The economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers

BACKGROUND

We sought to examine the economic value of specialized lower-extremity medical care by podiatric physicians in the treatment of diabetic foot ulcers by evaluating cost outcomes for patients with diabetic foot ulcer who did and did not receive care from a podiatric physician in the year before the onset of a foot ulcer.

METHODS

We analyzed the economic value among commercially insured patients and Medicare-eligible patients with employer-sponsored supplemental medical benefits using the MarketScan Databases. The analysis consisted of two parts. In part I, we examined cost or savings per patient associated with care by podiatric physicians using propensity score matching and regression techniques; in part II, we extrapolated cost or savings to populations.

RESULTS

Matched and regression-adjusted results indicated that patients who visited a podiatric physician had $13,474 lower costs in commercial plans and $3,624 lower costs in Medicare plans during 2-year follow-up (P < .01 for both). A positive net present value of increasing the share of patients at risk for diabetic foot ulcer by 1% was found, with a range of $1.2 to $17.7 million for employer-sponsored plans and $1.0 to $12.7 million for Medicare plans.

CONCLUSIONS

These findings suggest that podiatric medical care can reduce the disease and economic burdens of diabetes.

Cost burden of treatment resistance in patients with depression

OBJECTIVE

To develop a claims-based scale for treatment-resistant depression (TRD) and estimate the associated direct cost burden.

STUDY DESIGN

Retrospective, observational study of patients receiving antidepressant therapy between January 2000 and June 2007 (N = 78,477).

METHODS

The Massachusetts General Hospital (MGH) clinical staging method for treatment resistance (assigning points for adequate trials of antidepressant medication, upward dose titration, extended duration, augmentation, and electroconvulsive therapy) was applied to claims data from the MarketScan Research Databases over a 24-month time period. Direct expenditures were measured over a subsequent 12-month period. Patients identified as having TRD (MGH score >or=3.5) (n = 22,593) were matched to depressed patients without TRD using propensity score methods. Regression models estimated the relationship between TRD and expenditures, controlling for sociodemographics, health plan type, and health status. Similar regression models estimated costs for an antidepressant-only version of the scale (MGH-AD).

RESULTS

Treatment resistance among depressed patients was associated with 40% higher medical care costs (P <.001). The MGH-AD score was associated with an increasing gradient in direct costs. Annual costs for patients with mild TRD (MGH-AD 3.5-4) were $1530 higher than those for non-TRD patients, and costs for patients with complex TRD (MGH-AD >or=6.5) were $4425 higher than those for non-TRD patients (all P <.001). A 1-point increase in the MGH-AD score was associated with a $590 increase in annual costs (P <.001).

CONCLUSIONS

Early identification of TRD patients, using a claims-based algorithm, may support targeted interventions for these patients.

Clinical and economic impact of infusion reactions in patients with colorectal cancer treated with cetuximab

Background: Systemic agents in cancer treatment were often associated with possible infusion reactions (IRs). This study estimated the incidence of IRs requiring medical intervention and assessed the clinical and economic impacts of IRs in patients with colorectal cancer (CRC) treated with cetuximab.

Patients and methods: Details on patients with CRC receiving cetuximab in 2004–2006 were extracted from a large USA administrative claims database. IRs were identified based on the occurrence of outpatient treatment, emergency room (ER) visit, and/or hospitalization for hypersensitivity and allergic reactions. Multivariate regressions were used to examine potential risk factors and quantify the economic impact of IRs.

Results: A total of 1122 CRC patients receiving cetuximab were identified. The incidence of IRs requiring medical intervention was 8.4%. Sixty-eight percent of the patients had treatment disruptions and 34% discontinued cetuximab treatment. Mean adjusted costs were $13 863 for cetuximab administrations with an IR requiring ER visit or hospitalization and $6280 for those with an IR requiring outpatient treatment, compared with $4555 for those without an IR.

Conclusions: The incidence rate of cetuximab-related IRs requiring medical intervention in clinical practice was found to be higher than rates reported in the product label and clinical trials. The clinical and economic impacts of these IRs are substantial.