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Everingham H, Vance-Chalcraft HD, Moss ME. Trends in dental visits among US adults from 1997 through 2019: Implications for policy reform. J Am Dent Assoc 2024; 155:312-318.e2. [PMID: 38363251 DOI: 10.1016/j.adaj.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/20/2023] [Accepted: 11/20/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Examination of serial cross-sectional national surveys from a representative sample of the population can identify patterns and help support policy development. METHODS The authors used data from the National Health Interview Survey on US adults reporting a dental visit in the past 12 months to examine trends from 1997 through 2019. Groups analyzed were based on sociodemographic factors including residence in a metropolitan statistical area, race and ethnicity, family income level, and geographic region. RESULTS Over the 23-year period, the authors found differences for family income level, living in a rural (nonmetropolitan vs metropolitan) area, race and ethnicity, and geographic region (P < .0001). When stratified by family income, racial disparities have diminished. Gaps in dental service use are long-standing for rural nonmetropolitan communities. CONCLUSIONS Relative to urban locales, rural communities experienced persistent disparities in the use of the oral health care delivery system throughout the 23 years measured. Strategies to create innovative models of care are needed to address oral health needs in underserved rural communities. PRACTICAL IMPLICATIONS Policy is needed to foster a shift toward population health that will incentivize a health care system that reduces financial barriers and enhances health outcomes for adult oral health, especially for rural areas.
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Jeon N, Albogami Y, Jung SY, Bussing R, Winterstein AG. Comparing pregnancy and pregnancy outcome rates between adolescents with and without pre-existing mental disorders. PLoS One 2024; 19:e0296425. [PMID: 38483946 PMCID: PMC10939254 DOI: 10.1371/journal.pone.0296425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 12/13/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND There are limited population-based data on the role of mental disorders in adolescent pregnancy, despite the presence of mental disorders that may affect adolescents' desires and decisions to become pregnant. OBJECTIVE This study aimed to examine the relationship between specific types of mental disorders and pregnancy rates and outcome types among adolescents aged 13-19 years, using single-year age groups. METHODS We conducted a retrospective cohort study using data from the Merative™ MarketScan Research Databases. The study population consisted of females aged 13-19 years with continuous insurance enrollment for three consecutive calendar years between 2005 and 2015. Pregnancy incidence rates were calculated both overall and within the different categories of mental disorders. The presence of mental disorders, identified through diagnosis codes, was classified into 15 categories. Pregnancy and pregnancy outcome types were determined using diagnosis and procedure codes indicating the pregnancy status or outcome. To address potential over- or underestimations of mental disorder-specific pregnancy rates resulting from variations in age distribution across different mental disorder types, we applied age standardization using 2010 U.S. Census data. Finally, multivariable logistic regression models were used to examine the relationships between 15 specific types of mental disorders and pregnancy incidence rates, stratified by age. RESULTS The age-standardized pregnancy rate among adolescents diagnosed with at least one mental disorder was 15.4 per 1,000 person-years, compared to 8.5 per 1,000 person-years among adolescents without a mental disorder diagnosis. Compared to pregnant adolescents without a mental disorder diagnosis, those with a mental disorder diagnosis had a slightly but significantly higher abortion rate (26.7% vs 23.8%, P-value < 0.001). Multivariable logistic regression models showed that substance use-related disorders had the highest odds ratios (ORs) for pregnancy incidence, ranging from 2.4 [95% confidence interval (CI): 2.1-2.7] to 4.5 [95% CI:2.1-9.5] across different age groups. Overall, bipolar disorders (OR range: 1.6 [95% CI:1.4-1.9]- 1.8 [95% CI: 1.7-2.0]), depressive disorders (OR range: 1.4 [95% CI: 1.3-1.5]- 2.7 [95% CI: 2.3-3.1]), alcohol-related disorders (OR range: 1.2 [95% CI: 1.1-1.4]- 14.5 [95% CI: 1.2-178.6]), and attention-deficit/conduct/disruptive behavior disorders (OR range: 1.1 [95% CI: 1.0-1.1]- 1.8 [95% CI: 1.1-3.0]) were also significantly associated with adolescent pregnancy, compared to adolescents without diagnosed mental disorders of the same age. CONCLUSION This study emphasizes the elevated rates of pregnancy and pregnancy ending in abortion among adolescents diagnosed with mental disorders, and identifies the particular mental disorders associated with higher pregnancy rates.
