Health Care Costs, Utilization and Patterns of Care following Lyme Disease
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{"title"=>"Health care costs, utilization and patterns of care following lyme disease", "type"=>"journal", "authors"=>[{"first_name"=>"Emily R.", "last_name"=>"Adrion", "scopus_author_id"=>"23494944800"}, {"first_name"=>"John", "last_name"=>"Aucott", "scopus_author_id"=>"57027689200"}, {"first_name"=>"Klaus W.", "last_name"=>"Lemke", "scopus_author_id"=>"7004936360"}, {"first_name"=>"Jonathan P.", "last_name"=>"Weiner", "scopus_author_id"=>"7201522318"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"isbn"=>"1932-6203", "scopus"=>"2-s2.0-84922367990", "pmid"=>"25650808", "issn"=>"19326203", "pui"=>"602005537", "doi"=>"10.1371/journal.pone.0116767", "sgr"=>"84922367990"}, "id"=>"24523741-f339-3fe5-9c54-17eb44c5a9ef", "abstract"=>"BACKGROUND: Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome - a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States. OBJECTIVES: 1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization. METHODS: This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure. RESULTS: Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses. CONCLUSIONS: Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.", "link"=>"http://www.mendeley.com/research/health-care-costs-utilization-patterns-care-following-lyme-disease-1", "reader_count"=>64, "reader_count_by_academic_status"=>{"Professor > Associate Professor"=>3, "Researcher"=>18, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>4, "Other"=>5, "Student > Master"=>16, "Student > Bachelor"=>9, "Lecturer"=>2, "Professor"=>2, "Librarian"=>1}, "reader_count_by_user_role"=>{"Professor > Associate Professor"=>3, "Researcher"=>18, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>3, "Student > Postgraduate"=>4, "Other"=>5, "Student > Master"=>16, "Student > Bachelor"=>9, "Lecturer"=>2, "Professor"=>2, "Librarian"=>1}, "reader_count_by_subject_area"=>{"Engineering"=>2, "Environmental Science"=>3, "Biochemistry, Genetics and Molecular Biology"=>6, "Nursing and Health Professions"=>3, "Agricultural and Biological Sciences"=>14, "Medicine and Dentistry"=>23, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>2, "Chemistry"=>1, "Social Sciences"=>2, "Computer Science"=>2, "Economics, Econometrics and Finance"=>2, "Mathematics"=>1, "Neuroscience"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>23}, "Social Sciences"=>{"Social Sciences"=>2}, "Psychology"=>{"Psychology"=>2}, "Mathematics"=>{"Mathematics"=>1}, "Environmental Science"=>{"Environmental Science"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}, "Engineering"=>{"Engineering"=>2}, "Chemistry"=>{"Chemistry"=>1}, "Neuroscience"=>{"Neuroscience"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>2}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>14}, "Computer Science"=>{"Computer Science"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>6}}, "reader_count_by_country"=>{"Colombia"=>1, "Canada"=>1, "Vietnam"=>1, "Netherlands"=>1, "United States"=>3, "United Kingdom"=>2}, "group_count"=>6}

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  • {"files"=>["https://ndownloader.figshare.com/files/1880504", "https://ndownloader.figshare.com/files/1880505", "https://ndownloader.figshare.com/files/1880506", "https://ndownloader.figshare.com/files/1880507", "https://ndownloader.figshare.com/files/1880508", "https://ndownloader.figshare.com/files/1880509", "https://ndownloader.figshare.com/files/1880510"], "description"=>"<div><p>Background</p><p>Lyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome – a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States.</p><p>Objectives</p><p>1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization.</p><p>Methods</p><p>This study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure.</p><p>Results</p><p>Lyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses.</p><p>Conclusions</p><p>Lyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.</p></div>", "links"=>[], "tags"=>["health care costs", "health insurance plans", "Lyme disease exposure.ResultsLyme disease", "United States", "ci", "Lyme disease", "Lyme Disease BackgroundLyme disease", "PTLDS"], "article_id"=>1301353, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Emily R. Adrion", "John Aucott", "Klaus W. Lemke", "Jonathan P. Weiner"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0116767.s001", "https://dx.doi.org/10.1371/journal.pone.0116767.s002", "https://dx.doi.org/10.1371/journal.pone.0116767.s003", "https://dx.doi.org/10.1371/journal.pone.0116767.s004", "https://dx.doi.org/10.1371/journal.pone.0116767.s005", "https://dx.doi.org/10.1371/journal.pone.0116767.s006", "https://dx.doi.org/10.1371/journal.pone.0116767.s007"], "stats"=>{"downloads"=>1, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Health_Care_Costs_Utilization_and_Patterns_of_Care_following_Lyme_Disease_/1301353", "title"=>"Health Care Costs, Utilization and Patterns of Care following Lyme Disease", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2015-02-04 