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Hwang SH, Ah YM, Jun KH, Jung JW, Kang MG, Park HK, Lee EK, Park HK, Chung JE, Kim SH, Lee JY. Development and Validation of a Trigger Tool for Identifying Drug-Related Emergency Department Visits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168572. [PMID: 34444320 PMCID: PMC8391800 DOI: 10.3390/ijerph18168572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/09/2021] [Accepted: 08/11/2021] [Indexed: 11/16/2022]
Abstract
There are various trigger tools for detecting adverse drug events (ADEs), however, a drug-related emergency department (ED) visit trigger tool (DrEDTT) has not yet been developed. We aimed to develop and validate a DrEDTT with a multi-center cohort. In this cross-sectional study, we developed the DrEDTT consisting of 28 triggers through a comprehensive literature review and three phase expert group discussion. Next, we evaluated the performance of the DrEDTT by applying it to relevant medical records retrieved from four hospitals from January 2016 to June 2016. Two experts performed an in-depth chart review of a 25% of random sample of trigger flagged and unflagged ED visits and a true ADE was determined through causality assessment. Among 66,564 patients who visited the ED for reasons other than traffic accident and trauma during the study period, at least one trigger was found in 21,268 (32.0%) patients. A total of 959 true ADE cases (5.8%) were identified from a randomly selected 25% of ED visit cases. The overall positive predictive value was 14.0% (range: 8.3-66.7%). Sensitivity and specificity of DrEDTT were 77.7% and 70.4%, respectively. In conclusion, this newly developed trigger tool might be helpful to detect ADE-related ED visits.
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Park H, Park CM, Woo JM, Shin JY, Lee EK, Kwon SH. Real-world data analysis of the clinical and economic burden and risk factors in patients with major depressive disorder with an inadequate response to initial antidepressants. J Med Econ 2021; 24:589-597. [PMID: 33879031 DOI: 10.1080/13696998.2021.1918922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM We aimed to determine the incidence of and identify the factors associated with treatment-resistant depression (TRD), psychiatric conditions, hospitalization, and cost in patients with major depressive disorder (MDD) who were treated using second-line strategies after an inadequate response to initial antidepressants (AD). MATERIALS AND METHODS Using South Korean National Health Insurance claims data (1 January 2013 to 30 June 2018), we conducted a retrospective cohort analysis in newly treated patients with MDD who subsequently switched or added AD, or added atypical antipsychotics (AAPs) as a second-line treatment. We assessed the incidence of treatment-resistant depression (TRD), psychiatric conditions, and hospitalization for the first 2 years and costs in the third year. Odds ratios (ORs) or relative ratios were estimated using logistic and linear regression models to identify the risk factors for clinical and economic outcomes. RESULTS In 15,887 patients, the TRD was 16.81% during the 24-month follow-up period (14.14% in switching AD, 19.65% in adding AD, and 19.91% in adding AAP; p < 0.0001). When adding AD or AAP, the OR of TRD was 1.43 (95% confidence interval (CI): 1.30-1.56) and 1.42 (95% CI: 1.23-1.65), respectively, compared to switching AD. However, these factors were not associated with the incidence of psychiatric conditions. Adding AAP increased hospitalization (OR = 1.25, 95% CI: 1.11-1.41), the number of inpatient days by 2.57-fold (95% CI: 1.75-3.76), and cost by 1.20-fold (95% CI: 1.02-1.40), compared to switching AD; adding AD did not show a significant association with these outcomes. CONCLUSIONS In patients with MDD with inadequate responses to initial AD, TRD still occurred after subsequent treatments according to clinical guidelines. Since the effectiveness of second treatment strategies can differ in reality, further analysis of the clinical and economic evidence regarding second treatment strategies, such as adding AD or AAP, is needed using real-world data.