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Affiliation(s)
- Nakyung Jeon
- Pusan National University College of Pharmacy, Busan, Republic of Korea
- Research Institute for Drug Development, Pusan National University, Busan, Republic of Korea
| | - Yasser Albogami
- Department of Clinical Pharmacy, College of Pharmacy, King Saudi University, Riyadh, Saudi Arabia
| | - Sun-Young Jung
- College of Pharmacy and Department of Global Innovative Drugs, Chung-Ang University, Seoul, Republic of Korea
| | - Regina Bussing
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, FL, United States of America
| | - Almut G. Winterstein
- Department of Pharamceutical Outcomes and Policy, Department of Epidemiology, and Center for drug Evaluation and Safety, University of Florida, Gainesville, FL, United States of America
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Fritz CDL, Otegbeye EE, Zong X, Demb J, Nickel KB, Olsen MA, Mutch M, Davidson NO, Gupta S, Cao Y. Red-flag signs and symptoms for earlier diagnosis of early-onset colorectal cancer. J Natl Cancer Inst 2023; 115:909-916. [PMID: 37138415 PMCID: PMC10407716 DOI: 10.1093/jnci/djad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Prompt detection of colorectal cancer (CRC) among individuals younger than age 50 years (early-onset CRC) is a clinical priority because of its alarming rise. METHODS We conducted a matched case-control study of 5075 incident early-onset CRC among US commercial insurance beneficiaries (113 million adults aged 18-64 years) with 2 or more years of continuous enrollment (2006-2015) to identify red-flag signs and symptoms between 3 months to 2 years before the index date among 17 prespecified signs and symptoms. We assessed diagnostic intervals according to the presence of these signs and symptoms before and within 3 months of diagnosis. RESULTS Between 3 months and 2 years before the index date, 4 red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron deficiency anemia) were associated with an increased risk of early-onset CRC, with odds ratios (ORs) ranging from 1.34 to 5.13. Having 1, 2, or at least 3 of these signs and symptoms were associated with a 1.94-fold (95% confidence interval [CI] = 1.76 to 2.14), 3.59-fold (95% CI = 2.89 to 4.44), and 6.52-fold (95% CI = 3.78 to 11.23) risk (Ptrend < .001), respectively, with stronger associations for younger ages (Pinteraction < .001) and rectal cancer (Pheterogenity = .012). The number of different signs and symptoms was predictive of early-onset CRC beginning 18 months before diagnosis. Approximately 19.3% of patients had their first sign or symptom occur between 3 months and 2 years before diagnosis (median diagnostic interval = 8.7 months), and approximately 49.3% had the first sign or symptom within 3 months of diagnosis (median diagnostic interval = 0.53 month). CONCLUSIONS Early recognition of red-flag signs and symptoms (abdominal pain, rectal bleeding, diarrhea, and iron-deficiency anemia) may improve early detection and timely diagnosis of early-onset CRC.
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Affiliation(s)
- Cassandra D L Fritz
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Ebunoluwa E Otegbeye
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Xiaoyu Zong
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Joshua Demb
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Katelin B Nickel
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret A Olsen
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew Mutch
- Section of Colon and Rectal Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Nicholas O Davidson
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Samir Gupta
- Division of Gastroenterology, University of California San Diego, San Diego, CA, USA
- Moores Cancer Center, University of California San Diego, La Jolla, CA, USA
- Department of Internal Medicine, University of California San Diego, San Diego, CA, USA
- Veteran Affairs San Diego Healthcare System, Department of Medicine, Division of Gastroenterology, San Diego, CA, USA
| | - Yin Cao
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
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Stanley SL, Denney JT. All-cause mortality risk for men and women in the United States: the role of partner's education relative to own education. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:161-178. [PMID: 36106426 DOI: 10.1080/14461242.2022.2113907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/11/2022] [Indexed: 05/18/2023]
Abstract
This study examines the association between educational attainment, relative to that of an intimate partner, and all-cause mortality for men and women in different-sex relationships. Research suggests some health benefits for partnered adults that arise from economic benefits and improved access to health-promoting tools. One way these benefits could be gained is through the pairing of the highly educated. While high individual educational attainment lowers mortality risk, less is known about the risks of mortality associated with one's education, relative to their partner's education. Using National Health Interview Survey Linked Mortality Files (NHIS-LMF) for the years 1999-2014 with prospective mortality follow-up through December 2015 (N = 347,994), we document the association between relative educational attainment and mortality for men and women with different-sex partners in the United States. Fully adjusted Cox proportional hazard models revealed a higher risk of all-cause mortality for men and women who have more education than their partner, relative to those having the same education as their partner. For women only, having less education than their male partner was associated with a lower risk of all-cause mortality. A better understanding of relative status within different-sex partnerships provides insights into partnered adult's mortality risks.
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Affiliation(s)
- Sandte L Stanley
- Department of Sociology, Washington State University, Pullman, WA, USA
| | - Justin T Denney
- Department of Sociology, Washington State University, Pullman, WA, USA
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Zablotsky B, Lessem SE, Gindi RM, Maitland AK, Dahlhamer JM, Blumberg SJ. Overview of the 2019 National Health Interview Survey Questionnaire Redesign. Am J Public Health 2023; 113:408-415. [PMID: 36758202 PMCID: PMC10003503 DOI: 10.2105/ajph.2022.307197] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Data System. Federal health surveys, like the National Health Interview Survey (NHIS), represent important surveillance mechanisms for collecting timely, representative data that can be used to monitor the health and health care of the US population. Data Collection/Processing. Conducted by the National Center for Health Statistics (NCHS), NHIS uses an address-based, complex clustered sample of housing units, yielding data representative of the civilian noninstitutionalized US population. Survey redesigns that reduce survey length and eliminate proxy reporting may reduce respondent burden and increase participation. Such were goals in 2019, when NCHS implemented a redesigned NHIS questionnaire that also focused on topics most relevant and appropriate for surveillance of child and adult health. Data Analysis/Dissemination. Public-use microdata files and selected health estimates and detailed documentation are released online annually. Public Health Implications. Declining response rates may lead to biased estimates and weaken users' ability to make valid conclusions from the data, hindering public health efforts. The 2019 NHIS questionnaire redesign was associated with improvements in the survey's response rate, declines in respondent burden, and increases in data quality and survey relevancy. (Am J Public Health. 2023;113(4):408-415. https://doi.org/10.2105/AJPH.2022.307197).
