NS

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11 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

$0 $3,000 $6,000

Total Outpatient Costs Medical Outpatient Costs Psychiatric Outpatient Costs

Median Outpatient Costs ($)

$5,139 $2,687 $4,820 $2,525 $220 $224

P-OCD P-D

p<0.0001 p<0.0001 not significant

Total Outpatient Costs Were Significantly Higher in Patients with P-OCD vs P-D

MEDIAN 2-YEAR OUTPATIENT COSTS

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12 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

$0 $3,000 $6,000

Total Outpatient Costs Medical Outpatient Costs Psychiatric Outpatient Costs

Median Outpatient Costs ($)

$5,139 $2,687 $4,820 $2,525 $220 $224

P-OCD P-D

p<0.0001 p<0.0001 not significant

Total Outpatient Costs Were Significantly Higher in Patients with P-OCD vs P-D

Medical (but not Psychiatric) Costs were Significantly Higher in Patients with P-OCD vs P-D

MEDIAN 2-YEAR OUTPATIENT COSTS

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13 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

Summary of Results

Total Costs Medical Costs Psychiatric Costs Overall Healthcare Costs Inpatient Costs NS NS

  • Outpatient Costs

NS Pharmacy Costs NS

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14 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

$0 $3,000 $6,000 Total Pharmacy Costs Medical Pharmacy Costs Psychiatric Pharmacy Costs $5,741 $2,578 $1,810 $1,346 $3,294 $818

Median Outpatient Costs ($)

P-OCD P-D

not significant p<0.0001 p<0.0001

Total Pharmacy Costs Were Significantly Higher in Patients with P-OCD vs P-D

MEDIAN 2-YEAR PHARMACY COSTS

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15 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

$0 $3,000 $6,000 Total Pharmacy Costs Medical Pharmacy Costs Psychiatric Pharmacy Costs $5,741 $2,578 $1,810 $1,346 $3,294 $818

Median Outpatient Costs ($)

P-OCD P-D

not significant p<0.0001 p<0.0001 Psychiatric (but not Medical) Costs were Significantly Higher in Patients with P-OCD vs P-D

Total Pharmacy Costs Were Significantly Higher in Patients with P-OCD vs P-D

MEDIAN 2-YEAR PHARMACY COSTS

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16 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

Summary of Results

Total Costs Medical Costs Psychiatric Costs Overall Healthcare Costs Inpatient Costs NS NS

  • Outpatient Costs

NS Pharmacy Costs NS *

* Antimanics, Antidepressants, Antipsychotics, Anxiolytics, Mood Stabilizers, Sedative/Hypnotics, Stimulants

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17 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

CONCLUSIONS

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18 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

  • Although patients were matched on medical illness severity, those

with P-OCD had 2 times greater outpatient medical costs than those with P-D.

  • Findings suggest that care for patients with OCD occurs in the
  • utpatient medical setting

CONCLUSIONS: OUTPATIENT COSTS

Total Costs Medical Costs Psychiatric Costs Overall Healthcare Costs Inpatient Costs NS NS

  • Outpatient Costs

NS Pharmacy Costs NS

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19 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

  • P-OCD patients had significantly greater psychotropic costs than those with

P-D. This may be attributable to

  • Higher SSRI doses required4
  • More frequent use of concomitant psychotropics5
  • Inappropriate pharmacologic treatment?

CONCLUSIONS: PHARMACY COSTS

Total Costs Medical Costs Psychiatric Costs Overall Healthcare Costs Inpatient Costs NS NS

  • Outpatient Costs

NS Pharmacy Costs NS

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20 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

  • Although a relatively rare disorder, the overall healthcare

costs of patients with OCD appear to exceed those of patients with depression

  • Findings suggest that care for patients with OCD

commonly occurs in the outpatient medical setting

  • Further research is required to determine whether

appropriate treatment of OCD improves patient

  • utcomes and reduces costs

CONCLUSIONS

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21 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

BACKUP

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22 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

METHODS: P-OCD PATIENT IDENTIFICATION

  • 1. OCD = ICD-9 300.3
  • 2. Depression = ICD-9 296.2, 296.3, 296.9, 300.4, 309.0, 309.1, 311
  • 3. Psychoses = ICD-9 295, 298
  • 4. Bipolar disorder = ICD-9 296

1997 2006 2001

1st OCD diagnosis

No OCD1, Depression,2 Bipolar,3 Psychoses4

1999 2003

P-D patients were identified similarly, except index claim was depression and exclusion diagnoses included OCD rather than depression.

No Depression,2 Bipolar,3 Psychoses4

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23 Society of General Internal Medicine, 31st Annual Meeting; April 11, 2008; Pittsburgh, PA

  • 21 P-OCD patients could not be matched
  • Numbers of matches of P-OCD to P-D patients ranged

from 1 to 76

135 patients with P-OCD were matched to 1,511 patients with P-D on sex, race/ethnicity, medical illness severity (Charlson index), and age and year at index diagnosis Adults with newly-diagnosed with P-OCD (N=156) Adults with newly-diagnosed with P-D (N= 16,055)

RESULTS: PATIENT MATCHING