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Le HH, Ken-Opurum J, LaPrade A, Maculaitis MC, Sheehan JJ. Exploring humanistic burden of fatigue in adults with multiple sclerosis: an analysis of US National Health and Wellness Survey data. BMC Neurol 2024; 24:51. [PMID: 38297247 PMCID: PMC10832085 DOI: 10.1186/s12883-023-03423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/05/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND This retrospective study examined the humanistic burden of fatigue in patients with relapsing-remitting multiple sclerosis (RRMS), compared with adults without MS, using data from the 2017 and 2019 US National Health and Wellness Survey. METHODS The 5-item Modified Fatigue Impact Scale (MFIS-5) was used to assess level of fatigue (MFIS-5 score <15: low fatigue [LF]; MFIS-5 score ≥15: high fatigue [HF]) in patients with RRMS. Health-related quality of life (HRQoL) measures (Short Form 36-Item Health Survey version 2, Euroqol-5 Dimensions-5 Levels [EQ-5D-5L], Patient Health Questionnaire-9 [PHQ-9], Generalized Anxiety Disorder-7 [GAD-7], Perceived Deficits Questionnaire-5) and treatment-related characteristics were assessed. RESULTS In total, 498 respondents were identified as RRMS (n=375 RRMS+LF, n=123 RRMS+HF) and compared with 1,494 matched non-MS controls. RRMS+LF and RRMS+HF had significantly lower Short Form 6 Dimensions health utility, Mental and Physical Component Summary, and EQ-5D-5L scores and higher PHQ-9 and GAD-7 scores, compared with matched non-MS controls (all p<0.001); scores were worse for RRMS+HF than RRMS+LF across all measures (all p<0.001). A higher proportion of RRMS+HF reported moderate-to-severe depression and moderate-to-severe anxiety, compared with RRMS+LF and matched non-MS controls (both p<0.001). Fatigue was a significant predictor of poor HRQoL across all measures (all p<0.001). CONCLUSIONS Patients with RRMS experienced lower HRQoL with higher levels of fatigue, highlighting an unmet need. Results may help to inform physician-patient communication and shared decision-making to address fatigue and its associated impact on patients' HRQoL.
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Affiliation(s)
- Hoa H Le
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
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2
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Sheehan JJ, LaVallee C, Maughn K, Balakrishnan S, Pesa JA, Joshi K, Nelson C. Real-world assessment of treatment inertia in the management of patients treated for major depressive disorder in the USA. J Comp Eff Res 2024; 13:e230091. [PMID: 37987716 PMCID: PMC10842298 DOI: 10.57264/cer-2023-0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023] Open
Abstract
Aim: Major depressive disorder (MDD) is a debilitating illness in which depressive symptoms may persist after treatment. Treatment inertia is the continued use of the same pharmacotherapy regimen when treatment goals are not met. This study assessed the frequency of treatment inertia among adult patients with MDD treated in a real-world setting. Patients & methods: This was a retrospective, observational study of patients with MDD identified in the Decision Resources Group Real World Evidence US Data Repository from January 2014 to June 2018. Patients (≥18 years) had an elevated Patient Health Questionnaire-9 (PHQ-9) score (≥5) following 8 weeks of stable baseline antidepressant use with/without mental-health outpatient therapy. Treatment inertia, modification and discontinuation were evaluated over a 16-week follow-up period (timeline based on the APA Practice Guidelines). The primary outcome was the proportion of MDD patients experiencing treatment inertia. Results: 2850 patients (median age, 55 years; 74% female) met the study criteria. Of these patients, 834 (29%) had study-defined treatment inertia, 1534 (54%) received treatment modification and 482 (17%) discontinued treatment. Use of mirtazapine (Odd ratio [OR]: 0.63; 95% confidence interval [CI]: 0.50-0.79), selective serotonin reuptake inhibitors (OR: 0.64; 95% CI: 0.54-0.75) or bupropion (OR: 0.71; 95% CI: 0.60-0.84) in the baseline period was associated with an increased likelihood of treatment modification versus not receiving treatment with these medications. Frequency of treatment inertia may differ among those who do not have a documented PHQ-9 score. Conclusion: Effective symptom management is critical for optimal outcomes in MDD. Results demonstrate that treatment inertia is common in MDD despite guidelines recommending treatment modification in patients not reaching remission.
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Affiliation(s)
- John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Chris LaVallee
- Health Outcomes Research, Decision Resources Group, Boston, MA 02116, USA
| | - Keshia Maughn
- Analytics, Decision Resources Group, Boston, MA 02116, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Craig Nelson
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
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3
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Johnson FR, Gonzalez JM, Sheehan JJ, Reed SD. How Much Better is Faster? Value Adjustments for Health-Improvement Sequences. Pharmacoeconomics 2023:10.1007/s40273-023-01266-7. [PMID: 37133682 DOI: 10.1007/s40273-023-01266-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 05/04/2023]
Abstract
While the quality-adjusted life-year construct has advantages of simplicity and consistency, simplicity requires strong assumptions. In particular, standard assumptions result in health-state utility functions that are unrealistically linear and separable in risk and duration. Consequently, sequencing of a series of health improvements has no effect on the total value of the sequence because each increment is assessed independently of previous increments. Utility functions in nearly all other areas of applied economics are assumed to be nonlinear with diminishing marginal utility so it matters where an improvement occurs in a sequence. We construct a conceptual framework that that demonstrates how diminishing marginal utility for health improvements could affect preferences for different sequence patterns. Using this framework, we derive conditions for which the sum of conventional health-state utilities understates, overstates, or approximates the sequence-sensitive value of health improvements. These patterns suggest the direction and magnitude of possible adjustments to conventional value calculations. We provide numerical examples and identify recent studies whose results are consistent with the conceptual model.
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Affiliation(s)
- F Reed Johnson
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - John J Sheehan
- Value and Evidence, Neuroscience, Janssen Scientific Affairs, Titusville, NJ, USA
| | - Shelby D Reed
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Turkoz I, Nelson JC, Wilkinson ST, Borentain S, Macaluso M, Trivedi MH, Williamson D, Sheehan JJ, Salvadore G, Singh J, Daly E. Predictors of response and remission in patients with treatment-resistant depression: A post hoc pooled analysis of two acute trials of esketamine nasal spray. Psychiatry Res 2023; 323:115165. [PMID: 37019044 DOI: 10.1016/j.psychres.2023.115165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/01/2023] [Accepted: 03/10/2023] [Indexed: 04/07/2023]
Abstract
This exploratory post hoc analysis of two pooled 4-week, phase 3, double-blind, placebo- and active-controlled studies that compared esketamine nasal spray plus a newly initiated oral antidepressant (ESK+AD; n = 310) with a newly initiated oral AD plus placebo nasal spray (AD+PBO; n = 208) in patients with treatment-resistant depression (TRD) examined baseline patient demographic and psychiatric characteristics as potential predictors of response (≥50% reduction from baseline in Montgomery-Åsberg Depression Rating Scale [MADRS] total score) and remission (MADRS total score ≤12) at day 28. Overall, younger age, any employment, fewer failed ADs in the current depressive episode, and reduction in Clinical Global Impression-Severity (CGI-S) score at day 8 were significant positive predictors of response and remission at day 28. Treatment assignment was an important predictor of both response and remission. Patients treated with ESK+AD had 68% and 55% increased odds of achieving response and remission, respectively, versus those treated with AD+PBO. In the ESK+AD group, attainment of response and remission was more likely in patients who were employed, without significant anxiety at baseline, and who experienced a reduction in CGI-S score at day 8. Identification of predictors of response and remission may facilitate identification of those patients with TRD most likely to benefit from ESK+AD. Trial Registration: ClinicalTrials.gov: NCT02417064 (clinicaltrials.gov/ct2/show/NCT02417064) and NCT02418585 (clinicaltrials.gov/ct2/show/NCT02418585).
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Affiliation(s)
- Ibrahim Turkoz
- Janssen Research & Development, LLC, Titusville, NJ, United States of America.
| | - J Craig Nelson
- Department of Psychiatry, UCSF, San Francisco, CA, United States of America.
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States of America.
| | - Stephane Borentain
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Madhukar H Trivedi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States of America.
| | - David Williamson
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
| | - John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
| | - Giacomo Salvadore
- Janssen Research & Development, LLC, Titusville, NJ, United States of America.
| | - Jaskaran Singh
- Janssen Research & Development, LLC, Titusville, NJ, United States of America
| | - Ella Daly
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America.
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5
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Zhao X, Karkare S, Nash AI, Sheehan JJ, Aboumrad M, Near AM, Banerji T, Joshi K. Characteristics and current standard of care among veterans with major depressive disorder in the United States: A real-world data analysis. J Affect Disord 2022; 307:184-190. [PMID: 35351492 DOI: 10.1016/j.jad.2022.03.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/04/2022] [Accepted: 03/20/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND This study examined MDD treatment regimens received during the first observed and treated major depressive episode (MDE) among US veterans. METHODS This retrospective study, conducted using the Veterans Health Administration (VHA) database, supplemented with Medicare Part A/B/D data, included adults with ≥1 MDD diagnosis (index date) between 10/1/2015-2/28/2017 and ≥1 line of therapy (LOT) within the first observed complete MDE. Patient baseline (6-month pre-index) characteristics and up to six LOTs received during the first observed and treated MDE were assessed. RESULTS Of 40,240 veterans with MDD identified (mean age: 50.9 years, 83.9% male, 63.4% White, 88.6% non-Hispanic), hypertension (27.5%), hyperlipidemia (20.8%), and post-traumatic stress disorder (17.5%) were the most common baseline comorbidities. During the first observed and treated MDE, patients received a mean of 1.6 ± 1.0 LOTs, with 14.6% of patients receiving ≥3 LOTs. SSRI-monotherapy was the most commonly observed regimen in the first six LOTs, followed by SNRI-monotherapy in LOT 1 and antidepressants augmented by anticonvulsants in the remaining five LOTs. The antidepressant class of the previous LOT was commonly used in the subsequent LOT. SSRI-SSRI-SSRI was the most common LOT1-to-LOT3 sequencing pattern among patients receiving ≥3 LOTs. LIMITATIONS The study findings are limited to data in the VHA database and may not be generalizable to the non-veteran US population. CONCLUSIONS During the first observed and treated MDE, SSRI-monotherapy was the most common therapy in the first six LOTs. Cycling within SSRI class was the leading sequencing pattern of the first three LOTs among veterans who received ≥3 LOTs.
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Affiliation(s)
| | | | | | | | - Maya Aboumrad
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, Titusville, NJ, USA
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6
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Voelker J, Wilkinson ST, Katz EG, Nash AI, Daly E, Ali A, Lovink A, Stahl J, Desai A, Kuvadia H, Neslusan C, Sheehan JJ. A Choice-Based Conjoint Analysis of the Psychiatrist Decision-Making Process Used in Determining When to Discharge Adults With Major Depressive Disorder Hospitalized for Active Suicidal Ideation With Intent. J Nerv Ment Dis 2022; 210:373-379. [PMID: 34937847 DOI: 10.1097/nmd.0000000000001463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT To ascertain the relative importance of attributes considered when deciding to discharge patients hospitalized with major depressive disorder (MDD) and active suicidal ideation with intent, a choice-based conjoint analysis was conducted via online survey among US-based psychiatrists actively managing such patients. Potential attributes and attribute levels were identified. Attribute importance in decision to discharge and the discharge time frame were assessed. One hundred psychiatrists completed the survey. The relative importance of attributes were current MDD severity (relative importance weight [out of 100] 24.8 [95% confidence interval, 23.3-26.3]), clinician assessment of current suicidal ideation (20.8 [18.5-23.0]), previous history of suicide attempts (16.7 [15.9-17.6]), psychosocial support at discharge (13.0 [11.7-14.4]), postdischarge outpatient follow-up (9.8 [8.8-10.8]), current length of hospital stay (9.2 [8.1-10.3]), and suicidal ideation at admission (5.7 [4.8-6.6]). Thus, current clinical symptoms were considered the most important attributes by psychiatrists when discharging patients initially hospitalized with MDD and active suicidal ideation with intent.