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Affiliation(s)
- Benjamin Zablotsky
- Benjamin Zablotsky, Renee M. Gindi, Aaron K. Maitland, James M. Dahlhamer, and Stephen J. Blumberg are with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Sarah E. Lessem is with RTI International, Washington, DC
| | - Sarah E Lessem
- Benjamin Zablotsky, Renee M. Gindi, Aaron K. Maitland, James M. Dahlhamer, and Stephen J. Blumberg are with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Sarah E. Lessem is with RTI International, Washington, DC
| | - Renee M Gindi
- Benjamin Zablotsky, Renee M. Gindi, Aaron K. Maitland, James M. Dahlhamer, and Stephen J. Blumberg are with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Sarah E. Lessem is with RTI International, Washington, DC
| | - Aaron K Maitland
- Benjamin Zablotsky, Renee M. Gindi, Aaron K. Maitland, James M. Dahlhamer, and Stephen J. Blumberg are with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Sarah E. Lessem is with RTI International, Washington, DC
| | - James M Dahlhamer
- Benjamin Zablotsky, Renee M. Gindi, Aaron K. Maitland, James M. Dahlhamer, and Stephen J. Blumberg are with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Sarah E. Lessem is with RTI International, Washington, DC
| | - Stephen J Blumberg
- Benjamin Zablotsky, Renee M. Gindi, Aaron K. Maitland, James M. Dahlhamer, and Stephen J. Blumberg are with the National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD. Sarah E. Lessem is with RTI International, Washington, DC
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Blewett LA, Mac Arthur NS, Campbell J. The Future of State All-Payer Claims Databases. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2023; 48:93-115. [PMID: 36112957 DOI: 10.1215/03616878-10171104] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
State policy makers are under increasing pressure to address the prohibitive cost of health care given the lack of action at the federal level. In 2020, the United States spent more on health care than any other country in the world-$4.1 trillion, representing 19.7% of the nation's gross domestic product. States are trying to better understand their role in health care spending and to think creatively about strategies for addressing health care cost growth. One way they are doing this is through the development and use of state-based all-payer claims databases (APCDs). APCDs are health data organizations that hold transactional information from public (Medicare and Medicaid) and private health insurers (commercial plans and some self-insured employers). APCDs transform this data into useful information on health care costs and trends. This article describes states' use of APCDs and recent efforts that have provided benefits and challenges for states interested in this unique opportunity to inform health policy. Although challenges exist, there is new funding for state APCD improvements in the No Surprises Act, and potential new federal interest will help states enhance their APCD capacity so they can better understand their markets, educate consumers, and create actionable market information.
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Erwin Johnson C, Colquhoun D, Ruppar DA, Vetter S. De-identified data quality assessment approaches by data vendors who license data to healthcare and life sciences researchers. JAMIA Open 2022; 5:ooac093. [PMID: 36339052 PMCID: PMC9629893 DOI: 10.1093/jamiaopen/ooac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/22/2022] [Accepted: 10/26/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To gain insights into how data vendor companies (DVs), an important source of de-identified/anonymized licensed patient-related data (D/ALD) used in clinical informatics research in life sciences and the pharmaceutical industry, characterize, conduct, and communicate data quality assessments to researcher purchasers of D/ALD. MATERIALS AND METHODS A qualitative study with interviews of DVs executives and decision-makers in data quality assessments (n = 12) and content analysis of interviews transcripts. RESULTS Data quality, from the perspective of DVs, is characterized by how it is defined, validated, and processed. DVs identify data quality as the main contributor to successful collaborations with life sciences/pharmaceutical research partners. Data quality feedback from clients provides the basis for DVs reviews and inspections of quality processes. DVs value customer interactions, view collaboration, shared common goals, mutual expertise, and communication related to data quality as success factors. CONCLUSION Data quality evaluation practices are important. However, no uniform DVs industry standards for data quality assessment were identified. DVs describe their orientation to data quality evaluation as a direct result of not only the complex nature of data sources, but also of techniques, processes, and approaches used to construct data sets. Because real-world data (RWD), eg, patient data from electronic medical records, is used for real-world evidence (RWE) generation, the use of D/ALD will expand and require refinement. The focus on (and rigor in) data quality assessment (particularly in research necessary to make regulatory decisions) will require more structure, standards, and collaboration between DVs, life sciences/pharmaceutical, informaticists, and RWD/RWE policy-making stakeholders.
