EE415 Spatial Cost-Efficiency Analysis on the Separability Condition of COVID-19 Potential Determinants

Objectives: Prior research indicates prolonged delays between fi rst parental concern and ASD diagnosis, yet questions remain regarding the diagnostic journey, including characterizing healthcare resource use (HCRU) and costs in commercial healthcare plans.Thecurrentstudysoughttoaddress these informationalgapsin the diagnostic pathway. Methods: A longitudinal analysis (2015-2019) of 1-18-year-olds was con- ducted using Optum ’ s Claims/EHR Dataset. The analysis covered 4 years pre-diag-nosis to date of ASD diagnosis. Time from fi rst concern to diagnosis and ASD-related HCRU and costs were examined. Results: The median delay from fi rst reported ASD-speci fi c clinical feature to diagnosis was 26 months, with ASD-related tests and services starting up to 4 years prior to diagnosis. Pediatricians, psychiatrists, and family medicine were the most common provider types, with of fi ce visits and outpatient hospital as most frequent sites of care. Prior to diagnosis, up to 11% of patients were on ASD-related pharmacotherapies. From fi rst reported ASD-related concern to diagnosis, there was a median ASD-related cost per patient of $3,360, with 85% occurring between screening and diagnosis. Median time between fi rst concernand screeningwas 3.5 monthswith associated ASD-relatedcosts of $479 per patient ($136 per member per month, PMPM). Median time from screening to diagnosis was 21 months with median ASD-associated costs of $2,881 ($137 PMPM). All costs increased annually over the 4-year period prior to diagnosis. Conclusions: Results indicate long delays between fi rst concern and ASD diagnosis and suggest inef fi ciencies in the diagnostic journey. Tools developed to streamline diagnosis in the primarycare setting may reduce these delays. Earlierdiagnoses may result in more children gaining access to early interventions, which are linked to improved outcomes (e.g., cognitive abilities, adaptive behavior) and longer-term savings. Limitations include the under-representation of ASD-related expenditures such as school-based services and out-of-pocket Objectives: Macimorelin is a novel, oral growth hormone stimulation test approved by EMA and FDAfor the diagnosis of adult growth hormone de fi ciency (AGHD). The objective of this study is to investigate the budget impact arising from the introduction of macimorelin as a diagnostic test for AGHD across France, Germany, Italy, Spain and the United Kingdom. Methods: A budget impact model was developed from the health care perspective, using only direct costs, over a 3-year time hori- zon. Analyses were run to compare the macimorelin test against two separate comparators: the insulin tolerance test (ITT) and the GHRH-arginine test. A micro- costing approach was taken to calculate the total cost of each test; estimates of resource utilisation for each test were based on clinical guidelines. Costs included were drug acquisition, treatment administration, nurse time, clinical specialist time and adverse event management. Cost inputs were sourced from national databases and, where available, literature. Results: The results from the budget impact analysis suggest that the introduction of the macimorelin test is associated with reduced resource utilisation and therefore cost-savings for healthcare systems across all countries included in the analysis. This is the case when compared against both the ITT and the GHRH-arginine test. Cost savings are driven primarily by reductions in clinical time taken to administer the test, leading to lower clinical resource utilisation and savings in staff costs. However, savings also arise from an improved safety pro fi le leading to fewer mild and transient adverse events. Conclusions: From a fi nancing perspective, the adoption of macimorelin for AGHD diagnosis represents the best alternative to reduce costs to healthcare systems across the countries considered. The macimorelin test is also associated with fewer adverse events, leading to a potentially better patient experience. Finally, maci- morelin test requires less clinical staff time and may ultimately increase hospital capacity through ef fi cient resource Objectives: This study aims to investigate some potential spatial, socioeconomic and demographicdeterminantsofmunicipalef fi ciencyincombatingtheCOVID-19usingData EnvelopmentAnalysisandGeographicInforamtionSystems. Methods: We test the null hypothesis for the Separability Condition that latitude, longitude, population density, social isolation index and the proportion of Bolsonaro ’ s votes can in fl uence the distribution of inef fi ciencies fordifferent COVID-19 municipalities in Pernambuco,Brazil. The inputsforthecost-ef fi ciencymodelwerethemunicipalcostsforprimaryhealthcareand federal transfers. The output was the number of healthy population. The Moran Index was applied for investigating the spatial concentrations of inef fi ciencies and their re-lationswiththepotentialdeterminants. Results: About2.17%municipalities(4from184 cities)areinput-orientedef fi cientandbenchmarkforCOVID-19best-practices:Calumbi, Jaboatâo dos Guararapes, Recife and Toritama. From the inne fi cient municipalities, 94 score above 0.5 and 86below 0.5 and above 0.09. The mean potential for improvement is a 46.80% reduction in the costs to attain ef fi cient prospects. For the separability condition, the reported p-values for the potential determinants are latitude: 0,491, longitude:0,886,latitudeandlongitude:0,773,SocialIsolationIndex:0,5135,populationdensity:0,896,andBolsonaro ’ s votes: 0,297, all failing to reject the null hypothesis of separability (the exogenous determinants affect the distribution of municipal inef fi ciencies but not the frontier estimation). Medicaid Illicit-use opioid co-morbidity (RIOP) (IOP) minimum continuous enrollment of post-index identi fi ed RIOP and IOP naloxone, state, comorbidities, Results: 845 RIOP 5,633 NY of IOP Medicaid. the highest IOP The and for RIOP and were respectively. for RIOP the cost difference in RIOP and naloxone annual plan savings respectively. Conclusions: the higher CCI scores, RIOP had higher costs. Both RIOP and IOP demonstrated signi cant economic burden, while naloxone lower costs. Future research should explore naloxone co-prescribing bene ts among these