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Yang SY, Park SK, Kang HR, Kim HL, Lee EK, Kwon SH. Haematological cancer versus solid tumour end-of-life care: a longitudinal data analysis. BMJ Support Palliat Care 2020:bmjspcare-2020-002453. [PMID: 33376113 DOI: 10.1136/bmjspcare-2020-002453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/14/2020] [Accepted: 11/20/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore differences in end-of-life healthcare utilisation and medication costs between patients with haematological malignancies and patients with solid tumours. METHODS Data on deceased patients with cancer were selected from the sample cohort data of health insurance claims from 2008 to 2015 in South Korea. They were categorised into two groups: patients with haematological malignancies and patients with solid tumours. Longitudinal data comprised the patient-month unit and aggregated healthcare utilisation and medication cost for 1 year before death. Healthcare utilisation included emergency room visits, hospitalisation and blood transfusions. Medication costs were subdivided into anticancer drugs, antibiotics, opioids, sedatives and blood preparation. Generalised linear mixed models were used to evaluate differences between the two groups and time trends. RESULTS Of the 8719 deceased patients with cancer, 349 died from haematological malignancies. Compared with solid tumours, patients with haematological malignancies were more likely to visit the emergency room (OR=1.36, 95% CI 1.10 to 1.69) and receive blood transfusions (OR=5.44, 95% CI 4.29 to 6.90). The length of hospitalisation of patients was significantly different (difference=2.49 days, 95% CI 1.75 to 3.22). Medication costs, except for anticancer treatment, increased as death approached. The costs of antibiotics and blood preparations were higher in patients with haematological malignancies than in those with solid tumours: 3.24 (95% CI 2.14 to 4.90) and 4.10 (95% CI 2.77 to 6.09) times higher, respectively. CONCLUSIONS Patients with haematological malignancies are at a higher risk for aggressive care and economic burden at the end of life compared with those with solid tumours. Detailed attention is required when developing care plans for end-of-life care of haematological patients.
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Park SK, Nam JH, Lee H, Chung H, Lee EK, Shin JY. Beyond uncertainty: Negative findings for the association between the use of proton pump inhibitors and risk of dementia. J Gastroenterol Hepatol 2019; 34:2135-2143. [PMID: 31145825 DOI: 10.1111/jgh.14745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/29/2019] [Accepted: 05/26/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We investigated the risk of dementia associated with the use of proton pump inhibitors (PPIs) as compared with the use of histamine-2 receptor antagonist (H2RA). METHODS We conducted retrospective propensity score-matched cohort study using the National Health Insurance Service-National Sample Cohort. Subjects were defined as the patients newly prescribed with PPI or H2RA between 2003 and 2013 without prior prescriptions of PPI/H2RA or diagnosis of dementia from their history within the past 1 year. We followed up participants until dementia occurrence, death, or the end of the study, whichever occurred first, with an intention-to-treat approach. A 1-year lag time between exposure and outcome measure was used to reduce protopathic bias. The incidence rate per 1000 person-years was estimated. The incidence rate of PPI was compared with that of H2RA, defined as incidence rate ratio (IRR), calculated with a 95% confidence interval. To control for potential confounds, propensity score matching at a 1:1 ratio was conducted, and the crude IRR was adjusted by risk factors. RESULTS Our propensity score-matched cohort included 87 562 patients on PPIs and 87 562 patients on H2RAs. The IRR was 1.01 (95% confidence interval 0.96-1.06) with 1-year lag time. IRR showed the decreased trend as the longer lag time. Also, no treatment duration or dose-response relationship was observed. CONCLUSIONS Our finding demonstrated that PPIs did not associate with dementia more strongly than did H2RA. On this basis, we suggest that the previously reported risk for dementia associated with PPI may have been overestimated.
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Thi Nguyen NT, Jung S, Lee SH, Bae ON, Lee EK. Mono-PEGylates of exenatide in branched and dimeric structures can improve in vivo stability and hypoglycemic bioactivity. J Biotechnol 2019; 306:89-96. [PMID: 31580912 DOI: 10.1016/j.jbiotec.2019.09.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/25/2019] [Accepted: 09/29/2019] [Indexed: 02/08/2023]
Abstract
Exenatide, a synthetic version of exendin-4, is a glucagon-like peptide-1 receptor agonist (GLP-1RA) used for treating diabetes, but its relatively short half-life is a major disadvantage. In this study, we attempted residue-specific mono-PEGylation to the middle of the amino acid backbone to extend its in vivo half-life. Exenatide was point-mutated from Lys to Cys at the 12th residue to yield a variant (K12C), and PEG-maleimide of varying molecular weights (MW) (5, 10, 20, 40 kD) was site-specifically conjugated to yield a mono-PEGylate with branched T-shape molecular structure. In another approach, we conjugated a bis-maleimide PEG (10 kD) to the middle of two K12Cs to yield an H-shape homodimer PEGylate In vitro bioactivity assays indicated that: (1) PEGylates conjugated with higher MW PEG lead to stronger receptor binding, (2) the branched form was superior to the linear configuration in the binding, and (3) both T-shape and H-shape mono-PEGylates demonstrated better potency than the native exenatide, evidenced by lower EC50. Db/db mouse experiments to evaluate in vivo hypoglycemic activity indicated that: (1) all mono-PEGylates resulted in improved glucose tolerance compared to the native exenatide, (2) the homodimer PEGylate demonstrated much stronger hypoglycemic activity, especially during the initial period, and (3) the H-shape and T-shape mono-PEGylates (40 kD) maintained hypoglycemia for up to ca. 168 and 140 h, representing approximately 12- and 14-fold increase, respectively, compared with the native exenatide. Our findings suggest that the exenatide mono-PEGylates in unclassical molecular structures can improve in vivo pharmacokinetics properties.
