Document Detail


Healthcare resource utilization and economic impact of a ≥2 g/dL decrease in hemoglobin in osteoarthritis patients.
MedLine Citation:
PMID:  23339465     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Abstract Objective: In nonsteroidal anti-inflammatory drug (NSAID) users, chronic occult blood loss may lead to decreases in hemoglobin, which may lead to increased healthcare expenditures. We therefore sought to quantify healthcare resource utilization of ≥2 g/dL hemoglobin decrease in osteoarthritis patients. Methods: Using a large US managed care database, we evaluated osteoarthritis patients aged ≥18 years who had exposure to ≥90 days of nonselective or selective COX-2 NSAID use, a hemoglobin value within 6 months before index NSAID and at least one hemoglobin value 24 months after. Resource utilization was evaluated in those with ≥2 g/dL hemoglobin drop versus patients with ≤0.5 g/dL hemoglobin drop (control). Results: Of 1800 NSAID users meeting inclusion criteria, 228 patients [mean (SD): 59.8 (9.3) years] had ≥2 g/dL hemoglobin drop versus 1572 controls [mean (SD) 58.3 (8.0) years]. Despite relatively low absolute rates, endoscopic procedures were more commonly observed in the ≥2 g/dL hemoglobin drop group [endoscopy: 37/228 (16.2%) vs. 65/1572 (4.1%); adjusted odds ratio (AOR) 3.5, (95% confidence interval [CI] 2.1-6.0); colonoscopy: 36/228 (15.8%) vs. 137/1572 (8.7%); AOR 2.0 (95% CI 1.2-3.2)]. During the 12-month follow-up, patients with ≥2 g/dL hemoglobin drop utilized significantly more healthcare resources [adjusted relative risk (95% CI) for hospitalization, 2.1 (1.5-2.9); outpatient visits, 1.4 (1.3-1.5); physician visits, 1.3 (1.1-1.4)] and charges (total adjusted charges $47,766 vs. $23,342) across major categories of healthcare services. Limitations: This was a retrospective analysis with baseline demographic differences. The source or cause of the hemoglobin drops could not be verified; and it is assumed that they are related to occult gastrointestinal loss. Differences with healthcare utilization and charges were not linked to hemoglobin-associated complications. Conclusion: In patients exposed to NSAIDs, those with significant hemoglobin drops experienced higher subsequent healthcare utilization and charges than controls who did not have a significant hemoglobin drop.
Authors:
Jay L Goldstein; Xuemei Luo; Joseph C Cappelleri; George H Sands
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-22
Journal Detail:
Title:  Journal of medical economics     Volume:  -     ISSN:  1941-837X     ISO Abbreviation:  J Med Econ     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9892255     Medline TA:  J Med Econ     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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