Healthcare Costs for 17 Chronic Condi3ons in Ontario. Walter P Wodchis, PhD CAHSPR May 26, 2015

Transcription

1 Healthcare Costs for 17 Chronic Condi3ons in Ontario Walter P Wodchis, PhD CAHSPR May 26, 2015

2 Overview Background Purpose Methods Results Strengths and Limita3ons Implica3ons & Next Steps 2

3 Research Team YuQing Bai, Susan Bronskill, Andrea Gruneir, Anna Kone, Natasha Lane, Colleen Maxwell, Yelena Petrosyan, Kednapa Thavorn, Walter Wodchis 3

4 Background The high and growing cost burden of chronic condi3ons is a highly cited feature of most western countries. There is an increasing apprecia3on of the magnitude of costs associated with caring for individuals with common chronic condi3ons. However, es3mates to date were derived for specific condi3ons with varied methods precluding direct comparison of costs. 4

5 Background or, in the nearest approxima3on to the ideal, es3mates of burden were based on Ambulatory Care Group (ACG ) weights See: Broemeling, Watson, Black. Chronic condi3ons and co- morbidity among residents of Bri3sh Columbia. Centre for Health Services and Policy Research

6 Background Depression Degenerative joint disease Hypertension Diabetes Ischemic heart disease High Impact/Prevalence: hypertension, depression, diabetes, ischemic heart disease, asthma, cancers, cardiac arrhythmia, COPD, congestive heart failure, stroke 25 Cancers Prevalence 20 Thyroid Dis Dis Lymphoid Metab. Asthma Cardiac Arrhythmia 15 Allergic Rhinitis Autoimmune / conn. tissue COPD Congestive heart failure 10 Deafness / Hearing loss Prostatic hypertrophy Cerebrovascular disease 5 0 Chronic Cystic Dis Breast ADD Obesity Psoriasis Endometriosis Congenital anom: limbs Glaucoma MS Malignant neoplasm of skin IBD Devt dis Seizure CF Personality disorders Chromosomal Diverticular dis. of colon Schizophrenia/ affective psychosis Osteoperosis Parkinson s CHD MD Kyphoscoliosis HAnem Generalized atherosclerosis HIV / AIDS Impact Blindness Peripheral vascular disease Cardiac valve dis Chronic liver dis Cardiomyopathy Dementia / delerium Chronic skin ulcer Chronic renal failure Aplastic anemia 6

7 Purpose The objec3ve of the present study was to es3mate the annual incremental costs associated with 17 common chronic condi3ons using a common methodology to measure the compara3ve costs associated with each condi3on. 7

8 Methods: Data Sources Ontario has rich health administra3ve data held at the Ins3tute for Clinical Evalua3ve Sciences (ICES) that are linkable at the individual level using coded iden3fiers: Hospital Data from Canadian Ins3tute for Health Informa3on (CIHI) Discharge Abstract Database, Na3onal Rehabilita3on Repor3ng System, Con3nuing Care Repor3ng System, Mental Health Repor3ng System, Ambulatory Care Repor3ng System Physician, pharmaceu3cal and home care billing databases maintained in Ontario Also hospital cost databases from the Management Informa3on System (MIS) 8

9 Methods: Popula3on Cross sec3onal 20% sample of Ontario residents aged as of the index date of the study (April 1, 2012) diagnosed with one of the following 17 condi3ons: Cardiac arrhythmia Osteoporosis Acute myocardial infarc3on Rheumatoid arthri3s Hypertension Osteo- and other arthri3s Chronic coronary syndrome Mood disorders Conges3ve heart failure Demen3a Stroke Other mental health Asthma Cancer Chronic obstruc3ve pulmonary disorder Diabetes Renal failure 9

10 Methods: Popula3on Validated ICES derived chronic disease databases were used to iden3fy prevalent cases of: Hypertension, Conges3ve Heart Failure, Asthma, Chronic Obstruc3ve Pulmonary Disorder, Diabetes, Acute Myocardial Infarc3on (April 2011 to March 2012) 10

11 Methods: Popula3on All other diagnoses: One acute care code in an acute care episode (Canadian Ins3tute for Health Informa3on Discharge Abstract Database, CIHI- DAD), OR 2 relevant ICD9 codes in OHIP physician billing records within 2 years prior to the index date (April 1, 2012) This is generally the approach of the ICES derived databases. For details, see: Koné Pefoyo AJ, Bronskill SE, Gruneir A, Calzavara A, Thavorn K, Petrosyan Y, Maxwell CJ, Bai Y, Wodchis WP. The increasing burden and complexity of mul3morbidity. BMC Public Health Apr 23;15(1):415., 11

