OBJECTIVES:

Quantifying healthcare resource utilization (HCRU) is key for health economics and outcomes research. This study aims to establish HCRU benchmarks for the general US population (GP) to facilitate comparisons between patients and GPs to quantify disease burden.

METHODS:

This retrospective, cross-sectional study analyzed 2021 enrollee-level US claims in the Komodo Healthcare Map™ dataset including longitudinal medical and prescription claims encompassing adjudicated claims of >320 million unique enrollees from US commercial, Medicare, and Medicaid insurances. A random sample of 10 million enrollees with continuous pharmacy/medical coverage for 2021 were stratified by age, gender, and payer and weighted to represent the GP based on US Census data.

RESULTS:

3,233,591 unique enrollees were included: 49% males with mean (±standard deviation (SD)) age of 39.5 years (±23.1). The mean (95% CI) Charlson Comorbidity Index was 0.66 (0.658, 0.662). 30.6% enrollees represented 80% of medical claims; 24.8% enrollees accounted for 80% of paid pharmacy claims.

7% enrollees represented mean inpatient visits of 11.9 (±24.6) with a length of stay of 2.9 (±42.9) days. 21% enrollees with ≥1 emergency visit had a mean of 4.76 (±6.5) visits.

Enrollees had a mean of 11 (±21.1) healthcare provider visits: family practice (10%), internal medicine (7%), nurse practitioners (7%), radiology (6%), and behavioral care (6%).

2,509,660 enrollees received ≥1 paid pharmacy claim: 44% vaccines, 22% antihyperlipidemics, 22% antidepressants, and 21% anti-inflammatories. Enrollees with ≥1 paid pharmacy claim (78%) had a mean of 34.02 (±53.7).

CONCLUSIONS:

This is the first study to publish RWE-based HCRU benchmarks for the US GP and establishes an important baseline. Future researchers can use this reference to demonstrate the comparative impact of specific diseases on patients’ lives relative to the GP. Future analyses may be valuable to evaluate subpopulations to compare patient experiences with diseases with high HCRU burden and help prioritize limited healthcare resources.