Healthcare Utilization and Costs associated with Hereditary Hemorrhagic Telangiectasia Patients in a Large US Claims Database

Hasan Ahmad Hasan Albitar; Holly Van Houten; Lindsey R Sangaralingham; Meghan Knoedler; Yahya Almodallal; Adham K Alkurashi; Alice Gallo De Moraes; Hector Cajigas; Hillary DuBrock; Deepti Warad; Nadir Demirel; Michael Krowka; Waleed Brinjikji; Vivek N Iyer

doi:10.1016/j.mayocpiqo.2020.08.010

Healthcare Utilization and Costs associated with Hereditary Hemorrhagic Telangiectasia Patients in a Large US Claims Database

Mayo Clin Proc Innov Qual Outcomes. 2020 Nov 20;5(1):55-64. doi: 10.1016/j.mayocpiqo.2020.08.010. eCollection 2021 Feb.

Authors

Hasan Ahmad Hasan Albitar¹, Holly Van Houten^{2

3}, Lindsey R Sangaralingham^{2

3}, Meghan Knoedler^{2

3}, Yahya Almodallal⁴, Adham K Alkurashi⁵, Alice Gallo De Moraes¹, Hector Cajigas¹, Hillary DuBrock¹, Deepti Warad⁶, Nadir Demirel⁷, Michael Krowka¹, Waleed Brinjikji⁸, Vivek N Iyer¹

Affiliations

¹ Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
² Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
³ OptumLabs, Cambridge, MA.
⁴ Department of Pediatrics, Mayo Clinic, Rochester, MN.
⁵ Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
⁶ Division of Pediatric Hematology/Oncology, Mayo Clinic, Rochester, MN.
⁷ Division of Pediatric Pulmonary Medicine, Mayo Clinic, Rochester, MN.
⁸ Department of Radiology, Mayo Clinic, Rochester, MN.

Abstract

Objective: To assess the health care costs and utilization in patients with hereditary hemorrhagic telangiectasia (HHT) in the United States.

Patients and methods: Retrospective analysis of patients with HHT diagnosed between 2007 and 2017 was performed using deidentified administrative claims data from the OptumLabs Data Warehouse. Adult patients with new (incident) diagnosis of HHT between January 1, 2007, and December 31, 2017, were included. Comparisons were made using the Wilcoxon rank sum test.

Results: Three thousand nine hundred seventy-seven patients with a first diagnosis of HHT between 2007 and 2017 were identified, of which 3590 were matched 1:1 to non-HHT patients with similar baseline characteristics and comorbidities. These 3590 patients with HHT were 63.1% female and 83.9% white with a mean age of 51.1 ± 18.5 years, and a mean follow-up period of 3.2 ± 2.2 years (range, 1.0-11.7 years). Compared with the control group, the cumulative 5-year median total health care cost for patients with HHT was 41.4% higher ($21,118 vs $14,929; P < .001) in those with private commercial insurance and 31.7% higher ($35,462 vs $26,925; P < .001) in those with Medicare Advantage coverage. The median annual health care costs were significantly higher in patients with HHT with commercial insurance and Medicare Advantage in the first year after diagnosis ($4,333 vs $1,804; P < .001), and ($7,322 vs $5,245; P < .001), respectively, and remained higher throughout the duration of follow-up. Further analysis showed that outpatient clinic visits, hospital admission, imaging rates, invasive procedures, iron infusions, and blood transfusions were all significantly higher in the HHT group.

Conclusion: Patients with HHT have significantly higher health care costs compared with a matched control group. A better understanding of the reasons underlying these cost differences will provide opportunities for patients, providers, and other stakeholders to better manage this rare condition.

Keywords: AVM, arteriovenous malformation; CT, computed tomography; GI, gastrointestinal; HHT, hereditary hemorrhagic telangiectasia; ICD, International Classification of Diseases; MRI, magnetic resonance imaging; OLDW, OptumLabs Data Warehouse.