02:51:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/1880501"], "description"=>"<p>Note: Above table includes Lyme disease sample only. Lyme disease sample includes only those persons with a test order and antibiotic treatment within 30 days of the test order, a diagnosis and antibiotic treatment within 30 days of the diagnosis, or a diagnosis, test order and antibiotic treatment within 30 days. The Lyme disease sample includes only those with 18 consecutive months of enrollment, including a 6-month “clean period” of enrollment prior to Lyme disease episode in which they were neither diagnosed with nor tested for Lyme disease. Lyme disease sample restricted to persons under 65 years of age, with commercial health insurance plans</p><p><sup>*</sup> Adjusted impact calculations based on GLM regression analysis using the Huber/White sandwich estimator of variance and adjusting for year, region, age, and sex, and controlling for high-cost non-Lyme disease-related conditions.</p><p><sup>†</sup> Adjusted ratio calculations for outpatient and emergency visits are based on negative binomial regression analysis using the Huber/White sandwich estimator of variance and adjusting for year, region, age, and sex, and controlling for high-cost non-Lyme disease-related conditions.</p><p>Adjusted 12-month health care costs and utilization for patients in the Lyme disease sample with one or more post-treatment Lyme disease symptom (PTLDS)-related diagnosis, as compared to patients in Lyme disease sample with no post-treatment Lyme disease symptom-related diagnoses.</p>", "links"=>[], "tags"=>["health care costs", "health insurance plans", "Lyme disease exposure.ResultsLyme disease", "United States", "ci", "Lyme disease", "Lyme Disease BackgroundLyme disease", "PTLDS"], "article_id"=>1301350, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Emily R. Adrion", "John Aucott", "Klaus W. Lemke", "Jonathan P. Weiner"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0116767.t004", "stats"=>{"downloads"=>2, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Adjusted_12_month_health_care_costs_and_utilization_for_patients_in_the_Lyme_disease_sample_with_one_or_more_post_treatment_Lyme_disease_symptom_PTLDS_related_diagnosis_as_compared_to_patients_in_Lyme_disease_sample_with_no_post_treatment_Lyme_disease_sy/1301350", "title"=>"Adjusted 12-month health care costs and utilization for patients in the Lyme disease sample with one or more post-treatment Lyme disease symptom (PTLDS)-related diagnosis, as compared to patients in Lyme disease sample with no post-treatment Lyme disease symptom-related diagnoses.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-02-04 02:51:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/1880498"], "description"=>"<p>*** statistically significant at p<.001 level,</p><p><sup>*</sup> Lyme disease sample includes only those persons with a test order and antibiotic treatment within 30 days of the test order, a diagnosis and antibiotic treatment within 30 days of the diagnosis, or a diagnosis, test order and antibiotic treatment within 30 days. The Lyme disease sample includes only those with 18 consecutive months of enrollment, including a 6-month “clean period” of enrollment prior to Lyme disease episode in which they were neither diagnosed with nor tested for Lyme disease.</p><p><sup>†</sup> Lyme disease and control samples are restricted to persons under 65 years of age, in commercial health insurance plans.</p><p><sup><b>‡</b></sup> Controls were matched to Lyme disease cases on age, sex, region, payer and enrollment year. Control group includes only those with 18 consecutive months of enrollment in a commercial health insurance plan. Control group was restricted to persons with outpatient costs greater than $0.</p><p><sup>§</sup> Medicine includes acupuncture, home health, home infusion and other special services, procedures and reports.</p><p><sup>||</sup> Adjusted impact calculations based on GLM regression analysis using the Huber/White sandwich estimator of variance and adjusting for year, region, age, and sex, and controlling for 44 high-cost conditions</p><p><sup>¶</sup> Adjusted ratio calculations for outpatient and emergency visits are based on negative binomial regression analysis using the Huber/White sandwich estimator of variance and adjusting for year, region, age, and sex, and controlling for 44 high-cost conditions.</p><p>12-month health care costs and utilization, Lyme disease and control groups.</p>", "links"=>[], "tags"=>["health care costs", "health insurance plans", "Lyme disease exposure.ResultsLyme disease", "United States", "ci", "Lyme disease", "Lyme Disease BackgroundLyme disease", "PTLDS"], "article_id"=>1301347, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Emily R. Adrion", "John Aucott", "Klaus W. Lemke", "Jonathan P. Weiner"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0116767.t002", "stats"=>{"downloads"=>19, "page_views"=>50, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_12_month_health_care_costs_and_utilization_Lyme_disease_and_control_groups_/1301347", "title"=>"12-month health care costs and utilization, Lyme disease and control groups.