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Affiliation(s)
- C Erwin Johnson
- Corresponding Author: C. Erwin Johnson, MD, EdM, MSc, Policy Evidence Research (Global Market Access), Merck & Co., Inc., 200 Galloping Hill Road, Kenilworth, NJ, 07033, USA;
| | | | - Daniel A Ruppar
- Health & Life Sciences, Frost & Sullivan, San Antonio, Texas, USA
| | - Sascha Vetter
- Customer Research, Frost & Sullivan, San Antonio, Texas, USA
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Annis A, Reaves C, Sender J, Bumpus S. U.S. government, health-related data sources accessible to health researchers: A mapping review (Preprint). J Med Internet Res 2022; 25:e43802. [PMID: 37103987 PMCID: PMC10176148 DOI: 10.2196/43802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/26/2022] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Big data from large, government-sponsored surveys and data sets offers researchers opportunities to conduct population-based studies of important health issues in the United States, as well as develop preliminary data to support proposed future work. Yet, navigating these national data sources is challenging. Despite the widespread availability of national data, there is little guidance for researchers on how to access and evaluate the use of these resources. OBJECTIVE Our aim was to identify and summarize a comprehensive list of federally sponsored, health- and health care-related data sources that are accessible in the public domain in order to facilitate their use by researchers. METHODS We conducted a systematic mapping review of government sources of health-related data on US populations and with active or recent (previous 10 years) data collection. The key measures were government sponsor, overview and purpose of data, population of interest, sampling design, sample size, data collection methodology, type and description of data, and cost to obtain data. Convergent synthesis was used to aggregate findings. RESULTS Among 106 unique data sources, 57 met the inclusion criteria. Data sources were classified as survey or assessment data (n=30, 53%), trends data (n=27, 47%), summative processed data (n=27, 47%), primary registry data (n=17, 30%), and evaluative data (n=11, 19%). Most (n=39, 68%) served more than 1 purpose. The population of interest included individuals/patients (n=40, 70%), providers (n=15, 26%), and health care sites and systems (n=14, 25%). The sources collected data on demographic (n=44, 77%) and clinical information (n=35, 61%), health behaviors (n=24, 42%), provider or practice characteristics (n=22, 39%), health care costs (n=17, 30%), and laboratory tests (n=8, 14%). Most (n=43, 75%) offered free data sets. CONCLUSIONS A broad scope of national health data is accessible to researchers. These data provide insights into important health issues and the nation's health care system while eliminating the burden of primary data collection. Data standardization and uniformity were uncommon across government entities, highlighting a need to improve data consistency. Secondary analyses of national data are a feasible, cost-efficient means to address national health concerns.
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Affiliation(s)
- Ann Annis
- College of Nursing, Michigan State University, East Lansing, MI, United States
- Institute for Health Policy, Michigan State University, East Lansing, MI, United States
| | - Crista Reaves
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Jessica Sender
- University Libraries, Michigan State University, East Lansing, MI, United States
| | - Sherry Bumpus
- School of Nursing, Eastern Michigan University, Ypsilanti, MI, United States
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Trujillo AJ, Gutierrez JC, Garcia Morales EE, Socal M, Ballreich J, Anderson G. Trajectories of prices in generic drug markets: what can we infer from looking at trajectories rather than average prices? HEALTH ECONOMICS REVIEW 2022; 12:37. [PMID: 35819735 PMCID: PMC9278003 DOI: 10.1186/s13561-022-00384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Well-functioning competitive markets are key to controlling generic drug prices. This is important since over 90% of all drugs sold in the US are generics. Recently, there have been examples of large price increases in the generic market. METHODS This paper examines price trajectories for generic drugs using a group-based trajectory modelling approach (GBTM). We fit the model using quarterly price information in the IBM MarketScan claims database for the past decade. RESULTS We identify three dominant price trajectories for this period: rapid increase trajectories, slow decline and rapid decline. Most generic drugs show a slow or a rapid decline in price trajectories. However, around 17% of all generic drugs show rapid price increase trajectories. CONCLUSIONS As Congress is exploring an excise tax on drugs whose list price increases faster than the rate of inflation, we discuss what drugs would be most likely to be affected by this law.
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Affiliation(s)
- Antonio J. Trujillo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Jose C. Gutierrez
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | | | - Mariana Socal
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Jeromie Ballreich
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Gerard Anderson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
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Butler O, Ju S, Hoernig S, Vogtländer K, Bansilal S, Heresi GA. Assessment for residual disease after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension. ERJ Open Res 2022; 8:00572-2021. [PMID: 35651369 PMCID: PMC9149390 DOI: 10.1183/23120541.00572-2021] [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: 10/01/2021] [Accepted: 03/29/2022] [Indexed: 11/08/2022] Open
Abstract