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Park SK, Hong SH, Kim H, Kim S, Lee EK. Cost-Utility Analysis of Sacubitril/Valsartan Use Compared With Standard Care in Chronic Heart Failure Patients With Reduced Ejection Fraction in South Korea. Clin Ther 2019; 41:1066-1079. [DOI: 10.1016/j.clinthera.2019.04.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/10/2019] [Accepted: 04/17/2019] [Indexed: 01/14/2023]
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Kang HR, Kim JH, Lee EK, Shin JY. Risk of neuropsychiatric adverse events associated with the use of oseltamivir: a nationwide population-based case-crossover study-authors' response. J Antimicrob Chemother 2019; 74:1764-1765. [PMID: 30989178 DOI: 10.1093/jac/dkz131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Lee MS, Lee JY, Kang MG, Jung JW, Park HK, Park HK, Kim SH, Lee EK. Cost implications of adverse drug event-related emergency department visits - a multicenter study in South Korea. Expert Rev Pharmacoecon Outcomes Res 2019; 20:139-146. [PMID: 31012333 DOI: 10.1080/14737167.2019.1608825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Adverse drug reactions (ADRs) increase health-care resource utilization, including that for emergency department (ED) visits. However, cost analyses of ADRs resulting in ED visits are scarce. Therefore, we aimed to estimate the direct medical costs before and after ADR occurrence and analyzed the cost-driving factors.Methods: The ADR cases were identified by a retrospective review of medical records of patients who visited the ED of three tertiary hospitals in South Korea from July to December 2014. The direct medical cost was estimated by the difference in costs six months before and after the ED visit. A generalized linear model was used to identify the ADR-associated cost-driving factors.Results: The mean cost per ADR increased by 26.1% (±SD = 4.3) during the six-month follow-up compared with that during the six months before the ED visit (p < 0.05). Preventable ADRs accounted for approximately 19.9% of the cost increase among all ADR cases. The regression analysis revealed that 'ADR-related hospitalization' was a significant (p < 0.05) factor leading to an increase in the direct medical costs.Conclusion: Drug-related ED visits increase the burden on health insurance systems and patients' out-of-pocket costs, mostly due to the hospitalization costs.
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Kang HR, Hong SH, Ha SY, Kim TB, Lee EK. Differences in the risk of mood disorders in patients with asthma-COPD overlap and in patients with COPD alone: a nationwide population-based retrospective cohort study in Korea. Respir Res 2019; 20:80. [PMID: 31039780 PMCID: PMC6492426 DOI: 10.1186/s12931-019-1039-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 04/01/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although feelings of anxiety and depression are common in patients with chronic obstructive pulmonary disease (COPD), little is known about the estimates of their incidence in patients with asthma-COPD overlap (ACO), which has been described and acknowledged as a distinct clinical entity. We aimed to estimate the risk of depression and anxiety among patients with ACO and compare it with the risk among those with COPD alone in the general population. METHODS We conducted a nationwide population-based retrospective cohort study using the Korean National Sample Cohort database between 1 January, 2002, and 31 December, 2013. Patients who were diagnosed with COPD (International Classification of Diseases, 10th revision [ICD-10] codes J42-J44) at least twice and prescribed COPD medications at least once between 2003 and 2011 were classified into two categories: patients who were diagnosed with asthma (ICD-10 codes J45-J46) more than twice and at least once prescribed asthma medications comprised the ACO group, and the remaining COPD patients comprised the COPD alone group. Patients who had been diagnosed with depression or anxiety within a year before the index date were excluded. We defined the outcome as time to first diagnosis with depression and anxiety. Matched Cox regression models were used to compare the risk of depression and anxiety among patients with ACO and patients with COPD alone after propensity score matching with a 1:1 ratio. RESULTS After propensity score estimation and matching in a 1:1 ratio, the cohort used in the analysis included 15,644 patients. The risk of depression during the entire study period was higher for patients with ACO than for patients with COPD alone (adjusted hazard ratio, 1.10; 95% confidence interval, 1.03-1.18; P value = 0.0039), with an elevated risk in patients aged 40-64 years (1.21; 1.10-1.34; 0.0001) and in women (1.18; 1.07-1.29; 0.0005). The risk of anxiety was higher for patients with ACO than for patients with COPD alone (1.06; 1.01-1.12; 0.0272), with a higher risk in patients aged 40-64 years (1.08; 1.00-1.17; 0.0392); however, the risk was not significant when stratified by sex. CONCLUSIONS This population-based study revealed a higher incidence of depression and anxiety in patients with ACO than in patients with COPD alone.
