Use of Insurance Claims Data
With the increasing frequency of antibiotic-resistant gram-positive infections in the United States, many patients are being treated outside the hospital setting. The majority of studies on the cost of outpatient antimicrobial therapy involve retrospective medical record review or prospective data collection. These methods tend to be expensive and time consuming, and often fail to produce a sufficiently large sample size. Analysis of insurance claims data offers a convenient approach for studying the costs associated with outpatient therapy for gram-positive infections. To demonstrate this approach, a study of the cost of intravenous vancomycin home care therapy was conducted using claims data from a large insurance company.
Infections caused by gram-positive organisms often require a long duration of antibiotic treatment that extends beyond hospitalization. In these cases, antibiotic therapy at home usually is preferred over hospitalization when it does not compromise patient care. Patients prefer home care to inpatient care because it improves their quality of life; patients gain freedom of mobility, return to work, and resume their daily activities. Hospitals prefer home care because it shortens hospital stays and increases the revenues/ admission, and health insurers prefer home care -- and even home intravenous therapy -- because it is less expensive than inpatient care.
Most studies of antibiotic therapy at home reported the cost as savings compared with inpatient care. These studies quantified the components of care differently. Some cost evaluations were limited to direct cost of treat-ment (i.e., costs for drug acquisition, nursing care, and medical supplies). Other studies included indirect costs, such as wages lost to the caregiver and patient, transportation cost, and even intangible costs such as psychosocial cost.
Retrospective medical record review commonly is used to determine which patients received antibiotic therapy at home; however, information regarding the home care episode and associated cost are not recorded in an inpatient medical record. In addition, many episodes of home care begin in the outpatient setting; thus, a hospital-based sample may not accurately represent the population receiving home care. A prospective cohort study design is one option to follow health care utilization and associated costs during an episode of home care. But prospective studies tend to be expensive and time consuming and therefore represent a less practical method for studying health care utilization and associated cost.
Health care claims data offer a novel approach to studying utilization and cost of care. These databases represent a convenient alternative because data already are collected and stored electronically by health insurance companies. Claims data include outpatient and inpatient services, and cost of outpatient prescription drugs. Despite the availability of these databases, few studies have used health care claims to describe outpatient therapy for gram-positive infections.
With the increasing frequency of antibiotic-resistant gram-positive infections in the United States, many patients are being treated outside the hospital setting. The majority of studies on the cost of outpatient antimicrobial therapy involve retrospective medical record review or prospective data collection. These methods tend to be expensive and time consuming, and often fail to produce a sufficiently large sample size. Analysis of insurance claims data offers a convenient approach for studying the costs associated with outpatient therapy for gram-positive infections. To demonstrate this approach, a study of the cost of intravenous vancomycin home care therapy was conducted using claims data from a large insurance company.
Infections caused by gram-positive organisms often require a long duration of antibiotic treatment that extends beyond hospitalization. In these cases, antibiotic therapy at home usually is preferred over hospitalization when it does not compromise patient care. Patients prefer home care to inpatient care because it improves their quality of life; patients gain freedom of mobility, return to work, and resume their daily activities. Hospitals prefer home care because it shortens hospital stays and increases the revenues/ admission, and health insurers prefer home care -- and even home intravenous therapy -- because it is less expensive than inpatient care.
Most studies of antibiotic therapy at home reported the cost as savings compared with inpatient care. These studies quantified the components of care differently. Some cost evaluations were limited to direct cost of treat-ment (i.e., costs for drug acquisition, nursing care, and medical supplies). Other studies included indirect costs, such as wages lost to the caregiver and patient, transportation cost, and even intangible costs such as psychosocial cost.
Retrospective medical record review commonly is used to determine which patients received antibiotic therapy at home; however, information regarding the home care episode and associated cost are not recorded in an inpatient medical record. In addition, many episodes of home care begin in the outpatient setting; thus, a hospital-based sample may not accurately represent the population receiving home care. A prospective cohort study design is one option to follow health care utilization and associated costs during an episode of home care. But prospective studies tend to be expensive and time consuming and therefore represent a less practical method for studying health care utilization and associated cost.
Health care claims data offer a novel approach to studying utilization and cost of care. These databases represent a convenient alternative because data already are collected and stored electronically by health insurance companies. Claims data include outpatient and inpatient services, and cost of outpatient prescription drugs. Despite the availability of these databases, few studies have used health care claims to describe outpatient therapy for gram-positive infections.
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