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-02-04 02:51:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/1880497"], "description"=>"<p><sup>*</sup> Lyme disease sample includes only those persons with a test order and antibiotic treatment within 30 days of the test order, a diagnosis and antibiotic treatment within 30 days of the diagnosis, or a diagnosis, test order and antibiotic treatment within 30 days. The Lyme disease sample includes only those with 18 consecutive months of enrollment, including a 6-month “clean period” of enrollment prior to Lyme disease episode in which they were neither diagnosed with nor tested for Lyme disease.</p><p><sup>†</sup> Lyme disease and control samples are restricted to persons under 65 years of age, with commercial health insurance plans.</p><p><sup><b>‡</b></sup> Controls were matched to Lyme disease cases on age, sex, region, payer and enrollment year. Control group includes only those with 12 consecutive months of enrollment in a commercial health insurance plan. Control group was restricted to persons with outpatient costs greater than $0.</p><p>Characteristics of study sample.</p>", "links"=>[], "tags"=>["health care costs", "health insurance plans", "Lyme disease exposure.ResultsLyme disease", "United States", "ci", "Lyme disease", "Lyme Disease BackgroundLyme disease", "PTLDS"], "article_id"=>1301346, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Emily R. Adrion", "John Aucott", "Klaus W. Lemke", "Jonathan P. Weiner"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0116767.t001", "stats"=>{"downloads"=>4, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Characteristics_of_study_sample_/1301346", "title"=>"Characteristics of study sample.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-02-04 02:51:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/1880499"], "description"=>"<p>*** statistically significant at p<.001 level</p><p><sup>*</sup> Lyme disease sample includes only those persons with a test order and antibiotic treatment within 30 days of the test order, a diagnosis and antibiotic treatment within 30 days of the diagnosis, or a diagnosis, test order and antibiotic treatment within 30 days. The Lyme disease sample includes only those with 18 consecutive months of enrollment, including a 6-month “clean period” of enrollment prior to Lyme disease episode in which they were neither diagnosed with nor tested for Lyme disease.</p><p><sup>†</sup> Controls were matched to Lyme disease cases on age, sex, region, payer and enrollment year. Control group includes only those with 18 consecutive months of enrollment in a commercial health insurance plan. Control group was restricted to persons with outpatient costs greater than $0.</p><p><sup><b>‡</b></sup> Lyme disease and control samples are restricted to persons under 65 years of age, with commercial health insurance plans.</p><p><sup>§</sup> Odds are calculated using logistic regression analysis and are adjusted for year, region, age, and sex, and controls for 44 high-cost conditions.</p><p>Post-treatment Lyme disease symptom-related diagnoses, Lyme disease and control groups.</p>", "links"=>[], "tags"=>["health care costs", "health insurance plans", "Lyme disease exposure.ResultsLyme disease", "United States", "ci", "Lyme disease", "Lyme Disease BackgroundLyme disease", "PTLDS"], "article_id"=>1301348, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Emily R. Adrion", "John Aucott", "Klaus W. Lemke", "Jonathan P. Weiner"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0116767.t003", "stats"=>{"downloads"=>6, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Post_treatment_Lyme_disease_symptom_related_diagnoses_Lyme_disease_and_control_groups_/1301348", "title"=>"Post-treatment Lyme disease symptom-related diagnoses, Lyme disease and control groups.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-02-04 02:51:48"}
  • {"files"=>["https://ndownloader.figshare.com/files/1880496"], "description"=>"<p>Lyme disease case selection flow diagram.</p>", "links"=>[], "tags"=>["health care costs", "health insurance plans", "Lyme disease exposure.ResultsLyme disease", "United States", "ci", "Lyme disease", "Lyme Disease BackgroundLyme disease", "PTLDS"], "article_id"=>1301345, "categories"=>["Biological Sciences", "Science Policy"], "users"=>["Emily R. Adrion", "John Aucott", "Klaus W. Lemke", "Jonathan P. Weiner"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0116767.g001", "stats"=>{"downloads"=>1, "page_views"=>73, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Lyme_disease_case_selection_flow_diagram_/1301345", "title"=>"Lyme disease case selection flow diagram.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-02-04 02:51:48"}

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Relative Metric

{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}
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