The burden of cystic fibrosis in the Medicaid population
Authors Hassan M, Bonafede MM, Limone BL, Hodgkins P, Sawicki GS
Received 9 January 2018
Accepted for publication 26 April 2018
Published 25 July 2018 Volume 2018:10 Pages 423—431
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Dean Smith
Mariam Hassan,1 Machaon M Bonafede,2 Brendan L Limone,2 Paul Hodgkins,1 Gregory S Sawicki3
1Global Health Economics and Outcomes Research, Vertex Pharmaceuticals Incorporated, Boston, MA, USA; 2Life Sciences, Truven Health Analytics, Cambridge, MA, USA; 3Division of Respiratory Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
Purpose: To conduct an analysis describing clinical characteristics, pulmonary exacerbation (PEx) events, and health care resource utilization among Medicaid-insured patients with cystic fibrosis (CF).
Patients and methods: A retrospective analysis of the Truven Health MarketScan® Medicaid Multi-State administrative claims database (2010–2014) was undertaken. Patients aged ≥6 years with a CF diagnosis, continuously enrolled for 12 months, were identified. Demographics, comorbidities, PEx events, and health care resource utilization and costs over a 12-month enrollment period were analyzed for all patients and by age groups.
Results: In total, 1196 patients with CF aged ≥6 years were identified from a sample size of approximately 10 million Medicaid patients. Mean (SD) age was 16.1 (8.8) years. A greater proportion of patients were in younger age groups (6–11 years: 35.5%, 12–17 years: 29.1%, 18–26 years: 25.6%, 27–34 years: 6.7%, ≥35 years: 3.2%). Across all age groups, approximately 90% of patients had at least 1 PEx event; 50.7% of those had a PEx event involving treatment with intravenous antibiotics, and 42.8% required hospitalization. PEx recurrence was frequent: 55.7% of all patients experienced ≥3 PEx events during 1 year. Mean (SD) health care expenditures during a PEx event rose with increasing age, ranging from US$44,589 (US$139,024) to US$116,169 (US$387,752). Overall health care resource utilization was high among patients with CF; 47.2% of the population required an inpatient admission, and 26.8% had subsequent hospitalizations totaling 29.1 days per year in hospital.
Conclusion: High rates of PEx, hospitalizations, and time spent in hospital demonstrate the significant health care burden of CF among Medicaid beneficiaries.
Keywords: resource utilization, length of stay, pulmonary exacerbations
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