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Kim HL, An J, Park JA, Park SH, Lim YS, Lee EK. Magnetic Resonance Imaging Is Cost-Effective for Hepatocellular Carcinoma Surveillance in High-Risk Patients With Cirrhosis. Hepatology 2019; 69:1599-1613. [PMID: 30365164 DOI: 10.1002/hep.30330] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/21/2022]
Abstract
Ultrasonography (US) is generally recommended for the surveillance of hepatocellular carcinoma (HCC) in patients at risk. However, in patients with cirrhosis who have sufficiently high HCC incidence, surveillance using magnetic resonance imaging (MRI) with liver-specific contrast showed markedly higher sensitivity in detecting early-stage HCC than US. This study aimed to compare the cost-effectiveness of semiannual surveillance using MRI versus US in patients with compensated cirrhosis and to identify the population that would gain optimal cost-effectiveness through MRI surveillance. We designed a Markov model to compare the expected costs and quality-adjusted life-years (QALYs), between MRI and US, with a 20-year time horizon, from the health care system perspective. The starting age of the cohort was 50 years, and 71% had hepatitis B virus-associated cirrhosis. The cycle length was 6 months. Transition probabilities and costs were obtained mainly from a prospective cohort study (the PRIUS study, NCT01446666). Cost and effectiveness were discounted at 5%. An incremental cost-effectiveness ratio (ICER) was calculated and tested using sensitivity analyses. The cost-effectiveness analysis indicated that the use of MRI incurred $5,562 incremental costs, 0.384 incremental life-years (LYs), and 0.221 incremental QALYs compared to US. The annual HCC incidence was the most influential factor on the ICER. The ICERs were $14,474/LY and $25,202/QALY at an annual HCC incidence of 3%. When the HCC incidence rate was >1.81%, the ICER was below $50,000/QALY. With increased HCC incidence, MRI surveillance was acceptable as a cost-effective option, even with an increased MRI/US cost ratio. Conclusion: Semiannual surveillance using MRI with liver-specific contrast may be more cost-effective than US in patients with virus-associated compensated cirrhosis at sufficiently high HCC risk despite the higher test cost of MRI.
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Song HJ, Park H, Park SY, Lee EK, Ha SY, Park SY, Bae EJ, Ku H. Estimation of Health Utilities Based on the Response to Treatment in Atopic Dermatitis: a Population-based Study. Clin Ther 2019; 41:700-713. [PMID: 30827751 DOI: 10.1016/j.clinthera.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE This study estimated utility weights based on the response to treatment for atopic dermatitis in the general population. METHODS The Korean general population aged 20-60 years was stratified by using a random sampling method based on age and sex. Two hypothetical health states of atopic dermatitis were developed: response to treatment and no response to treatment. Health utility values were estimated by using time trade-off (TTO) based on a period of 10 years, TTO based on life expectancy, and EuroQol 5-Dimension (EQ-5D) including a visual analog scale (VAS). The mean utility value and 95% CI were derived, and comparisons of subgroups using the t test and ANOVA were performed. We conducted a multilevel analysis after controlling the sociodemographic variables to consider repeated measures. FINDINGS A total of 155 participants were included in the survey. Their mean age was 39.7 years; 58.7% of participants were women. The mean health utility values for response and no response using TTO based on 10 years were 0.847 and 0.380, respectively. The estimated health utility values of response and no response were 0.865 and 0.476 using TTO based on life expectancy, and 0.814 and 0.279 using EQ-5D. For VAS, the response and no response were 0.744 and 0.322. After controlling the covariates, the important factors that affected utility values were response and no response to treatment (P < 0.001). IMPLICATIONS This study showed that the utility weights of people with no response to atopic dermatitis treatment were lower compared with response from the general population. Health care providers should therefore consider symptom control as an important factor affecting the quality of life of those with atopic dermatitis.