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Affiliation(s)
| | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Eva G Katz
- Janssen Research & Development LLC, South Raritan, New Jersey
| | | | - Ella Daly
- Janssen Scientific Affairs LLC, Titusville, New Jersey
| | - Ahan Ali
- DRG Medtech, Toronto, Ontario, Canada
| | | | | | | | - Harsh Kuvadia
- Janssen Scientific Affairs LLC, Titusville, New Jersey
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7
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Pilon D, Neslusan C, Zhdanava M, Sheehan JJ, Joshi K, Morrison L, Rossi C, Lefebvre P, Greenberg PE. Economic Burden of Commercially Insured Patients With Major Depressive Disorder and Acute Suicidal Ideation or Behavior in the United States. J Clin Psychiatry 2022; 83. [PMID: 35390231 DOI: 10.4088/jcp.21m14090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: Suicidal ideation or behavior (SIB) is a symptom of major depressive disorder (MDD). This study evaluated health care resource utilization (HRU) and costs of commercially insured adults who had diagnosed MDD with acute SIB (MDSI). Methods: Adults with MDSI (index date: first SIB claim) and controls without MDD or suicide-related claims (random index date) were identified using International Classification of Diseases, Clinical Modification, 10th Revision codes in the OptumHealth Care Solutions, Inc. database (October 2014 to March 2017). Adults with < 12 months of plan enrollment pre-index and/or selected psychiatric comorbidities were excluded. MDSI and control cohorts were matched 1:1 on demographics and comorbidities. HRU and costs were compared between matched cohorts during up to 1 and 12 months post-index (inclusive) using regressions adjusted for baseline costs. Results: Among patients with MDSI (n = 1,576, mean age = 34 years, 55.6% female), most index events occurred in emergency department (ED; 50.7%) and inpatient (45.2%) settings. The MDSI cohort, compared with the control cohort within 1 and 12 months post-index, respectively, had 157.7 and 28.0 times more inpatient admissions, 16.4 and 5.4 times more ED visits, and 4.9 and 3.2 times more outpatient visits (all P < .01). Incremental health care costs per patient per month in the MDSI compared with the control cohort within 1 and 12 months were $7,839 and $2,757, respectively (both P values < .01). Inpatient and ED costs constituted 70.6% and 16.5% of the total incremental costs, respectively, within the first month of follow-up. Conclusions: Among commercially insured adults, MDSI was associated with significant economic burden; inpatient and ED services drove incremental costs of the condition. Further assessment of treatment options for this vulnerable patient population is warranted.
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Affiliation(s)
| | | | - Maryia Zhdanava
- Analyses Group, Inc., Montréal, QC, Canada.,Corresponding author: Masha (Maryia) Zhdanava, MA, Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Ste 1500, Montreal, QC, H3B 0G7
| | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
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8
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Voelker J, Sheehan JJ, Le HH, Toro-Diaz H, Li S, Joshi K. US budget impact analysis of esketamine nasal spray in major depressive disorder with acute suicidal ideation/behavior. J Comp Eff Res 2022; 11:319-328. [DOI: 10.2217/cer-2021-0226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background: Esketamine nasal spray plus an oral antidepressant is approved in adults with major depressive disorder with acute suicidal ideation or behavior (MDSI). Methods: A budget impact analysis from a US payer perspective was performed with a hypothetical 1-million-member plan, using pharmacy and medical costs associated with adding esketamine plus an oral antidepressant to usual care. Results: Estimated annual total healthcare costs of managing patients with MDSI increased from $32,988,247 without esketamine to $34,161,188 in Year 3 with esketamine (primarily due to medical costs). The per-member-per-month incremental costs were $0.02, $0.06 and $0.10 in Years 1, 2 and 3, respectively. Conclusion: Incorporation of esketamine results in a modest estimated impact on the annual budget over a 3-year time horizon.
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Affiliation(s)
| | - John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | - Hoa H Le
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
| | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ 08560, USA
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9
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Voelker J, Cai Q, Daly E, Connolly N, Pesa J, Sheehan JJ, Wilkinson ST. Mental Health Care Resource Utilization and Barriers to Receiving Mental Health Services Among US Adults With a Major Depressive Episode and Suicidal Ideation or Behavior With Intent. J Clin Psychiatry 2021; 82. [PMID: 34529898 DOI: 10.4088/jcp.20m13842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: To examine the incremental mental health care resource utilization (MHRU) and barriers to receiving mental health services among adults with a major depressive episode (MDE) and suicidal ideation or behavior with intent. Methods: Data from adult participants in the 2017 National Survey on Drug Use and Health were used to identify 3 cohorts: MDE (determined by Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] criteria) with suicidal ideation or behavior with intent (MDSI), MDE, and non-MDE. MHRU and barriers to receiving mental health services were compared among cohorts using logistic regression models. Results: The MDSI cohort had significantly higher odds (adjusted odds ratio [95% confidence interval]) of receiving mental health-related inpatient care, outpatient care, prescription medications, and any treatment versus the MDE cohort (10.2 [7.1-14.6], 2.4 [1.7-3.4], 2.4 [1.8-3.3], and 2.6 [1.8-3.7], respectively) and the non-MDE cohort (40.3 [27.3-59.5], 20.0 [14.5-27.7], 17.2 [12.9-22.9], and 19.6 [14.1-27.1], respectively). Compared to the MDE cohort, the MDSI cohort was significantly more likely to report barriers to receiving mental health services (2.6 [2.0-3.4]), with the largest differences between cohorts related to fear of negative impact (3.9 [2.8-5.4]). Additionally, 30.6% of the MDSI cohort and 47.0% of the MDE cohort did not receive any mental health treatment in the past year. Conclusions: Although respondents in the MDSI cohort reported substantially higher MHRU across all categories, they also reported greater barriers to receiving care than those in the MDE cohort. This study documents the extensive burden and unmet need in the MDSI population.
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Affiliation(s)
- Jennifer Voelker
- Janssen Scientific Affairs, LLC, Titusville, New Jersey.,Corresponding author: Jennifer Voelker, PharmD, MS, Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Rd, Titusville, NJ 08560
| | - Qian Cai
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Ella Daly
- Janssen Research & Development, LLC, Titusville, New Jersey
| | | | | | | | - Samuel T Wilkinson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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10
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Kuvadia H, Beren IA, Starr HL, Sheehan JJ, Kleinman NL, Brook RA. Direct and Indirect Costs Among Caregivers of Patients With Major Depressive Disorder and Suicidal Ideation or Suicidal Attempt. Prim Care Companion CNS Disord 2021; 23. [PMID: 34384005 DOI: 10.4088/pcc.20m02893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: To compare direct and indirect costs among caregivers of patients with major depressive disorder (MDD) and suicidal ideation and/or suicide attempts (MDSI) versus caregivers of patients with MDD alone versus caregivers of patients without MDD or suicidal ideation and/or suicide attempts (controls). Methods: Cohorts were based on caregivers of adult patients with MDSI, MDD alone, and controls. Patients were identified by Workpartners employer database ICD-9/ICD-10 codes (January 2010 to July 2019) and were spouses or domestic partners of employees (caregivers). Twenty controls and 20 MDD-alone caregivers were matched to each MDSI caregiver on sex, age, and index year. All caregiver-patient pairs had 6 months pre/postindex information and met additional inclusion/exclusion criteria. Patient and caregiver medical and prescription claims and caregiver absenteeism (payment/time) were analyzed. Direct costs (medical, prescription) and indirect costs (absence payments by benefit type) were analyzed using separate, 2-part stepwise regression models and controlling for demographics, job-related variables, region, index year, and Charlson Comorbidity Index score. Results: 570 MDSI caregiver-patient pairs and 11,400 matched MDD-alone and control pairs were identified. MDSI and MDD-alone caregivers had higher medical costs compared with controls ($5,131 and $4,548 versus $3,885, respectively; P < .0001). Prescription costs were highest among MDSI caregivers, followed by MDD-alone and control caregivers ($1,852, $1,425, and $1,005, respectively; P < .001). MDSI caregivers had the highest total indirect costs. MDSI patient medical and prescription costs were highest, followed by MDD-alone and control patients. Conclusion: MDSI caregivers had significantly greater direct and indirect costs compared with MDD-alone and non-MDD caregivers.
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Affiliation(s)
- Harsh Kuvadia
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Ian A Beren
- Integrated Data Analytics, Workpartners LLC, Cheyenne, Wyoming
| | - H Lynn Starr
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | | | - Richard A Brook
- Retrospective Research, Better Health Worldwide, Inc, Newfoundland, New Jersey.,Corresponding author: Richard Brook, MS, MBA, Retrospective Research, Better Health Worldwide, Inc, 18 Hirth Drive, Newfoundland, NJ 07435
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11
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Voelker J, Kuvadia H, Cai Q, Wang K, Daly E, Pesa J, Connolly N, Sheehan JJ, Wilkinson ST. United States national trends in prevalence of major depressive episode and co-occurring suicidal ideation and treatment resistance among adults. Journal of Affective Disorders Reports 2021. [DOI: 10.1016/j.jadr.2021.100172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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12
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Voelker J, Wang K, Tang W, He J, Daly E, Pericone CD, Sheehan JJ. Association of depression symptom severity with short-term risk of an initial hospital encounter in adults with major depressive disorder. BMC Psychiatry 2021; 21:257. [PMID: 34001045 PMCID: PMC8130130 DOI: 10.1186/s12888-021-03258-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the availability of pharmacologic and nonpharmacologic treatment options, depression continues to be one of the leading causes of disability worldwide. This study evaluated whether depression symptom severity, as measured by PHQ-9 score, of patients diagnosed with MDD is associated with short-term risk of a hospital encounter (ER visit or inpatient stay). METHODS Adults with ≥1 PHQ-9 assessment in an outpatient setting (index date) and ≥ 1 MDD diagnosis within 6 months prior were included from the de-identified Optum Electronic Health Record database (April 2016-June 2019). Patients were categorized by depression symptom severity based on PHQ-9 scores obtained by natural language processing. Crude rates, adjusted absolute risks, and adjusted relative risks of all-cause and MDD-related hospital encounters within 30 days following assessment of depression severity were determined. RESULTS The study population consisted of 280,145 patients with MDD and ≥ 1 PHQ-9 assessment in an outpatient setting. Based on PHQ-9 scores, 26.9% of patients were categorized as having none/minimal depression symptom severity, 16.4% as mild, 24.7% as moderate, 19.6% as moderately severe, and 12.5% as severe. Among patients with none/minimal, mild, moderate, moderately severe, and severe depression, the adjusted absolute short-term risks of an initial all-cause hospital encounter were 4.1, 4.4, 4.8, 5.6, and 6.5%, respectively; MDD-related hospital encounter adjusted absolute risks were 0.8, 1.0, 1.3, 1.6, and 2.1%, respectively. Compared to patients with none/minimal depression symptom severity, the adjusted relative risks of an all-cause hospital encounter were 1.60 (95% CI 1.50-1.70) for those with severe, 1.36 (1.29-1.44) for those with moderately severe, 1.18 (1.12-1.25) for those with moderate, and 1.07 (1.00-1.13) for those with mild depression symptom severity. CONCLUSIONS These study findings indicate that depression symptom severity is a key driver of short-term risk of hospital encounters, emphasizing the need for timely interventions that can ameliorate depression symptom severity.
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Affiliation(s)
- Jennifer Voelker
- Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ, 08560, USA.
| | - Kun Wang
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
| | - Wenze Tang
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
| | - Jinghua He
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
| | - Ella Daly
- grid.497530.c0000 0004 0389 4927Janssen Research & Development, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
| | - Christopher D. Pericone
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
| | - John J. Sheehan
- grid.497530.c0000 0004 0389 4927Janssen Scientific Affairs, LLC, 1125 Trenton Harbourton Rd, Titusville, NJ 08560 USA
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13
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Pilon D, Joshi K, Sheehan JJ, Zichlin ML, Zuckerman P, Lefebvre P, Greenberg PE. Correction: Burden of treatment-resistant depression in Medicare: A retrospective claims database analysis. PLoS One 2021; 16:e0249731. [PMID: 33793676 PMCID: PMC8016289 DOI: 10.1371/journal.pone.0249731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Zhdanava M, Pilon D, Ghelerter I, Chow W, Joshi K, Lefebvre P, Sheehan JJ. The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States. J Clin Psychiatry 2021; 82. [PMID: 33989464 DOI: 10.4088/jcp.20m13699] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the share of TRD in the burden of medication-treated major depressive disorder (MDD) using the most commonly accepted definition of TRD and a novel bottom-up approach. METHODS Prevalence and health care burden of TRD were estimated by synthetizing inputs across 4 similarly designed claims studies in adults covered by Medicare, Medicaid, commercial plans, and the US Veterans Health Administration (VHA). Productivity (absenteeism and presenteeism) and unemployment burden were estimated based on inputs from a study conducted with data from the Kantar National Health and Wellness Survey (NHWS; 2017). A targeted literature search for additional inputs was performed. A cost model was developed to estimate the burden of TRD and medication-treated DSM-5-defined MDD in the United States. Study outcomes were the 12-month prevalence of TRD and the annual health care, productivity, and unemployment burden of TRD and medication-treated MDD in the United States. RESULTS The estimated 12-month prevalence of medication-treated MDD in the United States was 8.9 million adults, and 2.8 million (30.9%) had TRD. The total annual burden of medication-treated MDD among the US population was $92.7 billion, with $43.8 billion (47.2%) attributable to TRD. The share of TRD was 56.6% ($25.8 billion) of the health care burden, 47.7% ($8.7 billion) of the unemployment burden, and 32.2% ($9.3 billion) of the productivity burden of medication-treated MDD. CONCLUSIONS TRD is associated with disproportionate health care costs and unemployment, suggesting potentially large economic and societal gains with effective management.