Objectives Pulmonary endarterectomy (PEA) is recommended for eligible patients with chronic thromboembolic pulmonary hypertension (CTEPH) and is potentially curative. However, persistent/recurrent CTEPH post-PEA can occur. Here we describe symptom and diagnostic assessment rates for residual disease post-PEA and longitudinal diagnostic patterns before and after riociguat approval for persistent/recurrent CTEPH after PEA. Methods This US retrospective cohort study analysed MarketScan data (1 January 2002–30 September 2018) from patients who underwent PEA following a CTEPH/pulmonary hypertension (PH) claim with at least 730 days of continuous enrolment post-PEA. Data on pre-specified PH symptoms and the types and timings of diagnostic assessments were collected. Results Of 103 patients (pre-riociguat approval, n=55; post-riociguat approval, n=48), residual PH symptoms >3 months after PEA were reported in 89% of patients. Overall, 89% of patients underwent one or more diagnostic tests (mean 4.6 tests/patient), most commonly echocardiography (84%), with only 5% of patients undergoing right heart catheterisation (RHC). In the post- versus pre-riociguat approval subgroup, assessments were more specific for CTEPH with an approximately two-fold increase in 6-min walk distance and N-terminal prohormone of brain natriuretic protein measurements and ventilation/perfusion scans, and a four-fold increase in RHCs. Conclusions Low RHC rates suggest that many patients with PH symptoms post-PEA are not being referred for full diagnostic workup. Changes to longitudinal diagnostic patterns may indicate increased recognition of persistent/recurrent CTEPH post-PEA; however, there remains a need for greater awareness around the importance of continued follow-up for patients with residual PH symptoms post-PEA. Rates of residual PH symptoms are high after PEA but referral of patients with suspected persistent/recurrent CTEPH following PEA for CTEPH-specific diagnostic assessments is suboptimal, highlighting potential gaps in CTEPH patient care post-PEAhttps://bit.ly/3jfUZlO
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Wesson P, Hswen Y, Valdes G, Stojanovski K, Handley MA. Risks and Opportunities to Ensure Equity in the Application of Big Data Research in Public Health. Annu Rev Public Health 2022; 43:59-78. [PMID: 34871504 PMCID: PMC8983486 DOI: 10.1146/annurev-publhealth-051920-110928] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The big data revolution presents an exciting frontier to expand public health research, broadening the scope of research and increasing the precision of answers. Despite these advances, scientists must be vigilant against also advancing potential harms toward marginalized communities. In this review, we provide examples in which big data applications have (unintentionally) perpetuated discriminatory practices, while also highlighting opportunities for big data applications to advance equity in public health. Here, big data is framed in the context of the five Vs (volume, velocity, veracity, variety, and value), and we propose a sixth V, virtuosity, which incorporates equity and justice frameworks. Analytic approaches to improving equity are presented using social computational big data, fairness in machine learning algorithms, medical claims data, and data augmentation as illustrations. Throughout, we emphasize the biasing influence of data absenteeism and positionality and conclude with recommendations for incorporating an equity lens into big data research.
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Affiliation(s)
- Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Yulin Hswen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Bakar Computational Health Sciences Institute, University of California, San Francisco, California, USA
| | - Gilmer Valdes
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Radiation Oncology, University of California, San Francisco, California, USA
| | - Kristefer Stojanovski
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Social, Behavioral and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA;
- Department of Medicine, University of California, San Francisco, California, USA
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California, USA
- Partnerships for Research in Implementation Science for Equity (PRISE), University of California, San Francisco, California, USA
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Data Resources for Evaluating the Economic and Financial Consequences of Surgical Care in the United States. J Trauma Acute Care Surg 2022; 93:e17-e29. [PMID: 35358106 DOI: 10.1097/ta.0000000000003631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
LEVEL OF EVIDENCE V.
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Butler O, Heeg S, Holl K, Frenz AK, Wicklein EM, Rametta M, Yeo S. Real-World Assessment of Interferon-β-1b and Interferon-β-1a Adherence Before and After the Introduction of the BETACONNECT ® Autoinjector: A Retrospective Cohort Study. Drugs Real World Outcomes 2021; 8:359-367. [PMID: 33928518 PMCID: PMC8324614 DOI: 10.1007/s40801-021-00248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Both interferon beta-1b (IFN-β-1b) and interferon beta-1a (IFN-β-1a) are immunomodulators that require regular subcutaneous self-administration by patients with multiple sclerosis (MS). However, no electronic autoinjector is available for IFN-β-1a in the US. OBJECTIVE This retrospective cohort study investigated adherence to two subcutaneous disease-modifying therapies, IFN-β-1b and IFN-β-1a, during two periods (before and after the introduction of the BETACONNECT® autoinjector for IFN-β-1b). PATIENTS AND METHODS Data were evaluated from the MarketScan database for adults in the US with an MS diagnosis and a medical claim for subcutaneous IFN-β-1b or IFN-β-1a, either before (October 2013-September 2015) or after the introduction of BETACONNECT (October 2016-September 2018). Patient populations were propensity-score matched by demographic and clinical characteristics. Persistence was recorded, and adherence was evaluated by medication possession ratio (MPR). RESULTS The study included 196 IFN-β-1b and 365 IFN-β-1a people with MS (PwMS) (pre-BETACONNECT period), and 126 IFN-β-1b and 223 IFN-β-1a PwMS (post-BETACONNECT period). In the pre-BETACONNECT period, the proportion with at least 80% MPR was higher for IFN-β-1a (90%) than for IFN-β-1b (83%), but in the post-BETACONNECT period the proportion with ≥ 80% MPR was higher for IFN-β-1b (92%) than for IFN-β-1a (86%). In the pre-BETACONNECT period, median persistence (in days) was higher for IFN-β-1a (199) than for IFN-β-1b (152), while in post-BETACONNECT period persistence was higher for IFN-β-1b (327) than for IFN-β-1a (229). CONCLUSIONS Following the introduction of BETACONNECT, this exploratory study suggested that PwMS taking IFN-β-1b were more adherent compared with those taking IFN-β-1a, with higher persistence, and more than 90% reached 80% MPR, a threshold commonly used to define good adherence.