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Shin JY, Shin E, Jeong HE, Kim JH, Lee EK. Current status of pharmacovigilance regulatory structures, processes, and outcomes in the Asia-Pacific region: Survey results from 15 countries. Pharmacoepidemiol Drug Saf 2019; 28:362-369. [DOI: 10.1002/pds.4717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/23/2018] [Accepted: 11/28/2018] [Indexed: 11/11/2022]
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Ha D, Song I, Lee EK, Shin JY. Projection of future pharmacy service fees using the dispensing claims in hospital and clinic outpatient pharmacies: national health insurance database between 2006 and 2012. BMC Health Serv Res 2018; 18:327. [PMID: 29724220 PMCID: PMC5934792 DOI: 10.1186/s12913-018-3067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 03/27/2018] [Indexed: 11/24/2022] Open
Abstract
Background Predicting pharmacy service fees is crucial to sustain the health insurance budget and maintain pharmacy management. However, there is no evidence on how to predict pharmacy service fees at the population level. This study compares the status of pharmacy services and constructs regression model to project annual pharmacy service fees in Korea. Methods We conducted a time-series analysis by using sample data from the national health insurance database from 2006 and 2012. To reflect the latest trend, we categorized pharmacies into general hospital, special hospital, and clinic outpatient pharmacies based on the major source of service fees, using a 1% sample of the 2012 data. We estimated the daily number of prescriptions, pharmacy service fees, and drugs costs according to these three types of pharmacy services. To forecast pharmacy service fees, a regression model was constructed to estimate annual fees in the following year (2013). The dependent variable was pharmacy service fees and the independent variables were the number of prescriptions and service fees per pharmacy, ratio of patients (≥ 65 years), conversion factor, change of policy, and types of pharmacy services. Results Among the 21,283 pharmacies identified, 5.0% (1064), 4.6% (974), and 77.5% (16,340) were general hospital, special hospital, and clinic outpatient pharmacies, respectively, in 2012. General hospital pharmacies showed a higher daily number of prescriptions (111.9), higher pharmacy service fees ($25,546,342), and higher annual drugs costs ($215,728,000) per pharmacy than any other pharmacy (p < 0.05). The regression model to project found the ratio of patients aged 65 years and older and the conversion factor to be associated with an increase in pharmacy service fees. It also estimated the future rate of increase in pharmacy service fees to be between 3.1% and 7.8%. Conclusions General hospital outpatient pharmacies spent more on annual pharmacy service fees than any other type of pharmacy. The forecast of annual pharmacy service fees in Korea was similar to that of Australia, but not that of the United Kingdom.
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Kwon HY, Bae S, Choi SE, Park S, Lee EK, Park S, Kim J. Easy cuts, easy rebound: Drug expenditures with massive price cuts in Korea. Health Policy 2018; 123:388-392. [PMID: 30503763 DOI: 10.1016/j.healthpol.2018.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/31/2018] [Accepted: 11/04/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUNDS Since 2012, the Korean government has introduced 46.5% price cut for off-patent medicines in order to reign everescalating drug expenditure. This study sought to appraise the impact of the price cut measure (in the context of Korean National Health Insurance system). METHODS We employed Korean National Health Insurance database from January 2007 until December 2016 for 120 month period. An interrupted time series analysis with segmented regression analysis was conducted to estimate the impact of price cut on overall drug spending. RESULTS Drug spending significantly dropped with the price cut by 186.22 billlion Korean Won (KRW) (p < 0.0001) and the trend after the price cut has also significantly decreased by 1.33 billion KRW (p = 0.002). However, it was predicted that total expenditures showed an increasing trend and bounced back to the original level. Quantity prescribed had no significance with the price cut. Unit price had a substantial drop (β = -41.68, p < 0.0001) with the price-cut, but the trend after the intervention has increased (β = 0.16, p = 0.656) with no significance. CONCLUSIONS Although the price cut has successfully countered the everescalating pharmaceutical expenditures in Korea, the impact was temporary. A lack of demand-side measures resulted in an ineffectiveness and unsustainability of policy effect. Thus, more aggressive demand-side measures should be introduced in the Korean context,and both the demand and supply-sides should be balanced.
