title: Massachusetts Health Reform Cost Less and Was More Effective for Uninsured Individuals With Venous Thromboembolism: A Cost-Effectiveness Analysis.
abstract: BACKGROUND
  Patients with venous thromboembolism (VTE) require access to comprehensive physician and pharmacy benefits to prevent recurrence and hemorrhage. Before 2006, Massachusetts provided these benefits through a program restricted to safety net hospitals called Free Care. Providing portable health insurance through Massachusetts health reform could improve outcomes for uninsured with VTE but its cost-effectiveness is unknown.
  
  
  RESULTS
  We constructed a Markov decision analysis model comparing our conceptualization of the Massachusetts health reform (health reform strategy) to no health reform strategy for a patient beginning warfarin for new episode of VTE. In the model, a patient may develop recurrent VTE or develop hemorrhage or stop warfarin after 6 months if no event occurs. To measure effectiveness, we analyzed laboratory data from Boston Medical Center, the largest safety net hospital in Massachusetts. Specifically, we measured the probability of having a subtherapeutic warfarin level for patients newly insured compared with those on Free Care prereform adjusting for secular trends. To calculate inpatient costs, we used the Health Care Utilization Project. We then calculated the incremental cost-effectiveness ratio for the health reform strategy adjusted to 2014 USD per quality-adjusted life-year (QALY) and performed sensitivity analyses. The health reform strategy cost less and gained more QALYs than the no health reform strategy. Our result was most sensitive to the odds that Health Reform protected against a subtherapeutic warfarin level, the cost of Health Reform, and the percentage of total health care costs attributable to VTE in Massachusetts.
  
  
  CONCLUSIONS
  The health reform strategy cost less and was more effective than the no health reform strategy for patients with VTE.
authors.affiliation: *Division of Hospital Medicine, University of Massachusetts Medical School, Worcester †Boston Medical Center ‡Section of General Internal Medicine, Boston University School of Medicine, Boston, MA §Department of Health Policy and Management, Division of General Internal Medicine ∥Section of Decision Sciences and Clinical Systems Modeling, University of Pittsburgh School of Medicine, Pittsburgh, PA.
authors.forename: Alok
authors.initials: A
authors.lastname: Kapoor
authors.forename: Nicholas
authors.initials: N
authors.lastname: Shaffer
authors.forename: Amresh
authors.initials: A
authors.lastname: Hanchate
authors.forename: Mark
authors.initials: M
authors.lastname: Roberts
authors.forename: Kenneth
authors.initials: K
authors.lastname: Smith
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D003362:Cost-Benefit Analysis; D018166:Health Care Reform / Q000191:economics / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008390:Markov Chains; D008404:Massachusetts; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D064876:Safety-net Providers / Q000706:statistics & numerical data; D054556:Venous Thromboembolism / Q000401:mortality / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics
chemical_list: D000925:Anticoagulants; D014859:Warfarin