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Affiliation(s)
- Oisín Butler
- Medical Affairs and Pharmacovigilance, Pharmaceuticals, RWE Strategy & Outcomes Data Generation, Bayer AG, Building P300, 13342, Berlin, Germany.
| | - Simone Heeg
- Medical Affairs and Pharmacovigilance, Pharmaceuticals, RWE Strategy & Outcomes Data Generation, Bayer AG, Building P300, 13342, Berlin, Germany
| | - Katsiaryna Holl
- Medical Affairs and Pharmacovigilance, Pharmaceuticals, RWE Strategy & Outcomes Data Generation, Bayer AG, Building P300, 13342, Berlin, Germany
| | | | - Eva-Maria Wicklein
- Medical Affairs and Pharmacovigilance, Pharmaceuticals, RWE Strategy & Outcomes Data Generation, Bayer AG, Building P300, 13342, Berlin, Germany
| | - Mark Rametta
- US Medical Affairs, Specialty Medicine and Pipeline Products, Bayer HealthCare Pharmaceuticals, Whippany, New Jersey, USA
| | - Sandy Yeo
- Bayer (South East Asia) Pte Ltd, Singapore, Singapore
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Miller C, Apple S, Paige JS, Grabowsky T, Shukla O, Agnese W, Merrill C. Current and Future Projections of Amyotrophic Lateral Sclerosis in the United States Using Administrative Claims Data. Neuroepidemiology 2021; 55:275-285. [PMID: 34153964 DOI: 10.1159/000515203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Various methodologies have been reported to assess the real-world epidemiology of amyotrophic lateral sclerosis (ALS) in the United States. The aim of this study was to estimate the prevalence, incidence, and geographical distribution of ALS using administrative claims data and to model future trends in ALS epidemiology. METHODS We performed a retrospective analysis of deidentified administrative claims data for >100 million patients, using 2 separate databases (IBM MarketScan Research Databases and Symphony Health Integrated DataVerse [IDV]), to identify patients with ALS. We evaluated disease prevalence, annual incidence, age- and population-controlled geographical distribution, and expected future trends. RESULTS From 2013 to 2017, we identified 7,316 and 35,208 ALS patients from the MarketScan databases and IDV, respectively. Average annual incidence estimates were 1.48 and 1.37 per 100,000 and point prevalence estimates were 6.85 and 5.16 per 100,000 and in the United States for the MarketScan databases and IDV, respectively. Predictive modeling estimates are reported out to the year 2060 and demonstrate an increasing trend in both incident and prevalent cases. CONCLUSIONS This study provides incidence and prevalence estimates as well as geographical distribution for what the authors believe to be the largest ALS population studied to date. By using 2 separate administrative claims data sets, confidence in our estimates is increased. Future projections based on either database demonstrate an increase in ALS cases, which has also been seen in other large-scale ALS studies. These results can be used to help improve the allocation of healthcare resources in the future.
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Affiliation(s)
- Chris Miller
- HVH Precision Analytics LL, Wayne, Pennsylvania, USA
| | - Stephen Apple
- Mitsubishi Tanabe Pharma America, Inc., Jersey City, New Jersey, USA
| | | | | | - Oodaye Shukla
- HVH Precision Analytics LL, Wayne, Pennsylvania, USA
| | - Wendy Agnese
- Formerly Employed by Mitsubishi Tanabe Pharma America, Inc., Jersey City, New Jersey, USA
| | - Charlotte Merrill
- Formerly Employed by Mitsubishi Tanabe Pharma America, Inc., Jersey City, New Jersey, USA
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King JH, Hall MAK, Goodman RA, Posner SF. Life in Data Sets: Locating and Accessing Data on the Health of Americans Across the Life Span. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:E126-E142. [PMID: 31688741 PMCID: PMC7190403 DOI: 10.1097/phh.0000000000001079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT The US government manages a large number of data sets, including federally funded data collection activities that examine infectious and chronic conditions, as well as risk and protective factors for adverse health outcomes. Although there currently is no mature, comprehensive metadata repository of existing data sets, US federal agencies are working to develop and make metadata repositories available that will improve discoverability. However, because these repositories are not yet operating at full capacity, researchers must rely on their own knowledge of the field to identify available data sets. PROGRAM OR POLICY We sought to identify and consolidate a practical and annotated listing of those data sets. IMPLEMENTATION AND/OR DISSEMINATION Creative use of data resources to address novel questions is an important research skill in a wide range of fields including public health. This report identifies, promotes, and encourages the use of a range of data sources for health, behavior, economic, and policy research efforts across the life span. EVALUATION We identified and organized 28 federal data sets by the age-group of primary focus; not all groups are mutually exclusive. These data sets collectively represent a rich source of information that can be used to conduct descriptive epidemiologic studies. DISCUSSION The data sets identified in this article are not intended to represent an exhaustive list of all available data sets. Rather, we present an introduction/overview of the current federal data collection landscape and some of its largest and most frequently utilized data sets.