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Affiliation(s)
- Maryia Zhdanava
- Analysis Group, Inc., Montréal, Quebec, Canada.,Corresponding author: Maryia Zhdanava, MA, Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Ste 1500, Montreal, QC, H3B 0G7, Canada
| | | | | | - Wing Chow
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
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15
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Turkoz I, Alphs L, Singh J, Jamieson C, Daly E, Shawi M, Sheehan JJ, Trivedi MH, Rush AJ. Clinically meaningful changes on depressive symptom measures and patient-reported outcomes in patients with treatment-resistant depression. Acta Psychiatr Scand 2021; 143:253-263. [PMID: 33249552 PMCID: PMC7986932 DOI: 10.1111/acps.13260] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To use the Clinical Global Impression-Severity (CGI-S) scale to estimate clinically meaningful and clinically substantial changes as measured using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Sheehan Disability Scale (SDS), and the Patient Health Questionnaire-9 (PHQ-9) in patients with treatment-resistant depression (TRD). METHODS Pooled data were derived from two 4-week, randomized, active-controlled studies evaluating esketamine nasal spray (ESK) plus oral antidepressant (OAD) or OAD plus placebo nasal spray (PBO) in adults with TRD (N = 565). CGI-S, MADRS, SDS, and PHQ-9 scores were obtained at baseline and over 4 weeks of treatment. In this post hoc analysis, change scores on the MADRS, SDS, and PHQ-9 that corresponded to a clinically meaningful (1-point) or clinically substantial (2-point) change on the CGI-S scale were identified. RESULTS Clinically meaningful changes in CGI-S scores after 28 days corresponded to 6-, 4-, and 3-point changes from baseline on the MADRS, SDS, and PHQ-9, respectively. Similarly, a 2-point CGI-S score change (clinically substantial change) corresponded to a 12-, 8-, and 6-point change on the MADRS, SDS, and PHQ-9, respectively. The proportion of patients showing substantial clinical improvement in the ESK plus OAD group versus the OAD plus PBO group after 28 days of treatment favored ESK plus OAD: 69.0% vs 55.3% (MADRS), 64.5% vs 48.9% (SDS), and 77.1% vs 64.7% (PHQ-9). CONCLUSION We provide a basis for identifying clinically meaningful and clinically substantial changes as assessed with commonly used outcome measures for depression to facilitate the translation of clinical trial results into clinical practice.
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Affiliation(s)
| | - Larry Alphs
- Janssen Scientific Affairs, LLCTitusvilleNJUSA
| | | | | | - Ella Daly
- Janssen Scientific Affairs, LLCTitusvilleNJUSA
| | - May Shawi
- Janssen Scientific Affairs, LLCTitusvilleNJUSA
| | | | | | - A. John Rush
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA,Department of Psychiatry, Texas Tech University Health Sciences CenterPermian Basin CampusOdessaTXUSA,Duke‐National University of Singapore Medical SchoolSingapore
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16
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Desai U, Kirson NY, Guglielmo A, Le HH, Spittle T, Tseng-Tham J, Shawi M, Sheehan JJ. Cost-per-remitter with esketamine nasal spray versus standard of care for treatment-resistant depression. J Comp Eff Res 2021; 10:393-407. [PMID: 33565893 DOI: 10.2217/cer-2020-0276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: Estimate the cost-per-remitter with esketamine nasal spray plus an oral antidepressant (ESK + oral AD) versus oral AD plus nasal placebo (oral AD + PBO) among patients with treatment-resistant depression. Patients & methods: An Excel-based model was developed to estimate the cost-per-remitter for ESK + oral AD versus oral AD + PBO over 52 weeks from multiple US payer perspectives. Clinical end points and cost inputs were derived from clinical trials and the literature, respectively. Results: Under the base-case scenario, the cost-per-remitter for ESK + oral AD and oral AD + PBO were as follows: Commercial: US$85,808 versus US$100,198; Medicaid: US$76,236 versus US$96,067; Veteran's Affairs: US$77,765 versus US$104,519; and Integrated Delivery Network: US$103,924 versus US$142,766. Conclusion: The findings suggest that ESK + oral AD is a cost-efficient alternative treatment for treatment-resistant depression compared with oral AD + PBO.
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Affiliation(s)
- Urvi Desai
- Analysis Group, Inc., Boston, MA 02199, USA
| | | | | | - Hoa H Le
- Janssen Scientific Affairs, Titusville, NJ 08560, USA
| | | | | | - May Shawi
- Janssen Scientific Affairs, Titusville, NJ 08560, USA
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17
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Voelker J, Joshi K, Daly E, Papademetriou E, Rotter D, Sheehan JJ, Kuvadia H, Liu X, Dasgupta A, Potluri R. How well do clinical and demographic characteristics predict Patient Health Questionnaire-9 scores among patients with treatment-resistant major depressive disorder in a real-world setting? Brain Behav 2021; 11:e02000. [PMID: 33403828 PMCID: PMC7882175 DOI: 10.1002/brb3.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To create and validate a model to predict depression symptom severity among patients with treatment-resistant depression (TRD) using commonly recorded variables within medical claims databases. METHODS Adults with TRD (here defined as > 2 antidepressant treatments in an episode, suggestive of nonresponse) and ≥ 1 Patient Health Questionnaire (PHQ)-9 record on or after the index TRD date were identified (2013-2018) in Decision Resource Group's Real World Data Repository, which links an electronic health record database to a medical claims database. A total of 116 clinical/demographic variables were utilized as predictors of the study outcome of depression symptom severity, which was measured by PHQ-9 total score category (score: 0-9 = none to mild, 10-14 = moderate, 15-27 = moderately severe to severe). A random forest approach was applied to develop and validate the predictive model. RESULTS Among 5,356 PHQ-9 scores in the study population, the mean (standard deviation) PHQ-9 score was 10.1 (7.2). The model yielded an accuracy of 62.7%. For each predicted depression symptom severity category, the mean observed scores (8.0, 12.2, and 16.2) fell within the appropriate range. CONCLUSIONS While there is room for improvement in its accuracy, the use of a machine learning tool that predicts depression symptom severity of patients with TRD can potentially have wide population-level applications. Healthcare systems and payers can build upon this groundwork and use the variables identified and the predictive modeling approach to create an algorithm specific to their population.
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Affiliation(s)
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Ella Daly
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | | | | | | | - Xing Liu
- SmartAnalyst, Inc, New York, NY, USA
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18
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Evans SR, Paraoan D, Perlmutter J, Raman SR, Sheehan JJ, Hallinan ZP. Real-World Data for Planning Eligibility Criteria and Enhancing Recruitment: Recommendations from the Clinical Trials Transformation Initiative. Ther Innov Regul Sci 2021; 55:545-552. [PMID: 33393014 PMCID: PMC8021522 DOI: 10.1007/s43441-020-00248-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/27/2020] [Indexed: 11/12/2022]
Abstract
The growing availability of real-world data (RWD) creates opportunities for new evidence generation and improved efficiency across the research enterprise. To varying degrees, sponsors now regularly use RWD to make data-driven decisions about trial feasibility, based on assessment of eligibility criteria for planned clinical trials. Increasingly, RWD are being used to support targeted, timely, and personalized outreach to potential trial participants that may improve the efficiency and effectiveness of the recruitment process. This paper highlights recommendations and resources, including specific case studies, developed by the Clinical Trials Transformation Initiative (CTTI) for applying RWD to planning eligibility criteria and recruiting for clinical trials. Developed through a multi-stakeholder, consensus- and evidence-driven process, these actionable tools support researchers in (1) determining whether RWD are fit for purpose with respect to study planning and recruitment, (2) engaging cross-functional teams in the use of RWD for study planning and recruitment, and (3) understanding patient and site needs to develop successful and patient-centric approaches to RWD-supported recruitment. Future considerations for the use of RWD are explored, including ensuring full patient understanding of data use and developing global datasets.
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Affiliation(s)
- Scott R Evans
- Biostatistics Center and the Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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19
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Pilon D, Karkare S, Zhdanava M, Sheehan JJ, Côté-Sergent A, Shah A, Lopena OJ, Lefebvre P, Joshi K, Citrome L. Health care resource use, short-term disability days, and costs associated with states of persistence on antidepressant lines of therapy. J Med Econ 2021; 24:1299-1308. [PMID: 34763603 DOI: 10.1080/13696998.2021.2003673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To compare health care resource utilization (HCRU), short-term disability days, and costs between states of persistence on antidepressant lines of therapy after evidence of treatment-resistant depression (TRD). METHODS Patients with major depressive disorder (MDD) were identified in the IBM MarketScan Commercial and Medicare Supplemental Databases (01/01/2013-03/04/2019), Multi-State Medicaid Database (01/01/2013-12/31/2018), and Health Productivity Management Database (01/01/2015-12/31/2018). The index date was the date of the first evidence of TRD during the first observed major depressive episode. The follow-up period was divided into 45-day increments and categorized into persistence states: (1) evaluation (first 45 days after evidence of TRD); (2) persistence on the early line after evidence of TRD; (3) persistence on a late line; and (4) non-persistence. HCRU, short-term disability days, and costs were compared between persistence states using multivariate generalized estimating equations. RESULTS Among 10,053 patients with TRD, the evaluation state was associated with higher likelihood of all-cause inpatient admissions (odds ratio [OR; 95% confidence interval (CI)] = 1.79 [1.49, 2.14]), emergency department visits (OR [95% CI] = 1.23 [1.12, 1.34]), and outpatient visits (OR [95% CI] = 3.83 [3.51, 4.18]; all p < .001) versus persistence on the early-line therapy. This resulted in $374 higher mean PPPM all-cause health care costs (95% CI = 265, 470; p < .001) during evaluation versus persistence on the early line therapy. The evaluation state was associated with 89% more short-term disability days (OR [95% CI] = 1.89 [1.49, 2.57] and $212 higher mean PPPM short-term disability costs (95% CI = 64, 259) relative to persistence on the early line (both p < .001). Moreover, during persistence on a later line, mean PPPM all-cause health care costs were $141 higher (95% CI = 13, 242; p = .028) relative to the early line. LIMITATIONS Medication may have been dispensed but not actually taken. CONCLUSIONS Higher costs during the first 45 days after evidence of the presence of TRD and during persistence on a late line relative to persistence on the early-line therapy suggest there are benefits to using more effective treatments earlier.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, USA
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20
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Harrison MA, Sheehan JJ, Seidel GE, Mooney DF, Rhoades RD, Ahola JK. Evaluation of biological and economic efficiency of the All Heifer, No Cow beef production system using a system dynamics model based on 6 yr of demonstration herd data. J Anim Sci 2021; 99:skaa405. [PMID: 33351139 PMCID: PMC7819636 DOI: 10.1093/jas/skaa405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/17/2020] [Indexed: 11/14/2022] Open
Abstract
Alternative management strategies with no cows and all heifers may improve biological and economic efficiency of beef production. The All Heifer, No Cow (AHNC) beef production system involves insemination of nulliparous heifers with female sex-selected semen (FSS) to produce primarily female calves that are early weaned at 3 mo of age. Dams are finished on a high concentrate diet and harvested before 30 mo of age. The objectives of this research were to: 1) build a dynamic model of an AHNC beef production system to quantify system biological and economic efficiency; 2) compare effects of utilizing FSS vs. conventional semen on biological and economic efficiency; 3) evaluate what-if scenarios to determine the effects on biological and economic efficiency of changing variables ±5%, 10%, 15%, and 20% from initial observed values; and 4) evaluate the effects on biological and economic efficiency of changing variables ±10% from initial observed values. A model was built over a 21-yr horizon using Stella Architect. Biological parameter values in the model were based on the 6 yr of data collected from the management of an AHNC demonstration herd. In the model animal, total digestible nutrients (TDN) intake, hot carcass weight (HCW), and age at harvest were randomized. Feed, animal, and carcass prices included in the model were based on 10 yr of historical U.S. price data. Key response variables were biological and economic efficiency (mean ± SD). Biological efficiency was defined as the ratio of output (kilograms of HCW produced) to input (lifetime kilograms of feed TDN consumed), and economic efficiency was measured using a benefit-cost ratio (BCR) and unit variable cost (UVC). Over 40 simulation runs, the predicted mean biological efficiency was 0.0714 ± 0.0008. Economic efficiency was 0.95 ± 0.02 and US $445.41 ± 0.06 for BCR and UVC, respectively. Biological and economic efficiency was improved in the conventional semen scenario; biological efficiency was 0.0738 ± 0.0008, and BCR and UVC were 0.99 ± 0.04 and US $407.24 ± 0.006, respectively. Under this parameterization and market conditions, the AHNC beef production system failed to achieve profitability under any scenario that was evaluated. However, this review did not account for the potential increased genetic benefit from a decreased generation interval and the reduction in feed energy in comparison to a conventional cow/calf system.
