OBJECTIVES: In 2019, people aged 65 years and above represented ~16% of the total US population, and this is expected to increase to ~22% by 2040. According to the US Centers for Medicare and Medicaid Services, in 2014, per person personal health care spending for the elderly population was $19,098, which is ~3 times the spending per working-age person ($7,153). Aim of this study is to determine the cost & disease burden of individuals aged 65 years and above in the US.

METHODS: In this study, Optum’s de-identified Clinformatics® Data Mart database was used to identify the patients who were 65 years and above for 3 different time-period from 2018-2021 (1st July to 30th June was selected for year-on-year comparison). These patients had to have continuous medical and pharmacy eligibility for 12 months after their first claim (index). The standard cost per member per year (PMPY) was calculated for different diseases and places of service.

RESULTS: From 1 July 2020 to 30 June 2021, we had 5.6 million (57% females and 43% males) patients who were 65 years and above and had continuous medical and pharmacy eligibility for 12 months in the follow-up period. During the study period, the top 3 diseases in terms of PMPY standard costs were lung cancer ($ 76,545), circulatory system diseases ($ 60,810), and respiratory diseases ($ 54,360). The top 3 places of service based on PMPY cost were inpatient facilities, outpatient departments, and skilled nursing facilities. Further trend analysis over the study period of three years and statistical tests will be performed.

CONCLUSIONS: One of the main drivers of costs in elderly patients is chronic diseases such as lung cancer, CVS diseases, and respiratory diseases. This study may help to create better management plans for the top diseases at early onset and help to reduce the overall cost.