THE USE OF QUINTILE ANALYSIS AS A MEASURE OF DISEASE SEVERITY- A COMPARISON WITHIN AND ACROSS DISEASES
Author(s)
Richard Brook, MS, MBA, Director, Business Development; Head, Retrospective Analysis1, Nathan Kleinman, PhD, Senior Research Analyst2, James Smeeding, RPh, MBA, President3, Kitty Rajagopalan, PhD, Director, Health Economics/Outcomes Research4, Peter Wahlqvist, MSc, Senior Health Economics Scientist5, Sara Campbell, MS, Research Analyst2, Sandra Joshua-Gotlib, MSPH, MBA, Associate Director-Health Economics and Outcomes Research6, Stephen George, MS, RPh, VP, Healthcare Consulting7, Dustin D. Wingenbach, MBA, Research Analyst2, Kem P Krueger, PhD, Associate Professor8, Arthur K Melkonian, MD, Research Analyst2, Suzanne Novak, MD, PhD, Senior Medical Consultant9, Harold Gardner, MD, President21The JeSTARx Group, Newfoundland, NJ, USA; 2 The HCMS Group, Cheyenne, WY, USA; 3 The JeSTARx Group, Dallas, TX, USA; 4 AstraZeneca Pharmaceuticals LP, Wilmington, DE, USA; 5 AstraZeneca R&D, Mölndal, AL, Sweden; 6 Cephalon Inc, Frazer, PA, USA; 7 Conexus Health, Tampa, FL, USA; 8 Auburn University, Auburn, AL, USA; 9 The JeSTARx Group, Austin, TX, USA
OBJECTIVES: Analysis of administrative claims data are often criticized for lacking adjustments for severity. We explored if disease-specific cost (DSC) quintiles may be indicative of disease severity in an examination of several diseases. METHODS: The Human Capital Management Services Reference Research Database of over 300,000 employees was used to examine the annual DSC of several diseases from 2001-2004. DSCs were calculated as the sum of the disease-specific medical costs (DSMC) for services tied to disease related ICD-9-CM codes and the disease-specific prescription cost (DSRxC) for outpatient medicines. Diseases included Back Disorders, Bipolar Disorder, Cancer, Functional Dyspepsia, Gastroesophageal Reflux Disease (GERD), Headaches, Neuropathic Disorders, and Osteoarthritis. Based on DSC, subjects in each disease state were rank ordered into 5 cost quintiles (20% each) ranging from lowest- highest cost quintile. Within and across diseases pairwise differences in the quintile distributions were assessed using Chi-squared tests. RESULTS: The range of the sum of costs related to each specific disease state found in the highest cost quintile (from lowest to highest) were the following (including percentage of subjects in the highest quintile): 1) Functional Dyspepsia (3.54%, DSMC $1,171, DSRxC $1,278 ); 2) GERD (2.57%, DSMC $4,886 DSRxC $1,108); 3) Bipolar Disorder (2.37%, DSMC $21,427, DSRxC $2,354) 4) Headaches (1.14%, DSMC $6,846, DSRxC $1,134); 5) Back Disorders (0.53%, DSMC $39,807, DSRxC $570; 6) Osteoarthritis (0.51%, DSMC $44,677, DSRxC $59); 7) Neuropathic Disorders (0.20%, DSMC $80,463, DSRxC $741); and 8) Cancer (0.38%, DSMC $108,678; DSRxC $167). All pairwise comparisons were significant (FD and GERD, P=0.0468) and the remaining comparisons (P ≤ 0.001). CONCLUSIONS: In all diseases explored, 3.5% of subjects or less consume the highest 20% of costs. These cost-comparison results may suggest that cost quintiles are indicative of severity in all disease states. Further investigation is warranted to confirm this relationship.
Conference/Value in Health Info
2006-05, ISPOR 2006, Philadelphia, PA
Value in Health, Vol. 9, No.3 (May/June 2006)
Code
PMC9
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Multiple Diseases
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