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Affiliation(s)
- Meredith A Harrison
- Department of Animal Sciences, Colorado State University, Fort Collins, CO, USA
| | - John J Sheehan
- Department of Chemical and Biological Engineering, Colorado State University, Fort Collins, CO, USA
| | - George E Seidel
- Department of Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Dan F Mooney
- Department of Agricultural and Resource Economics, Colorado State University, Fort Collins, CO, USA
| | - Ryan D Rhoades
- Department of Animal Sciences, Colorado State University, Fort Collins, CO, USA
| | - Jason K Ahola
- Department of Animal Sciences, Colorado State University, Fort Collins, CO, USA
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21
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Li G, Zhang L, DiBernardo A, Wang G, Sheehan JJ, Lee K, Reutfors J, Zhang Q. A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients. PLoS One 2020; 15:e0238843. [PMID: 32915863 PMCID: PMC7485754 DOI: 10.1371/journal.pone.0238843] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 08/25/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. METHODS Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. RESULTS 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive disorder = 2.86, 95% confidence interval = 0.86-4.86 days); and more total healthcare costs (mean difference vs non-treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. CONCLUSION Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non-treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.
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Affiliation(s)
- Gang Li
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
- * E-mail:
| | - Ling Zhang
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Allitia DiBernardo
- Janssen Research & Development, LLC, Titusville, New Jersey, United States of America
| | - Grace Wang
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - John J. Sheehan
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, United States of America
| | - Kwan Lee
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | | | - Qiaoyi Zhang
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
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22
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Field JL, Richard TL, Smithwick EAH, Cai H, Laser MS, LeBauer DS, Long SP, Paustian K, Qin Z, Sheehan JJ, Smith P, Wang MQ, Lynd LR. Robust paths to net greenhouse gas mitigation and negative emissions via advanced biofuels. Proc Natl Acad Sci U S A 2020; 117:21968-21977. [PMID: 32839342 PMCID: PMC7486778 DOI: 10.1073/pnas.1920877117] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Biofuel and bioenergy systems are integral to most climate stabilization scenarios for displacement of transport sector fossil fuel use and for producing negative emissions via carbon capture and storage (CCS). However, the net greenhouse gas mitigation benefit of such pathways is controversial due to concerns around ecosystem carbon losses from land use change and foregone sequestration benefits from alternative land uses. Here, we couple bottom-up ecosystem simulation with models of cellulosic biofuel production and CCS in order to track ecosystem and supply chain carbon flows for current and future biofuel systems, with comparison to competing land-based biological mitigation schemes. Analyzing three contrasting US case study sites, we show that on land transitioning out of crops or pasture, switchgrass cultivation for cellulosic ethanol production has per-hectare mitigation potential comparable to reforestation and severalfold greater than grassland restoration. In contrast, harvesting and converting existing secondary forest at those sites incurs large initial carbon debt requiring long payback periods. We also highlight how plausible future improvements in energy crop yields and biorefining technology together with CCS would achieve mitigation potential 4 and 15 times greater than forest and grassland restoration, respectively. Finally, we show that recent estimates of induced land use change are small relative to the opportunities for improving system performance that we quantify here. While climate and other ecosystem service benefits cannot be taken for granted from cellulosic biofuel deployment, our scenarios illustrate how conventional and carbon-negative biofuel systems could make a near-term, robust, and distinctive contribution to the climate challenge.
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Affiliation(s)
- John L Field
- Natural Resource Ecology Laboratory, Colorado State University, Fort Collins, CO 80523;
| | - Tom L Richard
- Department of Agricultural and Biological Engineering, The Pennsylvania State University, University Park, PA 16802
| | - Erica A H Smithwick
- Department of Geography, The Pennsylvania State University, University Park, PA 16802
- Earth and Environmental Systems Institute, The Pennsylvania State University, University Park, PA 16802
| | - Hao Cai
- Energy Systems Division, Argonne National Laboratory, Lemont, IL 60439
| | - Mark S Laser
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755
| | - David S LeBauer
- Arizona Experiment Station, University of Arizona, Tucson, AZ 85721
| | - Stephen P Long
- Department of Crop Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801
- Lancaster Environment Centre, Lancaster University, LA1 4YQ Lancaster, United Kingdom
- Department of Plant Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801
| | - Keith Paustian
- Natural Resource Ecology Laboratory, Colorado State University, Fort Collins, CO 80523
- Department of Soil and Crop Sciences, Colorado State University, Fort Collins, CO 80523
| | - Zhangcai Qin
- Earth and Environmental Systems Institute, The Pennsylvania State University, University Park, PA 16802
- School of Atmospheric Sciences, Guangdong Province Key Laboratory for Climate Change and Natural Disaster Studies, Sun Yat-sen University, Guangzhou 510245, China
- Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai 519082, China
| | - John J Sheehan
- School of Agricultural Engineering, University of Campinas, Campinas, SP 13083-875, Brazil
- Department of Chemical and Biological Engineering, Colorado State University, Fort Collins, CO 80523
| | - Pete Smith
- Institute of Biological and Environmental Sciences, University of Aberdeen, AB24 3UU Aberdeen, United Kingdom
| | - Michael Q Wang
- Energy Systems Division, Argonne National Laboratory, Lemont, IL 60439
| | - Lee R Lynd
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755
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23
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Shrestha A, Roach M, Joshi K, Sheehan JJ, Goutam P, Everson K, Heerlein K, Jena AB. Incremental Health Care Burden of Treatment-Resistant Depression Among Commercial, Medicaid, and Medicare Payers. Psychiatr Serv 2020; 71:593-601. [PMID: 32237982 DOI: 10.1176/appi.ps.201900398] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study compared health care use and costs among patients with treatment-resistant versus treatment-responsive depression across Medicaid, Medicare, and commercial payers. METHODS A retrospective cohort study was conducted by using Truven Health Analytics' commercial (2006-2017; N=111,544), Medicaid (2007-2017; N=24,036), and Medicare supplemental (2006-2017; N=8,889) claims databases. Participants were adults with major depressive disorder who had received one or more antidepressant treatments. Treatment resistance was defined as failure of two or more antidepressant treatments of adequate dose and duration. Annual use (hospitalizations and outpatient and emergency department [ED] visits) and costs were compared across patients by treatment-resistant status in each payer population. Incremental burden of treatment-resistant depression was estimated with regression analyses. Monthly changes in costs during 1-year follow-up were assessed to understand differential cost trends by treatment-resistant status. RESULTS In the three payer populations, patients with treatment-resistant depression incurred higher health care utilization than those with treatment-responsive depression (hospitalization, odds ratios [ORs]=1.32-1.76; ED visits, ORs=1.38-1.45; outpatient visits, incident rate ratio=1.29-1.54; p<0.001 for all). Compared with those with treatment-responsive depression, those with treatment resistance incurred higher annual costs (from $4,093 to $8,054 higher; p<0.001). Patients with treatment-resistant depression had higher costs at baseline compared with patients with treatment-responsive depression and incurred higher costs each month throughout follow-up. CONCLUSIONS Treatment-resistant depression imposes a significant health care burden on insurers. Treatment-resistant depression may exist and affect health care burden before a patient is identified as having treatment-resistant depression. Findings underscore the need for effective and timely treatment of treatment-resistant depression.
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Affiliation(s)
- Anshu Shrestha
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Meaghan Roach
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Kruti Joshi
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - John J Sheehan
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Prodyumna Goutam
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Katie Everson
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Kristin Heerlein
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
| | - Anupam B Jena
- Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena)
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Pilon D, Szukis H, Singer D, Morrison L, Sheehan JJ, Lefebvre P. Use of home health and other healthcare delivery pathways among privately insured patients with and without treatment-resistant depression. Curr Med Res Opin 2020; 36:865-874. [PMID: 31985319 DOI: 10.1080/03007995.2020.1722081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the real-world use of home health services (HHS) among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD).Methods: Adults (18-64 years) from a commercial claims database (07/2009 to 03/2015) were categorized into three cohorts: "TRD"(N = 6411), "non-TRD MDD"(N = 33,068), "non-MDD"(N = 149,884) stratified based on use of HHS (HHS vs. no-HHS). Healthcare resource utilization (HRU) and costs were evaluated up to two years following the first antidepressant pharmacy claim using descriptive statistics. HRU (e.g. inpatient, outpatient, emergency department visits) and costs were measured per-patient-per-year (PPPY) in 2015 USD.Results: During the follow-up period, 18.0% of TRD, 12.4% of non-TRD MDD, and 6.5% of non-MDD patients received HHS. Mean all-cause healthcare costs PPPY were numerically higher among patients with HHS use. Among the TRD cohort, patients using HHS had healthcare costs of $40,040 PPPY while patients with TRD and no-HHS had healthcare costs of $12,272 PPPY. Within the non-TRD MDD cohort, HHS users incurred healthcare costs of $28,767 PPPY and non-HHS users incurred costs of $7227 PPPY. Patients without MDD who used HHS had annual healthcare costs of $22,340 while non-MDD patients who did not use HHS had healthcare costs of $3479 PPPY. However, among HHS users, HHS costs represented a relatively small proportion of total healthcare costs.Conclusions: The high proportion of TRD patients using HHS suggests it is a utilized healthcare delivery pathway by TRD patients.
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Affiliation(s)
| | - Holly Szukis
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - David Singer
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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Karkare S, Le HH, Sheehan JJ, Sliwa JK, Zhang Q, Barber B. Pitfalls of Cost-Effectiveness Analysis in Practice: A TRD Case Example in the United States with Esketamine Versus Oral Antidepressants. J Manag Care Spec Pharm 2020; 26:568-569. [PMID: 32223604 PMCID: PMC10391107 DOI: 10.18553/jmcp.2020.26.4.568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
DISCLOSURES The writing of this letter was supported by Janssen Scientific Affairs. The authors are employees of Janssen Scientific Affairs or Janssen Global Services (Johnson & Johnson).
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Affiliation(s)
| | - Hoa H Le
- Janssen Scientific Affairs Titusville, NJ
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26
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Monteiro LA, Allee AM, Campbell EE, Lynd LR, Soares JR, Jaiswal D, de Castro Oliveira J, Dos Santos Vianna M, Morishige AE, Figueiredo GKDA, Lamparelli RAC, Mueller ND, Gerber J, Cortez LAB, Sheehan JJ. Assessment of yield gaps on global grazed-only permanent pasture using climate binning. Glob Chang Biol 2020; 26:1820-1832. [PMID: 31730282 DOI: 10.1111/gcb.14925] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 10/15/2019] [Indexed: 05/06/2023]
Abstract
To meet rising demands for agricultural products, existing agricultural lands must either produce more or expand in area. Yield gaps (YGs)-the difference between current and potential yield of agricultural systems-indicate the ability to increase output while holding land area constant. Here, we assess YGs in global grazed-only permanent pasture lands using a climate binning approach. We create a snapshot of circa 2000 empirical yields for meat and milk production from cattle, sheep, and goats by sorting pastures into climate bins defined by total annual precipitation and growing degree-days. We then estimate YGs from intra-bin yield comparisons. We evaluate YG patterns across three FAO definitions of grazed livestock agroecosystems (arid, humid, and temperate), and groups of animal production systems that vary in animal types and animal products. For all subcategories of grazed-only permanent pasture assessed, we find potential to increase productivity several-fold over current levels. However, because productivity of grazed pasture systems is generally low, even large relative increases in yield translated to small absolute gains in global protein production. In our dataset, milk-focused production systems were found to be seven times as productive as meat-focused production systems regardless of animal type, while cattle were four times as productive as sheep and goats regardless of animal output type. Sustainable intensification of pasture is most promising for local development, where large relative increases in production can substantially increase incomes or "spare" large amounts of land for other uses. Our results motivate the need for further studies to target agroecological and economic limitations on productivity to improve YG estimates and identify sustainable pathways toward intensification.
