Recent legislative changes such as the Patient Protection and Affordable Care Act, HITECH, and the Medicare Access and CHIP Reauthorization Act are forcing the health care industry to find ways to improve quality and outcomes while lowering costs.

Information technology and predictive analytics are being explored to identify viable, “cost-neutral” solutions to help achieve those goals.

Venebio has developed two such predictive analytic tools, Venebio Opioid AdvisorTM (VOA) and Venebio Statin AdvisorTM (VSA), that focus on the devastating U.S. epidemic of opioid overdose and a common health condition, high blood cholesterol, respectively.  VSA and VOA are proprietary algorithms that use multiple patient demographic and clinical variables and were developed with financial support from the National Institutes of Health (NIH)[1]. Each tool provides immediate and personalized clinical decision support to health care professionals regarding interventions to more safely and effectively prescribe either opioids or cholesterol-reducing statins for individual patients.

Earlier this summer, members of our team presented Venebio’s research on these technologies at the ISPOR (International Society for Pharmacoeconomics and Outcomes Research) conference in Boston that highlighted their potential economic and clinical impact.

Cardiovascular disease is the single most common disease and cause of death in the U.S., and lower low-density lipoprotein cholesterol (LDL-C) levels are associated with fewer heart attacks and other serious atherosclerotic cardiovascular events. The VSA poster “Utilizing Clinical Decision Support Systems to Align Clinical and Value-Based Reimbursement Initiatives” described results from a retrospective analysis of data from more than 850,000 individuals with commercial health insurance who had elevated LDL-C and were treated with statins. Venebio assessed the likelihood that a patient would achieve their goal LDL-C level with the VSA-recommended statin-dose combination compared with their current statin-dose combination. There was a three-fold greater chance of a patient reaching their LDL-C goal for VSA’s most vs. least-recommended statin-dose combination (42% vs. 14%). VSA’s top choice had a 50% greater likelihood of the patient reaching goal LDL-C than the clinician’s current statin-dose choice.

A simulation was performed of the corresponding costs for VSA’s most-recommended vs. least-recommended statin therapy based on the likelihood of adverse cardiovascular outcomes over 10 years for LDL-C at-goal vs. not at-goal per 20,000 patients treated. The economic analysis showed substantial savings in both the total cost of care ($83 million for most recommended vs. $99 million for least recommended) and patients’ out-of-pocket costs for deductibles ($26 million vs. $33 million).

VOA is a risk index and clinical decision support tool developed in response to the US epidemic of unintentional prescription opioid overdose. VOA quantifies a patient’s likelihood of experiencing a life-threatening overdose from a prescription opioid, determines a personalized risk factor profile for each patient and provides clinicians with individualized guidance regarding interventions to reduce the patient’s risk of overdose. In retrospective validation studies using data from opioid-treated patients in the US Veterans Health Administration (almost 2 million) and commercially insured patients (more than 18 million), VOA predicted the likelihood of a patient experiencing an overdose with 90% accuracy.  At ISPOR, Venebio presented economic and health outcome results of a simulated VOA-implementation study in 100,000 opioid-treated patients. VOA was projected to substantially reduce prescription opioid overdoses resulting in fewer emergency department visits and hospitalizations and a significant reduction in associated health care costs, as described in the poster “Utilizing Automated Clinical Decision Support Systems to Reduce Morbidity, Mortality, and Costs Due to Prescription Opioid Overdose.”

These studies validate the potential impact of predictive analytics like VOA and VSA in reducing the morbidity, mortality and health care costs associated with common public health problems such as cardiovascular disease and opioid overdose. Implementing the clinical decision support offered by these tools at the point of care can substantially improve health outcomes and lower the cost of care for payers and patients.

[1] Research reported in this article was supported by the National Institute on Drug Abuse under Award Number R44DA042655 (VOA) and the National Heart, Lung and Blood Institute under Award Number R44HL117553 (VSA). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.