Clinical trial NCT02815930: Characterizing the Senior High Cost User (HCU) in Ontario
Official title: Characterizing the Senior High Cost User in Ontario: A Population-Based Matched Cohort Study
Study type: OBSERVATIONAL
Overall status: UNKNOWN
Conditions: Senior High Cost Users (HCU)
Keywords: High cost user (HCU)
Healthcare utilization
Healthcare expenditures
Medication use
Medication expenditures
Multimorbidity
Observational study
Lead sponsor: McMaster University
Sponsor class: OTHER
Collaborators: name: Ontario Drug Policy Research Network (ODPRN)
name: Research Institute of St. Joseph's Hamilton
First posted: 2016-06-28
Enrollment: 700000
Sex: ALL
Minimum age (years): 66
Maximum age (years): 105
Standard ages: OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Newly incident senior high cost users (HCUs) in Ontario

Brief summary: High cost users (HCUs) are a small group of patients who use a disproportionate amount of health care resources. This study is a retrospective population-based matched cohort analysis of newly incident senior High Cost Users (HCUs) defined as Ontarians aged 66 years or older in the top 5% of healthcare expenditure users in fiscal year 2013 (FY2013). The study objectives are to characterize and contrast Ontario senior HCUs to non-HCUs based on their demographics, co-morbidities, medication use, health service utilization, healthcare expenditures, medication costs and clinical outcomes, and to determine the relative contribution of medications to senior HCUs expenditures

Detailed description: Senior high cost users (HCUs) with annual healthcare expenditures within the top 5% of Ontarians will be identified using established ICES costing algorithms. This cohort will be matched to a cohort of non-HCUs using a 3:1 matching ratio (non-HCU to HCU) based on age at cohort entry (+/- 1 month), sex and geographic location of residence (based on LHIN) for comparative analysis. Descriptive statistics will be used to describe the study populations and outcomes. Regression analyses will be used to adjust for potential confounders when analyzing healthcare resource utilization and costs as a function of HCU status (e.g. income, type of residence, co-morbidities, rural/urban) and/or when analyzing sub-populations \[e.g. chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF)\]. Logistic regression will be performed using the patient level data to predict the impact of individual factors on the likelihood of becoming a senior HCU.

Eligibility criteria: Inclusion Criteria:

* Ontario residents registered in RPDB between April 1, 2013 - March 31, 2014
* Annual total health care expenditures in FY2013 equal to or greater than financial threshold for the top 5% of all Ontarians

Exclusion Criteria:

* Death on OR prior to index date
* Age \> 105
* Annual total health care expenditures in FY2012 fiscal year greater than financial threshold of 5% of all Ontarians in FY2013

Primary outcomes:
measure: Total healthcare expenditures per patient
timeFrame: 1 year after index date
measure: Total drug costs per patient
timeFrame: 1 year after index date
measure: Drug cost to total healthcare expenditure ratio
timeFrame: 1 year after index date
Secondary outcomes:
measure: All-cause mortality
timeFrame: 1 year after index date
measure: All-cause hospitalization rate
timeFrame: 1 year after index date
Other outcomes:
Locations:
Study officials:
affiliation: McMaster University
name: Justin Lee, BScPhm, ACPR, MD, FRCPC
role: PRINCIPAL_INVESTIGATOR
References:
citation: Lee J, Muratov S, Tarride JE, Paterson JM, Thavorn K, Mbuagbaw L, Gomes T, Khuu W, Seow H, Thabane L, Holbrook A. Medication use and its impact on high-cost health care users among older adults: protocol for the population-based matched cohort HiCOSTT study. CMAJ Open. 2021 Jan 11;9(1):E44-E52. doi: 10.9778/cmajo.20190196. Print 2021 Jan-Mar.