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Affiliation(s)
- Leonardo A Monteiro
- School of Agricultural Engineering (FEAGRI), University of Campinas, Campinas, Brazil
- Department of Crop Production Ecology, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Andrew M Allee
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Eleanor E Campbell
- School of Agricultural Engineering (FEAGRI), University of Campinas, Campinas, Brazil
- Earth Systems Research Center, University of New Hampshire, Durham, NH, USA
| | - Lee R Lynd
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
- Interdisciplinary Center of Energy Planning (NIPE), University of Campinas (UNICAMP), Campinas, Brazil
| | - Johnny R Soares
- School of Agricultural Engineering (FEAGRI), University of Campinas, Campinas, Brazil
| | - Deepak Jaiswal
- School of Agricultural Engineering (FEAGRI), University of Campinas, Campinas, Brazil
- Carl R. Woese Institute for Genomic Biology, University of Illinois Urbana, Urbana, IL, USA
| | | | | | - Ashley E Morishige
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Rubens A C Lamparelli
- Interdisciplinary Center of Energy Planning (NIPE), University of Campinas (UNICAMP), Campinas, Brazil
| | - Nathaniel D Mueller
- Department of Ecosystem Science and Sustainability, Colorado State University, Fort Collins, CO, USA
| | - James Gerber
- Institute on the Environment, University of Minnesota, St. Paul, MN, USA
| | - Luis A B Cortez
- Interdisciplinary Center of Energy Planning (NIPE), University of Campinas (UNICAMP), Campinas, Brazil
| | - John J Sheehan
- School of Agricultural Engineering (FEAGRI), University of Campinas, Campinas, Brazil
- Department of Chemical and Biological Engineering, Colorado State University, Fort Collins, CO, USA
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Benson C, Szukis H, Sheehan JJ, Alphs L, Yuce H. An Evaluation of the Clinical and Economic Burden Among Older Adult Medicare-Covered Beneficiaries With Treatment-Resistant Depression. Am J Geriatr Psychiatry 2020; 28:350-362. [PMID: 31735488 DOI: 10.1016/j.jagp.2019.10.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/16/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the clinical and economic burden of treatment-resistant depression (TRD) among older adult patients with major depressive disorder (MDD) to non-TRD MDD and non-MDD patients. METHODS Retrospective cohort study using 5% Medicare data (January 1, 2012-December 31, 2015) for MDD patients aged ≥65 years who were defined as TRD if they received ≥2 antidepressant treatments in the current episode. MDD patients not meeting TRD criteria were deemed non-TRD MDD; those without an MDD diagnosis were categorized as non-MDD. All were required to have continuous health plan enrollment for ≥6 months pre- and ≥12 months postindex date (index: first antidepressant claim/random [non-MDD]). Three cohorts were matched, and generalized linear and Cox proportional hazards models were used to compare medication use, healthcare resource utilization, costs, and risks of initial hospitalization and readmission ≤30 days postdischarge from initial hospitalization. RESULTS After matching, 178 patients from each cohort were analyzed. During 12 months of follow-up, TRD patients had higher use of different antidepressants and antipsychotics, higher inpatient and emergency room visits, longer inpatient stays, and higher total healthcare costs ($24,543 versus $16,059, $8,058) than non-TRD MDD and non-MDD cohorts, respectively (all p <0.05). Risk of initial hospitalization was higher in the TRD (hazard ratio [HR] = 3.60, 95% confidence interval [CI] = 2.08-6.23) and non-TRD MDD cohorts (HR = 1.82, 95% CI = 1.02-3.25) than the non-MDD cohort. CONCLUSIONS The burden of MDD among older adult Medicare beneficiaries is substantial, and even greater among those with TRD compared to non-TRD MDD, demonstrating the need for more effective treatments than those currently available.
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Affiliation(s)
- Carmela Benson
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ
| | - Holly Szukis
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ
| | - John J Sheehan
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ.
| | - Larry Alphs
- Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ
| | - Huseyin Yuce
- New York City College of Technology (HY), Brooklyn, NY
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Pilon D, Szukis H, Joshi K, Singer D, Sheehan JJ, Wu JW, Lefebvre P, Greenberg P. US Integrated Delivery Networks Perspective on Economic Burden of Patients with Treatment-Resistant Depression: A Retrospective Matched-Cohort Study. Pharmacoecon Open 2020; 4:119-131. [PMID: 31254275 PMCID: PMC7018883 DOI: 10.1007/s41669-019-0154-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Our objective was to assess healthcare resource utilization (HRU) and costs among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD) and those without MDD in US Integrated Delivery Networks (IDNs). METHODS This was a retrospective matched-cohort study. The Optum© Integrated Claims Electronic Health Record de-identified database was used to identify adult patients with TRD (January 2011-June 2017) across US IDNs. TRD patients were propensity score matched 1:1 with non-TRD MDD and non-MDD patients on demographics. Rates of HRU and costs were compared up to 2 years following the first antidepressant pharmacy claim (or randomly imputed date for non-MDD patients) using negative binomial and ordinary least squares regressions, respectively, with 95% confidence intervals (CIs) from nonparametric bootstraps (costs only) adjusted for baseline comorbidity index and costs. RESULTS All 1582 TRD patients were matched to non-TRD MDD and non-MDD patients and evaluated. TRD patients were on average 46 years old, and 67% were female. Mean duration of observation was 20.1, 19.6, and 17.9 months in the TRD, non-TRD MDD, and non-MDD cohorts, respectively. Patients with TRD had significantly higher rates of HRU than did non-TRD MDD patients (inpatient visits 0.35 vs. 0.16 per patient per year [PPPY]; adjusted incidence rate ratio [IRR] 2.04 [95% CI 1.74-2.39]) and non-MDD patients (0.35 vs. 0.09 PPPY, adjusted IRR 3.05 [95% CI 2.54-3.66]). TRD patients incurred significantly higher costs PPPY than did non-TRD MDD patients ($US25,807 vs. 13,701, adjusted cost difference $US9479 [95% CI 7071-11,621]) and non-MDD patients ($US25,807 vs. 8500, adjusted cost difference $US11,433 [95% CI 8668-13,876]). CONCLUSIONS HRU and costs associated with TRD are significant in US IDNs.
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Affiliation(s)
- Dominic Pilon
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montreal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Holly Szukis
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ USA
| | - David Singer
- Thomas Jefferson University, Philadelphia, PA USA
| | | | - Jennifer W. Wu
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montreal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7 Canada
| | - Patrick Lefebvre
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montreal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7 Canada
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Abstract
Objectives: To assess characteristics and healthcare costs associated with pharmacologically treated episodes of treatment-resistant depression (TRD) in patients with major depressive disorder (MDD).Methods: Patients aged ≥18 years with continuous health plan enrollment for ≥12 months before and after a newly observed MDD diagnosis (observed between 1 January 2010 and 31 December 2015) were included in this retrospective claims-based analysis. A pharmacologically treated episode was defined as beginning at the date of the first MDD diagnosis and ending when a gap of 180 days occurred between MDD diagnoses, or when a gap of 180 days occurred following the end of the antidepressant (AD)/antipsychotic (AP) drug supply. When such a gap occurred, the episode end date was determined to be either the date of the last MDD diagnosis or date of the end of AD/AP drug supply, whichever was later. An episode was considered TRD if ≥3 AD regimens occurred. Episode duration, medication regimens used, and relapse hospitalization were reported for TRD and non-TRD MDD episodes. Total all-cause and per-patient-per-month (PPPM) healthcare costs (in 2016 $) were estimated.Results: Of 48,440 patients identified with ≥1 AD-treated MDD episode, the mean (SD) age was 39 (15) years, and 62% were female. Of all episodes, 7% were TRD, with a mean duration of 571 (285) days vs. 200 (198) days for non-TRD MDD episodes. Mean total all-cause costs were $19,626 ($44,160) for TRD and $7440 ($25,150) for non-TRD MDD episodes.Conclusions: Results show TRD episodes are longer and costlier than non-TRD MDD episodes, and that higher costs are driven by episode duration. Longer episodes imply protracted suffering for patients with TRD and increased burden on caregivers. Effective intervention to shorten TRD episodes may lessen disease burden and reduce costs.
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Affiliation(s)
- Qian Cai
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | - Bingcao Wu
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | - Larry Alphs
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
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Lin J, Szukis H, Sheehan JJ, Alphs L, Menges B, Lingohr‐Smith M, Benson C. Economic Burden of Treatment‐Resistant Depression Among Patients Hospitalized for Major Depressive Disorder in the United States. Psychiatr res clin pract 2019; 1:68-76. [PMID: 36101876 PMCID: PMC9175799 DOI: 10.1176/appi.prcp.20190001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/27/2019] [Accepted: 06/12/2019] [Indexed: 12/01/2022] Open
Abstract
Objectives: This study aimed to evaluate hospital length of stay (LOS) and cost as well as readmission risk and the associated economic burden among patients hospitalized for treatment‐resistant and non–treatment‐resistant major depressive disorder. Methods: Adult patients with a primary hospital discharge diagnosis of major depressive disorder were identified from the Premier Hospital Database (January 1, 2012–September 30, 2015). Patients were stratified into two cohorts: those whose hospital treatment was suggestive of treatment‐resistant depression and those with non–treatment‐resistant depression. Hospital LOS and cost during the initial admission and readmissions rates, LOS, and cost within the 6‐month follow‐up were compared between cohorts with a propensity score–matched sample. Results: After matching, 45,066 patients were included in each cohort. For index hospitalizations, mean hospital LOS was longer (7.4 vs. 5.9 days, p<0.001) and mean hospital cost higher ($8,681 vs. $6,632, p<0.001) for patients with treatment‐resistant depression vs. non–treatment‐resistant depression. Rates for all‐cause (24.4% vs. 20.0%, p<0.001), major depressive disorder–related (17.0% vs. 13.3%, p<0.001), and suicidal ideation/suicide attempt–related (12.8% vs. 9.5%, p<0.001) readmissions were higher for patients with treatment‐resistant depression. Mean LOS and total hospital costs per patient for readmissions were also greater for patients with treatment‐resistant depression vs. non–treatment‐resistant depression. Correspondingly, the combined hospital cost (index hospitalization+all‐cause readmissions) was greater for patients with treatment‐resistant depression ($12,370 vs. $9,429, p<0.001). Conclusions: Treatment‐resistant depression was associated with substantial economic burden among patients hospitalized for major depressive disorder. More‐effective treatment and care for this patient population may reduce the hospital burden of patients with treatment‐resistant depression.
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Affiliation(s)
- Jay Lin
- Novosys HealthGreen BrookNew Jersey
| | | | | | - Larry Alphs
- Janssen Scientific AffairsTitusvilleNew Jersey
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Pilon D, Joshi K, Sheehan JJ, Zichlin ML, Zuckerman P, Lefebvre P, Greenberg PE. Burden of treatment-resistant depression in Medicare: A retrospective claims database analysis. PLoS One 2019; 14:e0223255. [PMID: 31600244 PMCID: PMC6786597 DOI: 10.1371/journal.pone.0223255] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/17/2019] [Indexed: 12/28/2022] Open
Abstract
Background Previous studies have assessed the incremental economic burden of treatment-resistant depression (TRD) versus non-treatment-resistant major depressive disorder (i.e., non-TRD MDD) in commercially-insured and Medicaid-insured patients, but none have focused on Medicare-insured patients. Objective To assess healthcare resource utilization (HRU) and costs of patients with TRD versus non-TRD MDD or without major depressive disorder (MDD; i.e., non-MDD) in a Medicare-insured population. Methods Adult patients were retrospectively identified from the Chronic Condition Warehouse de-identified 100% Medicare database (01/2010-12/2016). MDD was defined as ≥1 MDD diagnosis and ≥1 claim for an antidepressant. Patients initiated on a third antidepressant following two antidepressant treatment regimens of adequate dose and duration were considered to have TRD. The index date was defined as the date of the first antidepressant claim for the TRD and non-TRD MDD cohorts, and as a randomly imputed date for the non-MDD cohort. Patients with TRD were matched 1:1 to non-TRD MDD patients and randomly selected non-MDD patients based on propensity scores. Analyses were also performed for a subset of patients aged ≥65. Results Of 29,543 patients with MDD, 3,225 (10.9%) met the study definition of TRD; 157,611 were included in the non-MDD cohort. Matched patients with TRD and non-TRD MDD were, on average, 58.9 and 59.0 years old, respectively. The TRD cohort had higher per-patient-per-year (PPPY) HRU than the non-TRD MDD (e.g., inpatient visits: incidence rate ratio [IRR] = 1.36) and non-MDD cohorts (e.g., inpatient visits: IRR = 1.84, all P<0.001). The TRD cohort had significantly higher total PPPY healthcare costs than the non-TRD MDD cohort ($25,517 vs. $20,425, adjusted cost difference = $3,385) and non-MDD cohort ($25,517 vs. $14,542, adjusted cost difference = $4,015, all P<0.001). Similar results were found for the subset of patients ≥65. Conclusion Among Medicare-insured patients, those with TRD had higher HRU and costs compared to those with non-TRD MDD and non-MDD.