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Kang HR, Lee EK, Kim WJ, Shin JY. Risk of neuropsychiatric adverse events associated with the use of oseltamivir: a nationwide population-based case-crossover study. J Antimicrob Chemother 2018; 74:453-461. [DOI: 10.1093/jac/dky445] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/02/2018] [Indexed: 11/14/2022] Open
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Park KR, Kim KB, Baek YH, Sung HG, Park JT, Lee EK, Shin JY. Signal detection of benzodiazepine use and risk of dementia: sequence symmetry analysis using South Korean national healthcare database. Int J Clin Pharm 2018; 40:1568-1576. [DOI: 10.1007/s11096-018-0739-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/13/2018] [Indexed: 10/28/2022]
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Song HJ, Lee EK. Evaluation of willingness to pay per quality-adjusted life year for a cure: A contingent valuation method using a scenario-based survey. Medicine (Baltimore) 2018; 97:e12453. [PMID: 30235732 PMCID: PMC6160178 DOI: 10.1097/md.0000000000012453] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cost-effectiveness is 1 of the most important factors in medicine reimbursement, and social willingness to pay (WTP) can provide evidence for the threshold of cost-effectiveness analysis. Recently, the concept of curative medicines has been introduced, so it is necessary to study their cost-effectiveness. This study aimed to estimate WTP per quality-adjusted life year (QALY) for a cure in the Korean general population.A total of 507 people from the general population, proportionally assigned by sex, age, and region, participated in face-to-face interviews. The contingent valuation survey was conducted with scenarios involving 4 EuroQol-5 dimensions (EQ-5D) with different health statuses. We assumed a treatment that moved the health status of each scenario to perfect health. WTP for 1 year of treatment was derived using a double-bounded format followed by open-ended answers. In the cure scenario, the post-treatment effect continued for a lifetime; in the non-cure scenario, the effect instantly stopped when treatment was terminated. Additionally, prolonged treatment effects lasting 5 and 10 years were added. To identify the factors influencing WTP, a multi-level analysis was performed.WTP per QALY for the non-cure scenario was KRW 15 million/QALY. For the cure scenario, WTP was 2.3 times higher (KRW 35 million/QALY) than in the non-cure scenario. The results for the prolonged treatment effect scenarios were KRW 22 million/QALY and KRW 27 million/QALY, which are 1.4 and 1.8 times higher than the non-cure scenario, respectively. In all scenarios, the statistically significant factors affecting WTP per QALY were higher education, higher household income, and healthcare provider.This study revealed that WTP for a cure treatment was higher than that for non-cure; this higher WTP should be considered in future decision-making regarding curative treatments.
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Ha D, Lee J, Kim D, Oh IS, Lee EK, Shin JY. Healthcare utilization and medical expenditure of Korean psoriasis patients: A descriptive result using a health insurance database. Medicine (Baltimore) 2018; 97:e11070. [PMID: 29901614 PMCID: PMC6024228 DOI: 10.1097/md.0000000000011070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Epidemiological evidence regarding healthcare utilization and medical expenditure of patients with psoriasis in Korea is needed. To analyze the differences in healthcare utilization and financial burdens between patients with and without psoriasis and compare these patterns according to the disease severity. METHODS We conducted a descriptive cross-sectional study using a sample of the National Health Insurance database between January 1, 2012 and December 31, 2013. We included patients diagnosed with psoriasis and those with nonpsoriasis skin diseases, matched for age, sex, income, and geographical region. The patients with psoriasis were further divided into mild and moderate-to-severe psoriasis groups. Each patient was followed up for 1 year to estimate their healthcare utilization and medical expenditure since their initial diagnosis. Healthcare utilization was defined as the sum of outpatient visits and inpatient stays per person. We conducted McNemar test or Bowker test of symmetry to compare the baseline characteristics and used the Wilcoxon matched-pair signed-rank test to compare the healthcare utilization and direct costs with a 5% significance level. RESULTS Our study subjects were 4016 patients with psoriasis and equally matched 4016 patients with nonpsoriasis skin diseases. Compared with patients without psoriasis, those with psoriasis had more days of healthcare service use (5.26 vs 4.19, P < .001) and higher medical expenditures within 1 year per person (209,320 vs 117,968 won, P < .001). Patients with moderate-to-severe psoriasis had more days of healthcare service use (12.71 vs 3.25, P < .001) and higher medical expenditures within 1 year per person (611,688 vs 107,445 won, P < .001) than those with mild psoriasis. CONCLUSION Patients with psoriasis had higher burdens of healthcare utilization than those without psoriasis, and patients with moderate-to-severe psoriasis had the greatest burdens.
