Cohen Adam, Gaebler Julia A, Izhakoff Jessica, Gullett Laura, Niecko Timothy, O'Donnell Thomas
a Health Advances LLC , Weston , MA , USA.
b Niecko Health Economics, LLC , Tierra Verde , FL , USA.
J Med Econ. 2018 Oct;21(10):993-1000. doi: 10.1080/13696998.2018.1491008. Epub 2018 Jul 5.
To assess the budget impact to a US commercial health plan of providing access to the Flexitouch (FLX) advanced pneumatic compression device (Tactile Medical) to lymphedema (LE) patients with either comorbid chronic venous insufficiency (CVI) or frequent infections.
Budget impact was calculated over 2 years for a hypothetical US payer with 10-million commercial members. Model inputs were derived from published sources and from a case-matched analysis of Blue Health Intelligence (BHI) claims data for the years 2012-2016. To calculate the budget impact, the Status Quo budget (i.e. total cost for LE and sequelae-related medical treatment) was compared to the budget under each of three Alternate Payer Policy scenarios which assumed that a sub-set of patients was redistributed from their initial treatment groups to a group that received FLX. Model outputs included cumulative payer costs, net budget impact, and breakeven point. Sensitivity analyses were performed to assess the impact of model inputs on results.
Increasing access to FLX yielded a favorable budget impact in every scenario. For LE patients with comorbid CVI, the three alternate scenarios resulted in cumulative 2-year budget impacts of -$52,841, -$173,317, and -$375,601, respectively. For LE patients with comorbid frequent infections, the three alternate scenarios resulted in cumulative 2-year budget impacts of -$192,729, -$259,339, and -$613,179, respectively.
Use of claims data assumes accurate coding and does not allow one to control for disease severity or treatment adherence. Also, the distribution of patients between treatment arms was determined using claims data from a specific payer organization, and could differ for health plans with different coverage policies.
While previous studies have illustrated cost savings with adoption of FLX, US commercial health plans may also achieve tangible cost savings by expanding access to FLX for LE patients with comorbid CVI and multiple infections.
评估向合并慢性静脉功能不全（CVI）或频繁感染的淋巴水肿（LE）患者提供Flexitouch（FLX）先进气动压缩装置（泰克医疗公司）对美国商业健康计划的预算影响。
针对拥有1000万商业会员的假设美国付款人，计算2年期间的预算影响。模型输入数据来自已发表的资料以及对2012 - 2016年蓝色健康情报（BHI）索赔数据的病例匹配分析。为计算预算影响，将现状预算（即淋巴水肿及后遗症相关医疗治疗的总成本）与三种替代付款人政策情景下的预算进行比较，这三种情景假设一部分患者从其初始治疗组重新分配到接受FLX治疗的组。模型输出包括累积付款人成本、净预算影响和盈亏平衡点。进行敏感性分析以评估模型输入对结果的影响。
在每种情景下，增加FLX的可及性都产生了有利的预算影响。对于合并CVI的LE患者，三种替代情景导致的2年累积预算影响分别为 - 52,841美元、 - 173,317美元和 - 375,601美元。对于合并频繁感染的LE患者，三种替代情景导致的2年累积预算影响分别为 - 192,729美元、 - 259,339美元和 - 613,179美元。
使用索赔数据假定编码准确，且无法控制疾病严重程度或治疗依从性。此外，治疗组之间患者的分布是根据特定付款人组织的索赔数据确定的，对于具有不同覆盖政策的健康计划可能有所不同。
虽然先前的研究表明采用FLX可节省成本，但美国商业健康计划通过扩大对合并CVI和多种感染的LE患者的FLX可及性，也可能实现切实的成本节省。