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Affiliation(s)
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC., Titusville, NJ, United States of America
| | - John J. Sheehan
- Janssen Scientific Affairs, LLC., Titusville, NJ, United States of America
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Wu B, Cai Q, Sheehan JJ, Benson C, Connolly N, Alphs L. An episode level evaluation of the treatment journey of patients with major depressive disorder and treatment-resistant depression. PLoS One 2019; 14:e0220763. [PMID: 31393922 PMCID: PMC6687173 DOI: 10.1371/journal.pone.0220763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/23/2019] [Indexed: 12/21/2022] Open
Abstract
Background Many patients with major depressive disorder (MDD) fail to respond to antidepressant (AD) pharmacotherapy. The objectives of this study were to characterize MDD and treatment-resistant depression (TRD) at the level of pharmacologically treated episodes and to describe the sequential treatment patterns by lines of therapy (LOT) in the first two episodes. Methods Adults (≥18 years of age) with continuous enrollment ≥12 months before and after the first MDD diagnosis and treated with an AD, with or without an MDD-indicated antipsychotic (AP), were identified (1/1/2010-12/31/2015). The MDD episode started on the date of MDD diagnosis that was preceded by a clean period without any MDD diagnosis. The MDD episode ended on the last MDD diagnosis or the end of the days’ supply of AD/AP medication, whichever came last. TRD was defined as an MDD episode with ≥3 AD/AP regimens. Measured outcomes included episode duration, number of LOT, relapse hospitalization, and sequential treatment patterns of MDD episode stratified by TRD and non-TRD episodes. Results Of 48,440 patients who received AD/AP in the 1st MDD episode, 3,317 (6.8%) of episodes were considered TRD. Mean duration of 1st TRD episodes was 571 days, mean number of AD/AP LOTs was 3.47, and 13.7% involved relapse hospitalization. Mean duration of 1st non-TRD episodes was 200 days, mean number of AD/AP LOTs was 1.21, and 9.6% involved relapse hospitalization. Among 1st MDD episodes, 25.5% had a second LOT; 7.3% had a third LOT. Most patients received selective serotonin reuptake inhibitors (SSRIs) as the first LOT (63.0%), and the plurality of regimens were SSRIs in second (44.9%) and third LOT (41.1%). Conclusions Compared to non-TRD episodes, TRD episodes were longer and more often involved relapse hospitalizations. SSRIs were the most common treatment; treatment changes and potential treatment unresponsiveness were frequent among MDD patients.
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Affiliation(s)
- Bingcao Wu
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
| | - Qian Cai
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
| | - John J. Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
- * E-mail:
| | - Carmela Benson
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
| | - Nancy Connolly
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
| | - Larry Alphs
- Janssen Scientific Affairs, LLC, Titusville, NJ, United States of America
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Pilon D, Sheehan JJ, Szukis H, Morrison L, Zhdanava M, Lefebvre P, Joshi K. Is clinician impression of depression symptom severity associated with incremental economic burden in privately insured US patients with treatment resistant depression? J Affect Disord 2019; 255:50-59. [PMID: 31128505 DOI: 10.1016/j.jad.2019.04.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/02/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Among patients with major depressive disorder (MDD), those with treatment-resistant depression (TRD) have a higher economic burden. However, the healthcare resource utilization (HRU) and costs may vary by severity status in TRD patients. This study quantified the incremental economic burden of severity status in TRD patients. METHODS In a US database of privately insured employees and dependents (07/01/2009-03/31/2015), a claims-based algorithm identified adult TRD patients who were stratified into mild, moderate, and severe cohorts based on the information in the last observed MDD ICD-9-CM code. HRU and costs of moderate and severe cohorts were compared to those of the mild cohort during the 2-year follow-up after the first antidepressant claim. RESULTS Among 6411 TRD patients, 455 (7.1%) were identified as mild, 2153 (33.6%) as moderate, and 1455 (22.7%) as severe. Moderate and severe patients compared to mild had 45% and 150% more inpatient admissions, 65% and 164% more inpatient days, 18% and 54% more emergency department visits and 8% and 10% more outpatient visits per-patient-per-year (PPPY), respectively (all-cause; all p < 0.05). Mean all-cause direct total healthcare costs were $12,123, $16,885, and $18,911 PPPY in mild, moderate, and severe patients, respectively. The all-cause total healthcare cost differences adjusted for baseline characteristics amounted to $3455 in moderate and $5150 in severe versus mild patients, respectively (PPPY; all p < 0.05). LIMITATIONS Not all TRD patients had a severity specifier; the severity specifier was not cross-validated against a depression scale. CONCLUSIONS Increased severity status is associated with incremental economic burden in TRD patients.
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Affiliation(s)
- Dominic Pilon
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7, Canada.
| | | | - Holly Szukis
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Laura Morrison
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7, Canada
| | - Maryia Zhdanava
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7, Canada
| | - Patrick Lefebvre
- Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Tour Deloitte Suite 1500, Montréal, QC H3B 0G7, Canada
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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Pilon D, Sheehan JJ, Szukis H, Singer D, Jacques P, Lejeune D, Lefebvre P, Greenberg PE. Medicaid spending burden among beneficiaries with treatment-resistant depression. J Comp Eff Res 2019; 8:381-392. [DOI: 10.2217/cer-2018-0140] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim: To evaluate Medicaid spending and healthcare resource utilization (HRU) in treatment-resistant depression (TRD). Materials & methods: TRD beneficiaries were identified from Medicaid claims databases (January 2010–March 2017) and matched 1:1 with major depressive disorder (MDD) beneficiaries without TRD (non-TRD-MDD) and randomly selected patients without MDD (non-MDD). Differences in HRU and per-patient-per-year costs were reported in incidence rate ratios (IRRs) and cost differences (CDs), respectively. Results: TRD beneficiaries had higher HRU than 1:1 matched non-TRD-MDD (e.g., inpatient visits: IRR = 1.41) and non-MDD beneficiaries (N = 14,710 per cohort; e.g., inpatient visits: IRR = 3.42, p < 0.01). TRD beneficiaries incurred greater costs versus non-TRD-MDD (CD = US$4382) and non-MDD beneficiaries (CD = US$8294; p < 0.05). Conclusion: TRD is associated with higher HRU and costs versus non-TRD-MDD and non-MDD. TRD poses a significant burden to Medicaid.
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Affiliation(s)
| | - John J Sheehan
- Janssen Scientific Affairs, LLC, Titusville, NJ, 08560, USA
| | - Holly Szukis
- Janssen Scientific Affairs, LLC, Titusville, NJ, 08560, USA
| | - David Singer
- Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Li G, Fife D, Wang G, Sheehan JJ, Bodén R, Brandt L, Brenner P, Reutfors J, DiBernardo A. All-cause mortality in patients with treatment-resistant depression: a cohort study in the US population. Ann Gen Psychiatry 2019; 18:23. [PMID: 31583010 PMCID: PMC6771113 DOI: 10.1186/s12991-019-0248-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Treatment-resistant depression (TRD) may represent a substantial proportion of major depressive disorder (MDD); however, the risk of mortality in TRD is still incompletely assessed. METHODS Data were obtained from Optum Clinformatics™ Extended, a US claims database. Date of the first antidepressant (AD) dispensing was designated as the index date for study entry and 6 months prior to that was considered the baseline period. Patients with MDD aged ≥ 18 years, index date between January 1, 2008 and September 30, 2015, no AD claims during baseline, and continuous enrollment in the database during baseline were included. Patients who started a third AD regimen after two regimens of appropriate duration were included in the TRD cohort. All-cause mortality was compared between patients with TRD and non-TRD MDD using a proportional hazards model and Kaplan-Meier estimate with TRD status being treated as a time-varying covariate. The model was adjusted for study year, age, gender, depression diagnosis, substance use disorder, psychiatric comorbidities, and Charlson comorbidity index. RESULTS Out of 355,942 patients with MDD, 34,176 (9.6%) met the criterion for TRD. TRD was associated with a significantly higher mortality compared with non-TRD MDD (adjusted HR: 1.29; 95% CI 1.22-1.38; p < 0.0001). Survival time was significantly shorter in the TRD cohort compared with the non-TRD MDD cohort (p < 0.0001). CONCLUSIONS Patients with TRD had a higher all-cause mortality compared with non-TRD MDD patients.
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Affiliation(s)
- Gang Li
- 1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
| | - Daniel Fife
- 2Department of Epidemiology, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
| | - Grace Wang
- 1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
| | | | - Robert Bodén
- 4Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.,5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lena Brandt
- 5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Philip Brenner
- 5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Reutfors
- 5Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Allitia DiBernardo
- 1Real World Evidence, Statistics & Decision Sciences, Janssen Research & Development, 920 US Highway 202 S, Raritan, NJ 08869 USA
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Hickey CD, Fallico V, Wilkinson MG, Sheehan JJ. Corrigendum to "Redefining the effect of salt on thermophilic starter cell viability, culturability and metabolic activity in cheese" [Food Microbiol. 69 (2018) 219-231]. Food Microbiol 2018; 76:575. [PMID: 30166190 DOI: 10.1016/j.fm.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- C D Hickey
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland; University of Limerick, Castletroy, Limerick, Ireland
| | - V Fallico
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland
| | - M G Wilkinson
- University of Limerick, Castletroy, Limerick, Ireland
| | - J J Sheehan
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland.
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Arnold RJG, Yang S, Gold EJ, Farahbakhshian S, Sheehan JJ. Assessment of the relationship between diabetes treatment intensification and quality measure performance using electronic medical records. PLoS One 2018; 13:e0199011. [PMID: 29894495 PMCID: PMC5997332 DOI: 10.1371/journal.pone.0199011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 05/30/2018] [Indexed: 11/19/2022] Open
Abstract
AIMS Assess the relationship between timely treatment intensification and hemoglobin A1C (HbA1C) control quality-of-care performance measures, i.e., HbA1C levels, among patients with uncontrolled type 2 diabetes. MATERIALS AND METHODS Electronic medical records and diabetes registry data from a large, accountable care organization (ACO) were used to isolate a sample of adult patients with type 2 diabetes who received at least one oral antidiabetes agent and had at least one HbA1C level measurement ≥8.0% (64 mmol/mol; i.e., uncontrolled diabetes) between 7/1/2011 and 6/30/2015. Treatment intensification status was evaluated for each patient during a 120-day treatment intensification window following the index HbA1c measure. Two-level hierarchical generalized linear models, with patients aggregated at the physician level, were used to assess the association between treatment intensification and achieving HbA1C quality performance measures. RESULTS 547 patients met study selection criteria and 480 patients had at least one HbA1C test after the treatment intensification window and were used for the statistical analyses. About 40% of patients who had uncontrolled diabetes received treatment intensification during the 120-day window. Greater index HbA1C, greater patient body mass index, and fewer unique pre-index oral antidiabetes agents were significantly associated with greater likelihood of receiving timely treatment intensification. The odds of receiving treatment intensification were about 1.8 times higher (P = 0.0027) among patients with poor index HbA1C control (HbA1c level >9.0% [75 mmol/mol]) compared to other patients (index HbA1c 8.0% - 9.0%). Hispanic patients (compared to White patients) were significantly more likely to exhibit poor control after treatment intensification (odds ratio [OR] 2.91, P = 0.0304), underscoring the difficulty of controlling diabetes in this vulnerable group. In contrast, being male and being treated primarily by an internist (compared to primary treatment by a family medicine specialist) were both significantly associated with achieving superior control (HbA1c level <8.0%) after treatment intensification (OR 0.53 [P = 0.0165]; OR 0.41 [P = 0.0275], respectively). CONCLUSIONS Timely treatment intensification was significantly associated with greater likelihood of patients achieving superior HbA1C control (<8.0%) and better HbA1C control quality performance for the practice. Even in an ACO with resources dedicated to diabetes control, it is incumbent upon clinicians to readily identify and open dialogues with patients who may benefit from closely supervised, individualized attention.