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Affiliation(s)
- Jaron Hoani King
- Department of Public Health, Brigham Young University, Provo, Utah (Mr King); Cherokee Nation Assurance (Ms Hall), National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Ms Hall and Dr Posner); and Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Goodman)
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16
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Sy J, Hsiung JT, Edgett D, Kalantar-Zadeh K, Streja E, Lau WL. Cardiovascular and Bleeding Outcomes with Anticoagulants across Kidney Disease Stages: Analysis of a National US Cohort. Am J Nephrol 2021; 52:199-208. [PMID: 33789276 DOI: 10.1159/000514753] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/28/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND While direct oral anticoagulants (DOACs) are considered safe among patients without chronic kidney disease (CKD), the evidence is conflicting as to whether they are also safe in the CKD and end-stage kidney disease (ESKD) population. In this observational cohort study, we examined whether DOACs are a safe alternative to warfarin across CKD stages for a variety of anticoagulation indications. METHODS Individuals on DOACs or warfarin were identified from OptumLabs® Data Warehouse (OLDW), a longitudinal dataset with de-identified administrative claims, from 2010 to 2017. Cox models with sensitivity analyses were used to assess the risk of cardiovascular disease and bleeding outcomes stratified by CKD stage. RESULTS Among 351,407 patients on anticoagulation, 45% were on DOACs. CKD stages 3-5 and ESKD patients comprised approximately 12% of the cohort. The most common indications for anticoagulation were atrial fibrillation (AF, 44%) and venous thromboembolism (VTE, 23%). DOACs were associated with a 22% decrease in the risk of cardiovascular outcomes (HR 0.78, 95% CI: 0.77-0.80, p < 0.001) and a 10% decrease in the risk of bleeding outcomes (HR 0.90, 95% CI: 0.88-0.92, p < 0.001) compared to warfarin after adjustment. On stratified analyses, DOACs maintained a superior safety profile across CKD stages. Patients with AF on DOACs had a consistently lower risk of cardiovascular and bleeding events than warfarin-treated patients, while among other indications (VTE, peripheral vascular disease, and arterial embolism), the risk of cardiovascular and bleeding events was the same among DOAC and warfarin users. CONCLUSION DOACs may be a safer alternative to warfarin even among CKD and ESKD patients.
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Affiliation(s)
- John Sy
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - Jiu-Ting Hsiung
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - Drake Edgett
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- Division of Nephrology, Tibor Rubin VA Medical Center, Long Beach, California, USA
| | - Wei Ling Lau
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
- OptumLabs Visiting Fellow, Eden Prairie, Minnesota, USA
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The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041384. [PMID: 33546168 PMCID: PMC7913122 DOI: 10.3390/ijerph18041384] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 12/15/2022]
Abstract
One in every twenty-five persons in America is a racial/ethnic minority who lives in a rural area. Our objective was to summarize how racism and, subsequently, the social determinants of health disproportionately affect rural racial/ethnic minority populations, provide a review of the cancer disparities experienced by rural racial/ethnic minority groups, and recommend policy, research, and intervention approaches to reduce these disparities. We found that rural Black and American Indian/Alaska Native populations experience greater poverty and lack of access to care, which expose them to greater risk of developing cancer and experiencing poorer cancer outcomes in treatment and ultimately survival. There is a critical need for additional research to understand the disparities experienced by all rural racial/ethnic minority populations. We propose that policies aim to increase access to care and healthcare resources for these communities. Further, that observational and interventional research should more effectively address the intersections of rurality and race/ethnicity through reduced structural and interpersonal biases in cancer care, increased data access, more research on newer cancer screening and treatment modalities, and continued intervention and implementation research to understand how evidence-based practices can most effectively reduce disparities among these populations.
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Navathe AS, Liao JM, Linn KA, Zhang Y, Mishra A, Wang R, Dinh CT, Zhu J, Cousins DS, Lindner J, Emanuel EJ. Spillover Effects of Medicare's Voluntary Bundled Payments for Joint Replacement Surgery to Patients Insured by Commercial Health Plans. Ann Intern Med 2021; 174:200-208. [PMID: 33347769 DOI: 10.7326/m19-3792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Under the Bundled Payments for Care Improvement (BPCI) program, bundled paymtents for lower-extremity joint replacement (LEJR) are associated with 2% to 4% cost savings with stable quality among Medicare fee-for-service beneficiaries. However, BPCI may prompt practice changes that benefit all patients, not just fee-for-service beneficiaries. OBJECTIVE To examine the association between hospital participation in BPCI and LEJR outcomes for patients with commercial insurance or Medicare Advantage (MA). DESIGN Quasi-experimental study using Health Care Cost Institute claims from 2011 to 2016. SETTING LEJR at 281 BPCI hospitals and 562 non-BPCI hospitals. PATIENTS 184 922 patients with MA or commercial insurance. MEASUREMENTS Differential changes in LEJR outcomes at BPCI hospitals versus at non-BPCI hospitals matched on propensity score were evaluated using a difference-in-differences (DID) method. Secondary analyses evaluated associations by patient MA status and hospital characteristics. Primary outcomes were changes in 90-day total spending on LEJR episodes and 90-day readmissions; secondary outcomes were postacute spending and discharge to postacute care providers. RESULTS Average episode spending decreased more at BPCI versus non-BPCI hospitals (change, -2.2% [95% CI, -3.6% to -0.71%]; P = 0.004), but differences in changes in 90-day readmissions were not significant (adjusted DID, -0.47 percentage point [CI, -1.0 to 0.06 percentage point]; P = 0.084). Participation in BPCI was also associated with differences in decreases in postacute spending and discharge to institutional postacute care providers. Decreases in episode spending were larger for hospitals with high baseline spending but did not vary by MA status. LIMITATION Nonrandomized studies are subject to residual confounding and selection. CONCLUSION Participation in BPCI was associated with modest spillovers in episode savings. Bundled payments may prompt hospitals to implement broad care redesign that produces benefits regardless of insurance coverage. PRIMARY FUNDING SOURCE Leonard Davis Institute of Health Economics at the University of Pennsylvania.