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Park SY, Jang EJ, Shin JY, Lee MY, Kim D, Lee EK. Prevalence and predictors of hypoglycemia in South Korea. THE AMERICAN JOURNAL OF MANAGED CARE 2018; 24:278-286. [PMID: 29939502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study aimed to identify the prevalence and predictors of hypoglycemia in patients with type 2 diabetes (T2D) using South Korea's nationwide healthcare database. STUDY DESIGN Retrospective cohort and nested case-control analyses were conducted to estimate the prevalence and predictors of hypoglycemia, respectively. METHODS A cohort of 2,273,481 patients with T2D was followed to estimate the 1-year prevalence of hypoglycemia. Total hypoglycemia was identified using outpatient, inpatient, or emergency department visit data containing a diagnosis code for hypoglycemia. Severe hypoglycemia was defined as an event with inpatient admission or emergency care. Within the T2D cohort, cases with hypoglycemia were identified, and up to 4 controls were randomly selected after matching by sex, age, and cohort entry date. Possible predictive factors included insurance type, medical institution type, hypoglycemic history, antidiabetic drugs, Charlson Comorbidity Index score, and diabetic complications. We conducted conditional logistic regression analyses to estimate adjusted odds ratios (aORs) and 95% CIs to identify predictors of hypoglycemia. RESULTS The prevalences of total and severe hypoglycemia were 1.38% and 0.96%, respectively. Those with a history of hypoglycemia had the highest risk for a further hypoglycemic event (aOR, 16.71; 95% CI, 15.62-17.88). Use of combination therapy with insulin and sulfonylurea was highly associated with severe hypoglycemia (aOR, 15.09; 95% CI, 13.60-16.74). Among diabetic complications, the presence of nephropathy was the greatest predictive factor (aOR, 1.79; 95% CI, 1.73-1.85). CONCLUSIONS Patients with a history of hypoglycemia or receiving combined antidiabetic therapy must be appropriately managed to achieve optimal glycemic control without significant risk of hypoglycemia.
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Kim J, Ha D, Song I, Park H, Lee SW, Lee EK, Shin JY. Estimation of cost savings between 2011 and 2014 attributed to infliximab biosimilar in the South Korean healthcare market: real-world evidence using a nationwide database. Int J Rheum Dis 2018; 21:1227-1236. [PMID: 29667324 DOI: 10.1111/1756-185x.13295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIM The introduction of biosimilars is expected to reduce the cost of biologic drugs, but the actual cost savings have not yet been quantified in Korea. The aim of this study was to estimate the annual cost savings attributed to the introduction of infliximab biosimilar. METHODS We conducted a retrospective analysis using data from the Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) between 2011 and 2014. The study subjects were patients who were treated with infliximab, adalimumab or etanercept. We compared the drug costs before and after the introduction of infliximab biosimilar in December 2012 (2011-2012 and 2013-2014) to estimate the annual drug cost savings attributed to this and the number of patients who could additionally benefit from the biosimilar in 2013 and 2014. RESULTS A total of 10 986 prescriptions were identified: 2620 for infliximab. The cost savings were estimated at $262 270 for 133 patients in 2013 and $395 220 for 174 patients in 2014. Among the patients who underwent a 1-year maintenance course of infliximab therapy, the annual expenditure on infliximab was lower in 2014 than in 2011. If the cost savings were used to treat additional patients, 13.3%-38.6% more patients per year could be treated by indication. CONCLUSION The introduction of infliximab biosimilar reduced direct medical costs for both patients and the payer, which could then be used to increase patient access to biologic medicines. The entry of infliximab biosimilar could result in further reductions in healthcare costs.
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Kang HR, Song HJ, Nam JH, Hong SH, Yang SY, Ju S, Lee SW, Kim TB, Kim HL, Lee EK. Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea. BMJ Open 2018; 8:e020825. [PMID: 29567854 PMCID: PMC5875610 DOI: 10.1136/bmjopen-2017-020825] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Asthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation. DESIGN Nationwide population-based observational study. SETTING Korean National Sample Cohort database. PARTICIPANTS We included 22 130 adults with asthma diagnoses more than twice (ICD-10 (International Classification of Diseases, Tenth revision) codes J45 and J46) and one prescription for asthma medication from 2010 to 2011. OUTCOME MEASURES Asthma exacerbation was defined as having a corticosteroid (CS) burst characterised by a prescription of high-dose oral CS for ≥3 days or one systemic CS injection, hospitalisation or emergency department visit. RESULTS Among severities, history of CS bursts was significantly associated with exacerbation. In mild and moderate asthma, exacerbation was significantly associated with age ≥45 years, being female, gastro-oesophageal reflux disease and chronic rhinitis. High medication possession ratio (MPR≥50%), compared with low MPR (<20%) showed adjusted ORs of 0.828 (95% CI 0.707 to 0.971) and 0.362 (0.185 to 0.708) in moderate and severe asthma, respectively. In severe asthma, compared with mild asthma, only allergic rhinitis and history of hospitalisation were strongly associated with exacerbation. When comparing frequent exacerbators to patients with single exacerbation, age ≥45 years, atopic dermatitis, anxiety and history of CS burst were significant risk factors in mild and moderate asthma, whereas no risk factors were significant in severe asthma. CONCLUSIONS Different associations between risk factors and asthma exacerbations based on asthma severity suggest that patients with mild asthma require greater attention to their age and comorbidities, whereas those with severe asthma require greater attention to hospitalisation history and drug adherence.
