Courtney Harold Van Houtven1,2,3, Valerie A Smith1,2,4, Karen M Stechuchak1, Theodore S Z Berkowitz1, Katherine E M Miller1,5, Megan Shepherd-Banigan1,2, Margaret Kabat6, Jennifer Henius6. 1. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC. 2. Department of Population Health Sciences, Duke University Medical Center, Durham, NC. 3. Duke-Margolis Center for Health Policy, Durham, NC. 4. Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC. 5. Department of Health Policy and Management, University of North Carolina at Chapel Hill, NC. 6. Caregiver Support Program, VA Central Office, Washington, DC.
Abstract
OBJECTIVES: To examine the effect of the Department of Veterans Affairs' (VA) Program of Comprehensive Assistance for Caregivers (PCAFC) on total VA health care costs for Veterans. DATA SOURCES: VA claims. STUDY DESIGN: Using a pre-post cohort design with nonequivalent control group, we estimated the effect of PCAFC on total VA costs up through 6 years. The treatment group included Veterans (n = 32 394) whose caregivers enrolled in PCAFC. The control group included an inverse probability of treatment weighted sample of Veterans whose caregivers were denied PCAFC enrollment (n = 38 402). DATA EXTRACTION: May 2009-September 2017. PRINCIPAL FINDINGS: Total VA costs pre-PCAFC application date were no different between groups. Veterans in PCAFC were estimated to have $13 227 in VA costs in the first 6 months post-PCAFC application, compared to $10 806 for controls. Estimated VA costs for both groups decreased in the first 3 years with a narrowing, but persistent and significant, difference, through 5.5 years. No significant difference in VA health care costs existed at 6 years, approximately $10 000 each, though confidence intervals reflect significant uncertainty in cost differences at 6 years. CONCLUSIONS: Increased costs arose from increased outpatient costs of participants. Sample composition changes may explain lack of significance in cost differences at 6 years because these costs comprise of early appliers to PCAFC. Examining 10-year costs could elucidate whether there are long-term cost offsets from increased engagement in outpatient care. Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
OBJECTIVES: To examine the effect of the Department of Veterans Affairs' (VA) Program of Comprehensive Assistance for Caregivers (PCAFC) on total VA health care costs for Veterans. DATA SOURCES: VA claims. STUDY DESIGN: Using a pre-post cohort design with nonequivalent control group, we estimated the effect of PCAFC on total VA costs up through 6 years. The treatment group included Veterans (n = 32 394) whose caregivers enrolled in PCAFC. The control group included an inverse probability of treatment weighted sample of Veterans whose caregivers were denied PCAFC enrollment (n = 38 402). DATA EXTRACTION: May 2009-September 2017. PRINCIPAL FINDINGS: Total VA costs pre-PCAFC application date were no different between groups. Veterans in PCAFC were estimated to have $13 227 in VA costs in the first 6 months post-PCAFC application, compared to $10 806 for controls. Estimated VA costs for both groups decreased in the first 3 years with a narrowing, but persistent and significant, difference, through 5.5 years. No significant difference in VA health care costs existed at 6 years, approximately $10 000 each, though confidence intervals reflect significant uncertainty in cost differences at 6 years. CONCLUSIONS: Increased costs arose from increased outpatient costs of participants. Sample composition changes may explain lack of significance in cost differences at 6 years because these costs comprise of early appliers to PCAFC. Examining 10-year costs could elucidate whether there are long-term cost offsets from increased engagement in outpatient care. Published 2020. This article is a U.S. Government work and is in the public domain in the USA.
Entities:
Keywords:
VA Health Care System; access/demand/utilization of services; health care costs; observational data/quasi-experiments; program evaluation
Authors: Courtney Harold Van Houtven; Valerie A Smith; Karen M Stechuchak; Megan Shepherd-Banigan; Susan Nicole Hastings; Matthew L Maciejewski; Gilbert Darryl Wieland; Maren K Olsen; Katherine E M Miller; Margaret Kabat; Jennifer Henius; Margaret Campbell-Kotler; Eugene Z Oddone Journal: Med Care Res Rev Date: 2017-04-01 Impact factor: 3.929
Authors: Courtney Harold Van Houtven; Valerie A Smith; Karen M Stechuchak; Theodore S Z Berkowitz; Katherine E M Miller; Megan Shepherd-Banigan; Margaret Kabat; Jennifer Henius Journal: Health Serv Res Date: 2020-07-04 Impact factor: 3.402
Authors: Yingzhe Yuan; Kali S Thomas; Austin B Frakt; Steven D Pizer; Melissa M Garrido Journal: Health Aff (Millwood) Date: 2019-06 Impact factor: 6.301
Authors: Courtney Harold Van Houtven; Valerie A Smith; Karen M Stechuchak; Theodore S Z Berkowitz; Katherine E M Miller; Megan Shepherd-Banigan; Margaret Kabat; Jennifer Henius Journal: Health Serv Res Date: 2020-07-04 Impact factor: 3.402