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Affiliation(s)
- Amol S Navathe
- Corporal Michael J. Crescenz VA Medical Center and Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (A.S.N.)
| | - Joshua M Liao
- University of Washington School of Medicine, Seattle, Washington, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (J.M.L.)
| | - Kristin A Linn
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Yi Zhang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Akriti Mishra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Robin Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Claire T Dinh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Jingsan Zhu
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (J.Z., E.J.E.)
| | - Deborah S Cousins
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Jacob Lindner
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (K.A.L., Y.Z., A.M., R.W., C.T.D., D.S.C., J.L.)
| | - Ezekiel J Emanuel
- Perelman School of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania (J.Z., E.J.E.)
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Socal MP, Parasrampuria S, Anderson GF. Modifying the Criteria for Granting Orphan Drug Market Exclusivity. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1470-1476. [PMID: 33127018 DOI: 10.1016/j.jval.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To examine policy options to deny orphan drug exclusivity after drugs exceed a target population of 200 000 across all orphan indications (combined prevalence threshold) or once drugs receive a nonorphan approval (market approval threshold). METHODS Retrospective analysis of drugs with 2 or more orphan approvals from 1983 to July 01, 2017 examining prevalence of orphan indications and approval years of orphan and nonorphan indications. Characteristics of drugs crossing either threshold are described. A budget impact analysis of Medicare and Marketscan® claims databases estimated potential savings from generic or biosimilar entry as a result of foregone market exclusivity periods determined by these policies. RESULTS Out of 86 drugs with 2 or more orphan approvals, 21 drugs would be denied orphan drug exclusivity periods under the prevalence threshold and 18 drugs would be denied orphan drug exclusivity periods under the market approval threshold. Drugs with orphan approvals after 2010 were more likely to be denied orphan drug exclusivity. In 2017, Medicare could have saved about $2 billion on 8 drugs under the prevalence threshold policy and $1.3 billion on 12 drugs under the market approval threshold policy). Private insurers could have saved $814 and $919 million, respectively. Over half of the savings would come from 9 drugs that first entered the market for a nonorphan indication. CONCLUSIONS Modifying the criteria for granting orphan drug exclusivity would affect a small number of orphan drugs but could generate large savings through increased competition. Other incentives such as grants or tax credits for clinical trials could be explored to incentivize research for new orphan indications for drugs that crossed either threshold.
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Affiliation(s)
- Mariana P Socal
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Sonal Parasrampuria
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Gerard F Anderson
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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The relationship between contralateral prophylactic mastectomy and breast reconstruction, complications, breast-related procedures, and costs: A population-based study of health insurance data. Surgery 2020; 168:859-867. [DOI: 10.1016/j.surg.2020.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/09/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022]
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21
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Chen ST, Huybrechts KF, Bateman BT, Hernández-Díaz S. Trends in Human Papillomavirus Vaccination in Commercially Insured Children in the United States. Pediatrics 2020; 146:peds.2019-3557. [PMID: 32928985 DOI: 10.1542/peds.2019-3557] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The human papillomavirus (HPV) vaccine was recommended in 2006 for girls and in 2011 for boys. The Healthy People 2020 goal for 2-dose HPV vaccination coverage is 80% by age 15 for girls and boys. We used nationwide population-based data to describe trends in HPV vaccination in children. METHODS We conducted a cohort study nested within the MarketScan health care database between January 2003 and December 2017. Children were followed from the year they turned 9 until HPV vaccination, insurance disenrollment, or the end of the year when they turned 17, whichever came first. We estimated the cumulative incidence of at least 1- and 2-dose HPV vaccination, stratified by birth year, sex, and state. In secondary analyses, we evaluated the association between state-level vaccination policies and HPV vaccination coverage. RESULTS This study included 7 837 480 children and 19.8 million person-years. The proportion of 15-year-old girls and boys with at least a 1-dose HPV vaccination increased from 38% and 5% in 2011 to 57% and 51% in 2017, respectively; the proportion with at least a 2-dose vaccination went from 30% and 2% in 2011 to 46% and 39% in 2017, respectively. By 2017, 2-dose HPV vaccination coverage varied from 80% in Washington, District of Columbia, among girls to 15% in Mississippi among boys and was positively correlated with legislation for HPV vaccine education and pediatrician availability. CONCLUSIONS Despite the increasing trends in uptake, HPV vaccine coverage among commercially insured children in the United States remains behind target levels, with substantial disparities by state.
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Affiliation(s)
- Szu-Ta Chen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Departments of Medicine and
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Departments of Medicine and.,Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and
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Variability in influenza vaccination opportunities and coverage among privately insured children. Vaccine 2020; 38:6464-6471. [DOI: 10.1016/j.vaccine.2020.07.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 05/26/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022]
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