12 Methods: Cost Es3ma3on Individual pa3ent- specific total direct cost es3ma3on based on methods developed for use with administra3ve data: Mostly bojom- up with some top- down algorithms to determine encounter- specific costs. Generally = Sum over one year of all Use x Cost/Use (all encounters, not those specific to one condi3on) U3liza3on includes all hospital, home care, long term care, physician, pharmacy for 65+ and all receiving provincial government income support payments 12

13 Methods: Cost Es3ma3on cont d Encounter- specific costs equal to amounts paid for physician, drugs, home care (plus allocated case- management) Hospital costs allocated to cost per weighted case (using CIHI Resource Intensity Weights) from hospital financial submissions using Management Informa3on System (MIS) and related sources from Ontario Ministry of Health and Long Term Care (MOHLTC) Health Data Branch, Other costs from MOHLTC (e.g. OHIP Architected Payment Database) For details, see: Wodchis WP, Bushmeneva K, Nikitovic M, McKillop I. Guidelines on Person- Level Cos3ng Using Administra3ve Databases in Ontario. Working Paper Series. Vol 1. Toronto: Health System Performance Research Network;

14 Methods: Cost Es3ma3on cont d For each condi3on: Find person in Ontario popula3on without condi3on but matched on : Age +/- 3 months, Sex, LTC residence Then propensity match on age, sex, LTC, rurality, 12 Collapsed ADG scores, neighborhood income quin3le, 14 provincial regions (caliper of 0.2 s.d. of propensity score) Match within 20% sample of residents except for Arthri3s, Hypertension and Asthma where we use en3re popula3on to find matches (large number of unmatched in 20% sample). Incremental cost = difference cost w/ vs w/o condi3on Provincial total cost = popula3on x incremental cost 14

15 Results: Study Popula3on ON Popula*on Study 20% Sample Cardiac arrhythmia 375,946 75,223 Acute myocardial infarc3on 11,994 2,430 Hypertension 2,755, ,899 Chronic coronary syndrome 684, ,071 Conges3ve heart failure 228,084 45,691 Stroke 145,156 28,758 Asthma 1,902, ,953 Chronic obstruc3ve pulmonary disorder 272,186 54,732 Osteoporosis 324,166 64,436 Rheumatoid arthri3s 163,151 32,934 Osteo- and other arthri3s 3,186, ,718 Mood disorders 1,388, ,103 Demen3a 175,082 35,300 Other mental health 1,775, ,454 Cancer 981, ,146 Diabetes 1,199, ,005 Renal failure 194,674 38,907 15

16 Results: Incremental Cost per year Cost (Incremental and Per Year Alive) ($) 12,000 10,000 8,000 6,000 4,000 2,000 0 (2,000) Renal CHF Dementia AMI COPD Stroke Diabetes Other mental health Arrhythmia Coronary syndrome Hypertension Depression Cancer Physician Hospital Drug/Device Long Term Care Other Rheumatoid arthritis Asthma Osteoarthritis Osteoporosis 16

17 Results: Total Direct Cost per year Total System Cost (Billion $) Physician Hospital Drug/Device Long Term Care Other (0.5) Renal CHF Dementia AMI COPD Stroke Diabetes Other mental health Arrhythmia Coronary syndrome Hypertension Depression Cancer Rheumatoid arthritis Asthma Osteoarthritis Osteoporosis 17

18 Results: Incremental vs Total Costs Total System Cost (Billion $) Hypertension Diabetes Other mental health Osteoarthri3s Renal 1.5 Depression CHF COPD 1.0 Cancer Coronary Demen3a Asthma syndrome 0.5 Arrhythmia Stroke Rheumatoid AMI arthri3s (1000) Osteoporosis (0.5) Total Incremental Cost ($) 18

19 Strengths and Limita3ons Study popula3on and costs representa3ve of Ontario popula3on (> 95% sample matched). Robust incremental cost es3mates. Condi3ons are those present at start of year and do not include new incident cases so cannot say annual cost for all diabetes care. Some condi3ons are episodic and episode- based costs may be more appropriate (AMI, cancer) 19

20 Implica3ons and Next Steps We want to understand how quality relates to costs. Do people who get bejer care have lower costs? Over what 3me horizon? (some early evidence for diabetes) We have examined mul3morbidity as incremental number of condi3ons but some clusters might have par3cularly important cost implica3ons. 20