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Affiliation(s)
- Renée J. G. Arnold
- Quorum Consulting, Inc., New York, New York, United States of America
- Icahn School of Medicine at Mount Sinai, New York City, New York, United States of America
| | - Shuo Yang
- Quorum Consulting, Inc., New York, New York, United States of America
| | - Edward J. Gold
- Old Hook Medical Associates, Emerson, New Jersey, United States of America
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Caspard H, Jabbour S, Hammar N, Fenici P, Sheehan JJ, Kosiborod M. Recent trends in the prevalence of type 2 diabetes and the association with abdominal obesity lead to growing health disparities in the USA: An analysis of the NHANES surveys from 1999 to 2014. Diabetes Obes Metab 2018; 20:667-671. [PMID: 29077244 PMCID: PMC5836923 DOI: 10.1111/dom.13143] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/04/2017] [Accepted: 10/21/2017] [Indexed: 12/29/2022]
Abstract
AIM To assess whether the secular trends in type 2 diabetes prevalence differ between abdominally obese and non-obese individuals. METHODS Data from the National Health and Nutrition Examination Surveys (NHANES) were used to estimate the prevalence of type 2 diabetes and abdominal obesity among individuals aged ≥20 years in the USA from 1999/2000 to 2013/2014, after standardization to the age, sex and ethnicity population distribution estimates on January 1, 2014, as published by the US Census Bureau. RESULTS The prevalence of abdominal obesity in the US population increased from 47.4% (95% confidence interval [CI] 42.6-52.2) in 1999/2000 to 57.2% (95% CI 55.9-58.5) in 2013/2014. A significant increase was observed in all age groups: 20 to 44, 45 to 64, and ≥65 years. The prevalence of type 2 diabetes has also increased from 8.8% (95% CI 7.2-10.4) in 1999/2000 to 11.7% (95% CI 10.9-12.6) in 2013/2014, with no substantial change in trend over the recent years. However, the increase in the prevalence of type 2 diabetes was limited to individuals with abdominal obesity, and more specifically to individuals aged ≥45 years with abdominal obesity, with no significant change in prevalence in the non-obese group and in individuals aged <45 years. CONCLUSION These findings highlight the critical importance of abdominal obesity-both as a likely key contributor to the continuing epidemic of type 2 diabetes in the USA and as a priority target for public health interventions.
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Affiliation(s)
| | - Serge Jabbour
- Division of Endocrinology, Diabetes and Metabolic DiseasesSidney Kimmel Medical College at Thomas Jefferson UniversityPhiladelphiaPennsylvania
| | - Niklas Hammar
- AstraZeneca R&DMölndalSweden
- Institute of Environmental Medicine, Karolinska InstitutetStockholmSweden
| | - Peter Fenici
- AstraZeneca Global Medicines DevelopmentCambridgeUK
| | | | - Mikhail Kosiborod
- Department of Cardiovascular Diseases, St Luke's Mid‐America Heart Institute and University of MissouriKansas CityMissouri
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Kong AM, Farahbakhshian S, Pendergraft T, Brouillette MA, Mukherjee B, Smith DM, Sheehan JJ. Healthcare costs among adults with type 2 diabetes initiating saxagliptin or linagliptin: a US-based claims analysis. Curr Med Res Opin 2017; 33:1869-1877. [PMID: 28613952 DOI: 10.1080/03007995.2017.1343187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitor medication class. METHODS Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 1 June 2011 and 30 June 2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1 year follow-up period. Saxagliptin and linagliptin initiators were matched using propensity score methods. Cost ratios (CRs) and predicted costs were estimated from generalized linear models and recycled predictions. RESULTS There were 34,560 saxagliptin initiators and 18,175 linagliptin initiators identified (mean ages 57 and 59; 55% and 56% male, respectively). Before matching, saxagliptin initiators had significantly lower all-cause total healthcare costs than linagliptin initiators (mean = $15,335 [SD $28,923] vs. mean = $20,069 [SD $48,541], p < .001) and significantly lower diabetes-related total healthcare costs (mean = $6109 [SD $13,851] vs. mean = $7393 [SD $26,041], p < .001). In matched analyses (n = 16,069 per cohort), saxagliptin initiators had lower all-cause follow-up costs than linagliptin initiators (CR = 0.953, 95% CI = 0.932-0.974, p < .001; predicted costs = $17,211 vs. $18,068). There was no significant difference in diabetes-related total costs after matching; however, diabetes-related medical costs were significantly lower for saxagliptin initiators (CR = 0.959, 95% CI = 0.927-0.993, p = 0.017; predicted costs = $3989 vs. $4159). CONCLUSIONS Adult patients with T2D initiating treatment with saxagliptin had lower total all-cause healthcare costs and diabetes-related medical costs over 1 year compared with patients initiating treatment with linagliptin.
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Affiliation(s)
- Amanda M Kong
- a Watson Health Value Based Care, Truven Health Analytics , an IBM Company, Bethesda , MD , USA
| | | | | | - Matthew A Brouillette
- a Watson Health Value Based Care, Truven Health Analytics , an IBM Company, Bethesda , MD , USA
| | - Biswarup Mukherjee
- a Watson Health Value Based Care, Truven Health Analytics , an IBM Company, Bethesda , MD , USA
| | - David M Smith
- a Watson Health Value Based Care, Truven Health Analytics , an IBM Company, Bethesda , MD , USA
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Hickey CD, Diehl BWK, Nuzzo M, Millqvist-Feurby A, Wilkinson MG, Sheehan JJ. Influence of buttermilk powder or buttermilk addition on phospholipid content, chemical and bio-chemical composition and bacterial viability in Cheddar style-cheese. Food Res Int 2017; 102:748-758. [PMID: 29196008 DOI: 10.1016/j.foodres.2017.09.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/31/2017] [Accepted: 09/24/2017] [Indexed: 11/27/2022]
Abstract
The effect of buttermilk powder addition post-curd formation or buttermilk addition to cheese milk on total and individual phospholipid content, chemical composition, enzyme activity, microbial populations and microstructure within Cheddar-style cheese was investigated. Buttermilk or buttermilk powder addition resulted in significant increases in total phospholipid content and their distribution throughout the cheese matrix. Addition of 10% buttermilk powder resulted in higher phospholipid content, moisture, pH and salt in moisture levels, and lower fat, fat in dry matter, L. helveticus and non-starter bacteria levels in cheeses. Buttermilk powder inclusion resulted in lower pH4.6/Soluble Nitrogen (SN) levels and significantly lower free amino acid levels in 10% buttermilk powder cheeses. Buttermilk addition provided a more porous cheese microstructure with greater fat globule coalescence and increased free fat pools, while also increasing moisture and decreasing protein, fat and pH levels. Addition of buttermilk in liquid or powdered form offers potential for new cheeses with associated health benefits.
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Affiliation(s)
- C D Hickey
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland; University of Limerick, Castletroy, Limerick, Ireland.
| | - B W K Diehl
- Spectral service AG, Emil-Hoffmann-Straße 33, 50996 Köln, Germany.
| | - M Nuzzo
- RISE-Research Institutes of Sweden, Stockholm, Sweden
| | | | - M G Wilkinson
- University of Limerick, Castletroy, Limerick, Ireland.
| | - J J Sheehan
- Teagasc Food Research Centre, Moorepark, Fermoy, Co. Cork, Ireland.
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Quiroz-Arita C, Sheehan JJ, Bradley TH. Life cycle net energy and greenhouse gas emissions of photosynthetic cyanobacterial biorefineries: Challenges for industrial production of biofuels. ALGAL RES 2017. [DOI: 10.1016/j.algal.2017.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sussell J, Bognar K, Schwartz TT, Shafrin J, Sheehan JJ, Aubry W, Scanlon D. Value-Based Payments and Incentives to Improve Care: A Case Study of Patients with Type 2 Diabetes in Medicare Advantage. Value Health 2017; 20:1216-1220. [PMID: 28964455 DOI: 10.1016/j.jval.2017.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/17/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To estimate the impact of increased glycated hemoglobin (A1C) monitoring and treatment intensification for patients with type 2 diabetes (T2D) on quality measures and reimbursement within the Medicare Advantage Star (MA Star) program. METHODS The primary endpoint was the share of patients with T2D with adequate A1C control (A1C ≤ 9%). We conducted a simulation of how increased A1C monitoring and treatment intensification affected this end point using data from the National Health and Nutrition Examination Survey and clinical trials. Using the estimated changes in measured A1C levels, we calculated corresponding changes in the plan-level A1C quality measure, overall star rating, and reimbursement. RESULTS At baseline, 24.4% of patients with T2D in the average plan had poor A1C control. The share of plans receiving the highest A1C rating increased from 27% at baseline to 49.5% (increased monitoring), 36.2% (intensification), and 57.1% (joint implementation of both interventions). However, overall star ratings increased for only 3.6%, 1.3%, and 4.8% of plans, respectively, by intervention. Projected per-member per-year rebate increases under the MA Star program were $7.71 (monitoring), $2.66 (intensification), and $10.55 (joint implementation). CONCLUSIONS The simulation showed that increased monitoring and treatment intensification would improve A1C levels; however, the resulting average increases in reimbursement would be small.
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Affiliation(s)
- Jesse Sussell
- Precision Health Economics, Oakland, CA, USA, at the time the research was conducted.
| | - Kata Bognar
- Precision Health Economics, Oakland, CA, USA, at the time the research was conducted
| | - Taylor T Schwartz
- Precision Health Economics, Oakland, CA, USA, at the time the research was conducted
| | - Jason Shafrin
- Precision Health Economics, Oakland, CA, USA, at the time the research was conducted
| | - John J Sheehan
- AstraZeneca Pharmaceuticals, LP (at the time the research was conducted), Wilmington, DE; current affiliation: Janssen Scientific Affairs, LLC, Titusville, NJ
| | - Wade Aubry
- University of California, San Francisco, CA, USA
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Folse HJ, Mukherjee J, Sheehan JJ, Ward AJ, Pelkey RL, Dinh TA, Qin L, Kim J. Delays in treatment intensification with oral antidiabetic drugs and risk of microvascular and macrovascular events in patients with poor glycaemic control: An individual patient simulation study. Diabetes Obes Metab 2017; 19:1006-1013. [PMID: 28211604 DOI: 10.1111/dom.12913] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/02/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
Abstract
AIMS To use the Archimedes model to estimate the consequences of delays in oral antidiabetic drug (OAD) treatment intensification on glycaemic control and long-term outcomes at 5 and 20 years. MATERIALS AND METHODS Using real-world data, we modelled a cohort of hypothetical patients with glycated haemoglobin (HbA1c) ≥8%, on metformin, with no history of insulin use. The cohort included 3 strata based on the number of OADs taken at baseline. The first add-on in the intensification sequence was a sulphonylurea, next was a dipeptidyl peptidase-4 inhibitor, and last, a thiazolidinedione. The scenarios included either no delay or delay, based on observed and extrapolated times to intensification. RESULTS At 1 year, HbA1c was 6.8% for patients intensifying without delay, and 8.2% for those delaying intensification. For no delay vs delay, risks of major adverse cardiac events, myocardial infarction, heart failure and amputations were reduced by 18.0%, 25.0%, 13.7%, and 20.4%, respectively, at 5 years; severe hypoglycaemia risk, however, increased to 19% for the no delay scenario vs 12.5% for delay. At 20 years, the results showed similar trends to those at 5 years. CONCLUSIONS Timing of intensification of OAD therapy according to guideline recommendations led to greater reductions in HbA1c and lower risks of complications, but higher risks of hypoglycaemia than delaying intensification. These results highlight the potential impact of timely treatment intensification on long-term outcomes.