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Song I, Lee MS, Lee EK, Shin JY. Patient and provider characteristics related with prescribing of ADHD medication: Nationwide health insurance claims database study in Korea. Asia Pac Psychiatry 2018. [PMID: 28631372 DOI: 10.1111/appy.12289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Little is known about the association between prescribing of attention deficit hyperactivity disorder (ADHD) medication and the patient's age, gender, and type of medical institution in Asia region. INTRODUCTION This study investigates the prevalence and factors of diagnosis and pharmacological treatment of ADHD in the pediatric population. METHODS Using the Korea Health Insurance database, study participants were identified as pediatric patients (≤17 years) with at least 1 diagnosis of ADHD (ICD-10, F90) from January 1, 2007 to December 31, 2011. The annual prevalence of ADHD diagnosis and medication was calculated. Annual differences in the prevalence between 2007 and 2011 with 95% confidence intervals (CIs) were estimated. We conducted multiple logistic regression analysis to estimate adjusted odds ratios (aORs) and their 95% CI to investigate predictors associated with prescribing of ADHD medication. RESULTS The prevalence of ADHD medication prescribing increased by 26.57% (95% CI, 26.27-26.88) from 0.53% in 2007 to 0.72% in 2011. The prevalence increased by 41.56% (95% CI, 40.51-42.65) in females compared with 34.91% (95% CI, 34.47-35.36) in males. Whereas the prevalence decreased in patients younger than 6 years old, it increased by 74.30% (95% CI, 72.84-75.79) in the 13 to 17-year group. Males were more likely than females to be treated with ADHD medication (aOR, 1.12; 95% CI, 1.10-1.13). Physician specialty (psychiatry vs non-psychiatry) (aOR, 1.37; 95% CI, 1.34-1.40) were associated with prescribing of ADHD medication. CONCLUSION Rapid increases in the diagnosis and pharmacological treatment of ADHD in the pediatric population have been observed. While demographic characteristics were similar to other countries, provider characteristics were different with others reporting that the majority of patients were treated by physicians specializing in psychiatry.
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Kang JE, Yu JM, Choi JH, Chung IM, Pyun WB, Kim SA, Lee EK, Han NY, Yoon JH, Oh JM, Rhie SJ. Development and clinical application of an evidence-based pharmaceutical care service algorithm in acute coronary syndrome. J Clin Pharm Ther 2018; 43:366-376. [PMID: 29468708 DOI: 10.1111/jcpt.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug therapies are critical for preventing secondary complications in acute coronary syndrome (ACS). The purpose of this study was to develop and apply a pharmaceutical care service (PCS) algorithm for ACS and confirm that it is applicable through a prospective clinical trial. METHODS The ACS-PCS algorithm was developed according to extant evidence-based treatment and pharmaceutical care guidelines. Quality assurance was conducted through two methods: literature comparison and expert panel evaluation. The literature comparison was used to compare the content of the algorithm with the referenced guidelines. Expert evaluations were conducted by nine experts for 75 questionnaire items. A trial was conducted to confirm its effectiveness. Seventy-nine patients were assigned to either the pharmacist-included multidisciplinary team care (MTC) group or the usual care (UC) group. The endpoints of the trial were the prescription rate of two important drugs, readmission, emergency room (ER) visit and mortality. RESULTS AND DISCUSSION The main frame of the algorithm was structured with three tasks: medication reconciliation, medication optimization and transition of care. The contents and context of the algorithm were compliant with class I recommendations and the main service items from the evidence-based guidelines. Opinions from the expert panel were mostly positive. There were significant differences in beta-blocker prescription rates in the overall period (P = .013) and ER visits (four cases, 9.76%, P = .016) in the MTC group compared to the UC group, respectively. WHAT IS NEW AND CONCLUSION We developed a PCS algorithm for ACS based on the contents of evidence-based drug therapy and the core concept of pharmacist services.
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Lee MY, Shin JY, Park SY, Kim D, Cha HS, Lee EK. Persistence of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis: An analysis of the South Korean National Health Insurance Database. Semin Arthritis Rheum 2018; 47:485-491. [DOI: 10.1016/j.semarthrit.2017.08.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/08/2017] [Accepted: 08/24/2017] [Indexed: 10/19/2022]
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Lee SY, Kang KN, Kang JH, Jeong KH, Lee SW, Park HK, Lee EK. Pharmacokinetics of a telmisartan, amlodipine and hydrochlorothiazide fixed-dose combination: A replicate crossover study in healthy Korean male subjects. TROP J PHARM RES 2017. [DOI: 10.4314/tjpr.v16i9.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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