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Affiliation(s)
| | | | - John J Sheehan
- AstraZeneca Pharmaceuticals, Fort Washington, Pennsylvania
| | | | | | | | - Lei Qin
- AstraZeneca, One MedImmune Way, Gaithersburg, Maryland
| | - Jennifer Kim
- AstraZeneca, One MedImmune Way, Gaithersburg, Maryland
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Abstract
OBJECTIVE We conducted a retrospective cohort study to investigate the HbA1c change associated with treatment intensification in a real-world population of patients with type 2 diabetes (T2D). METHODS Using a large US insurance claims database, patients aged ≥18 years with a T2D diagnosis and HbA1c ≥8.0% (64 mmol/mol) after ≥3 months of oral pharmacotherapy with metformin (± other oral antidiabetes agents) were identified (index date). Continuous enrollment was required for ≥12 months before (baseline) and after the index date with no baseline use of injectable antidiabetes drugs. We defined treatment intensification as prescriptions for injectable or additional oral antidiabetes drugs. Time to intensification was classified as timely (within 6 months) or not (≥6 months or not intensified). Linear regression models with propensity score 1:1 matching were performed to assess the effect of timely intensification on HbA1c. RESULTS Of the 11,525 patients meeting the inclusion criteria, only 37% had treatment intensified within 6 months. Mean age at index date was 57 years, 40% of the sample was female. The mean baseline A1C was 9.4% and 9.0%, while post-index A1C was 7.9% and 8.2% for timely intensified patients versus not, respectively. Patients with timely intensification had significantly greater HbA1c reduction compared with others (-0.33%, 95% CI: -0.41% to -0.25%) within 1 year of follow up. CONCLUSIONS In this analysis of patients with T2D and treatment failure in a real-world setting, earlier treatment intensification was associated with better glycemic control as indicated by lower HbA1c values.
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Affiliation(s)
- Alex Z Fu
- a Georgetown University Medical Center , Washington , DC , USA
| | - John J Sheehan
- b AstraZeneca Pharmaceuticals LP , Fort Washington , PA , USA at the time the research was conducted
- c Janssen Scientific Affairs LLC , Titusville , NJ , USA
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MacEwan JP, Sheehan JJ, Yin W, Vanderpuye-Orgle J, Sullivan J, Peneva D, Kalsekar I, Peters AL. The relationship between adherence and total spending among Medicare beneficiaries with type 2 diabetes. Am J Manag Care 2017; 23:248-252. [PMID: 28554205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES This study examined the relationship between medication adherence, cost sharing measured as out-of-pocket spending, and total annual spending in Medicare beneficiaries with type 2 diabetes (T2D) to evaluate whether pharmacy cost-sharing programs have the potential to decrease adherence. These programs may unintentionally increase the risk of medical complications and may result in higher spending overall. STUDY DESIGN This retrospective study used 2006 to 2009 Medicare claims data. The sample included patients 65 years or older with T2D (at least 1 claim with International Classification of Diseases, 9th Revision, Clinical Modification codes 250.x0 and 250.x2 and at least 1 antidiabetes drug claim). METHODS Medication adherence was measured as proportion of days covered over the first 12 months of observation. Spending and adherence outcomes were defined in deciles. RESULTS The sample included 12,305 patient-year observations. Pharmacy spending for patients in the most adherent (10th) decile was 59% higher than that for patients in the least adherent (1st) decile ($4839 vs $3046). Yet, patients in the 10th decile had 49% lower total ($12,531 vs $24,468) and 64% lower medical spending ($7692 vs $21,421) than patients in the 1st decile. Greater out-of-pocket spending was correlated with lower adherence and higher total and medical spending. CONCLUSIONS This study describes a widespread variation in medication adherence, pharmacy cost sharing, and medical spending in a sample of Medicare beneficiaries with T2D. We found that lower adherence was correlated with higher cost sharing in the Medicare population, perhaps because of unobserved confounding factors. However, the existing literature on patients with employer-sponsored insurance suggests some of this correlation may be indicative of causal relationships.
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Affiliation(s)
- Joanna P MacEwan
- Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA 90025. E-mail:
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Arnold SV, Inzucchi SE, McGuire DK, Tang F, Mehta SN, Goyal A, Sperling LS, Maddox TM, Einhorn D, Wong ND, Hammer N, Fenici P, Sheehan JJ, Kosiborod M. Abstract 135: Assessing the Personalization of Glycemic Management Strategies Through the Diabetes Collaborative Registry. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Although practice guidelines stress individualization of glucose management in patients with type 2 diabetes (T2D), the extent to which providers take patient factors into account when selecting medications is not well known. We used data from DCR to evaluate the current real-world landscape of glucose-lowering drugs in key subsets of patients with T2D.
Methods:
DCR is the first large-scale US outpatient registry of patients with diabetes recruited from cardiology, endocrinology, and primary care practices and currently encompasses 374 practices and 5114 providers. T2D medications were grouped as those which are suboptimal for patients with 1) obesity: insulin, sulfonylurea, TZD; 2) elderly (i.e., high hypoglycemia risk): insulin, sulfonylurea; 3) CKD 4/5: metformin, sulfonylurea; and 4) CV disease: sulfonylurea. We examined patient factors associated with use of these groups of meds using 4 hierarchical (for both specialty and site) modified Poisson models, adjusting for HbA1c, number of T2D meds, and insurance.
Results:
Overall, 157,551 patients with T2D were prescribed a med for glycemic control: metformin 75%, sulfonylurea 34%, insulin 28%, DPP-4i 18%, TZD 11%, GLP-1 RA 6.4%, SGLT2i 4.8%. After adjusting patient factors, glycemic control, and insurance status, patients with higher BMIs were
more
likely treated with medications prone to cause weight gain (obesity class I/II: rate ratio [RR] 1.02, 95% CI 1.00-1.03; obesity class III: RR 1.09, 95% CI 1.05-1.12). Older patients were
more
likely to be treated with meds with increased risk of hypoglycemia (RR 1.04 per 5 years, 95% CI 1.03-1.05). Patients with GFR <30 were
less
likely to be treated with meds with known risk in patients with CKD (RR 0.72, 95% CI 0.68-0.76). Patients with CAD were
less
likely to be treated with meds with known CV harm (RR 0.97, 95% CI 0.96-1.00).
Conclusion:
In a large US-based registry of T2D patients, we observed some targeted use of glucose-lowering therapy—in particular, patients with advanced CKD and CAD were not given meds known to be harmful to these patients. However, risk of hypoglycemia and risk of weight gain did not appear to factor substantially into decision making. As these are among several factors that go into drug selection for complicated patients with T2D, conclusions from these data are limited. Nonetheless, in an era of increasing number and complexity of medication choices with varying risk/benefits, databases like the DCR may allow investigators to assess these trends and to highlight potential areas for improvement in pharmacologic personalization, particularly as the use of newer drug classes grows.
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Affiliation(s)
| | | | | | - Fengming Tang
- Saint Luke’s Mid America Heart Institute, Kansas City, MO
| | | | | | | | - Thomas M Maddox
- Eastern Colorado Health Care System and Univ of Colorado Sch of Medicine, Denver, CO
| | - Daniel Einhorn
- Univ of California, San Diego Sch of Medicine, San Diego, CA
| | - Nathan D Wong
- Univ of California, Irvine Sch of Medicine, Irvine, CA
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Hodnett PA, Koktzoglou I, Davarpanah AH, Scanlon TG, Collins JD, Sheehan JJ, Dunkle EE, Gupta N, Carr JC, Edelman RR. Evaluation of Peripheral Arterial Disease with Nonenhanced Quiescent-Interval Single-Shot MR Angiography. Radiology 2017; 282:614. [DOI: 10.1148/radiol.2017164042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bell KF, Katz A, Sheehan JJ. Quality measure attainment with dapagliflozin plus metformin extended-release as initial combination therapy in patients with type 2 diabetes: a post hoc pooled analysis of two clinical studies. Risk Manag Healthc Policy 2016; 9:231-241. [PMID: 27790048 PMCID: PMC5072521 DOI: 10.2147/rmhp.s108586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The use of quality measures attempts to improve safety and health outcomes and to reduce costs. In two Phase III trials in treatment-naive patients with type 2 diabetes, dapagliflozin 5 or 10 mg/d as initial combination therapy with metformin extended-release (XR) significantly reduced glycated hemoglobin (A1C) from baseline to 24 weeks and allowed higher proportions of patients to achieve A1C <7% vs dapagliflozin or metformin monotherapy. Objective A pooled analysis of data from these two studies assessed the effect of dapagliflozin 5 or 10 mg/d plus metformin XR (combination therapy) compared with placebo plus metformin XR (metformin monotherapy) on diabetes quality measures. Quality measures include laboratory measures of A1C and low-density lipoprotein cholesterol (LDL-C) as well as vital status measures of blood pressure (BP) and body mass index (BMI). The proportion of patients achieving A1C, BP, and LDL-C individual and composite measures was assessed, as was the proportion with baseline BMI ≥25 kg/m2 who lost ≥4.5 kg. Subgroup analyses by baseline BMI were also performed. Results A total of 194 and 211 patients were treated with dapagliflozin 5- or 10-mg/d combination therapy, respectively, and 409 with metformin monotherapy. Significantly higher proportions of patients achieved A1C ≤6.5%, <7%, or <8% with combination therapy vs metformin monotherapy (P<0.02). Significantly higher proportions of patients achieved BP <140/90 mmHg (P<0.02 for each dapagliflozin dose) and BP <130/80 mmHg (P<0.02 with dapagliflozin 5 mg/d only) with combination therapy vs metformin monotherapy. Similar proportions (29%–33%) of patients had LDL-C <100 mg/dL across treatment groups. A higher proportion of patients with baseline BMI ≥25 kg/m2 lost ≥4.5 kg with combination therapy. Combination therapy had a more robust effect on patients with higher baseline BMI. Conclusion Initial combination therapy with dapagliflozin 5 or 10 mg/d and metformin improved quality measures relevant to clinical outcomes and diabetes care.
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Fu AZ, Sheehan JJ. Treatment intensification for patients with type 2 diabetes and poor glycaemic control. Diabetes Obes Metab 2016; 18:892-8. [PMID: 27160505 DOI: 10.1111/dom.12683] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
AIMS To identify the time to and patient characteristics associated with treatment intensification in patients with type 2 diabetes (T2D) and poor glycaemic control. METHODS Using a large US insurance claims database, we conducted a retrospective cohort study among adult patients with T2D and glycated haemoglobin (HbA1c) ≥8% (index date) after ≥3 months of therapy including metformin. Patients were required to have continuous enrolment for at least 12 months before (baseline) and after index date, and no injectable antidiabetes medications. We defined treatment intensification as prescription fill for injectable or additional oral antidiabetic drugs (OADs). Cox modelling was performed to identify factors associated with time to treatment intensification. RESULTS For the 11 525 patients meeting the inclusion criteria, the mean age at index date was 57 years, 40% were female and the mean index HbA1c was 9.1%. Overall, 37% of patients had their treatment intensified <6 months after, 11% had their treatment intensified 6-12 months after, and 52% did not have their treatment intensified <12 months after the index date. A higher index HbA1c was associated with early intensification [hazard ratio (HR) 1.18 for HbA1c ≥9 to <10% and HR 1.41 for HbA1c ≥10% compared with HbA1c ≥8 to <9%; p < 0.0001), and later line of therapy was associated with late intensification (HR 0.78 for metformin with one OAD and HR 0.68 for metformin with ≥2 OADs compared with metformin monotherapy; p < 0.0001). CONCLUSIONS Fewer than half of patients with T2D and treatment failure received intensification within 12 months in a real-world US population. Factors associated with treatment inertia can be used to target clinical care for these patients.
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Affiliation(s)
- A Z Fu
- Georgetown University Medical Center, Washington, DC, USA
| | - J J Sheehan
- AstraZeneca Pharmaceuticals, LP, Fort Washington, PA, USA
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Arnold SV, Inzucchi SE, McGuire DK, Mehta SN, Goyal A, Sperling LS, Maddox TM, Einhorn D, Wong ND, Ratner RE, Hammar N, Fenici P, Sheehan JJ, Wong JL, Kosiborod M. Evaluating the Quality of Comprehensive Cardiometabolic Care for Patients With Type 2 Diabetes in the U.S.: The Diabetes Collaborative Registry. Diabetes Care 2016; 39:e99-e101. [PMID: 27222504 DOI: 10.2337/dc16-0585] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 04/21/2016] [Indexed: 02/03/2023]
Affiliation(s)
- Suzanne V Arnold
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO
| | | | | | | | | | | | - Thomas M Maddox
- VA Eastern Colorado Health Care System and University of Colorado School of Medicine, Denver, CO
| | - Daniel Einhorn
- University of California, San Diego, School of Medicine, San Diego, CA
| | - Nathan D Wong
- University of California, Irvine, School of Medicine, Irvine, CA
| | | | | | | | | | | | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO
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