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Palatucci JS, Chakravarty S, Kratchman AL, Harris J, Pizzi LT, Coffield CN, Ibitamuno G, Spitalnik DM. Commentary: Determining Economic Factors That Matter to People With Intellectual and Developmental Disabilities and Their Caregivers: A Process Framework. Med Care 2023; 61:S104-S108. [PMID: 37963028 PMCID: PMC10635331 DOI: 10.1097/mlr.0000000000001913] [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] [Indexed: 11/16/2023]
Abstract
BACKGROUND The 2020-2029 strategic plan for the Patient-Centered Outcomes Research Trust Fund calls for addressing data infrastructure gaps that are critical for studying issues around intellectual and developmental disabilities (I/DD). Specifically, the plan calls for data collection on economic factors that affect person-centered approaches to health care decision-making. Among people with I/DD and their caregivers, such economic factors may include financial costs of care, decreased opportunities for leisure and recreation, income losses associated with caregiving, and foregone opportunities for skill acquisition or other human capital investments. OBJECTIVE This commentary supports responsiveness to the Patient-Centered OutcomesResearch Trust Fund (PCORTF) calls by conceptualizing and operationalizing a framework for identifying preferences on economic factors that are relevant to people with I/DD and their caregivers. MAIN ARGUMENTS The framework outlined in this commentary addresses barriers to data collection that hinder measure development in the study of I/DD. This work is significant and timely given the continued movement to integrate and maintain people with I/DD within communities and recent methodological advances for eliciting preferences among people with I/DD. RELEVANCE TO THE SPECIAL ISSUE Readers will be introduced to a framework for building data capacity in the study of economic outcomes among a population that is a high research priority for federal funding agencies. This commentary aims to be useful to researchers in planning, developing, and initiating projects in this area.
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Affiliation(s)
- John S. Palatucci
- Rutgers Center for State Health Policy
- Elizabeth M. Boggs Center on Developmental Disabilities, New Brunswick, NJ
| | | | | | - Jill Harris
- Children’s Specialized Hospital, New Brunswick
| | - Laura T. Pizzi
- ISPOR—The Professional Society for Health Economics and Outcomes Research, Lawrenceville
- Ernest Mario School of Pharmacy, Piscataway
| | - Caroline N. Coffield
- Elizabeth M. Boggs Center on Developmental Disabilities, New Brunswick, NJ
- Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Deborah M. Spitalnik
- Elizabeth M. Boggs Center on Developmental Disabilities, New Brunswick, NJ
- Robert Wood Johnson Medical School, New Brunswick, NJ
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Jutkowitz E, Pizzi LT, Shewmaker P, Alarid-Escudero F, Epstein-Lubow G, Prioli KM, Gaugler JE, Gitlin LN. Cost effectiveness of non-drug interventions that reduce nursing home admissions for people living with dementia. Alzheimers Dement 2023; 19:3867-3893. [PMID: 37021724 PMCID: PMC10524701 DOI: 10.1002/alz.12964] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 10/10/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION Six million Americans live with Alzheimer's disease and Alzheimer's disease and related dementias (AD/ADRD), a major health-care cost driver. We evaluated the cost effectiveness of non-pharmacologic interventions that reduce nursing home admissions for people living with AD/ADRD. METHODS We used a person-level microsimulation to model the hazard ratios (HR) on nursing home admission for four evidence-based interventions compared to usual care: Maximizing Independence at Home (MIND), NYU Caregiver (NYU); Alzheimer's and Dementia Care (ADC); and Adult Day Service Plus (ADS Plus). We evaluated societal costs, quality-adjusted life years and incremental cost-effectiveness ratios. RESULTS All four interventions cost less and are more effective (i.e., cost savings) than usual care from a societal perspective. Results did not materially change in 1-way, 2-way, structural, and probabilistic sensitivity analyses. CONCLUSION Dementia-care interventions that reduce nursing home admissions save societal costs compared to usual care. Policies should incentivize providers and health systems to implement non-pharmacologic interventions.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Providence Veterans Affairs Medical Center, Center of Innovation in Long Term Services and Supports, Providence, Rhode Island, USA
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Laura T. Pizzi
- Center for Health Outcomes, Policy, and Economics (HOPE), Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, New Jersey, USA
- ISPOR—The Professional Society for Health Economics and Outcomes Research, Lawrenceville, New Jersey, USA
| | - Peter Shewmaker
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Fernando Alarid-Escudero
- Department of Health Policy, School of Medicine, and Stanford Health Policy, Freeman-Spogli Institute for International Studies, Stanford University, Stanford, California, USA
| | - Gary Epstein-Lubow
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Butler Hospital, Providence, Rhode Island, USA
| | - Katherine M. Prioli
- Center for Health Outcomes, Policy, and Economics (HOPE), Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, New Jersey, USA
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, Minneapolis, Minnesota, USA
| | - Laura N. Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
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Prioli KM, Akincigil A, Namvar T, Mitchell-Williams J, Schafer JJ, Cunningham RC, Fields-Harris L, McCoy M, Vertsman R, Guesnier A, Pizzi LT. Addressing racial inequality and its effects on vaccination rate: A trial comparing a pharmacist and peer educational program (MOTIVATE) in diverse older adults. J Manag Care Spec Pharm 2023; 29:970-980. [PMID: 37523315 PMCID: PMC10397332 DOI: 10.18553/jmcp.2023.29.8.970] [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] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND: The mortality, morbidity, health care utilization, and cost attributable to vaccine-preventable diseases are substantial for those aged 50 years and older. Although vaccination is the most cost-effective strategy to prevent common infectious diseases in older adults, vaccination rates remain below US Centers for Disease Control and Prevention benchmarks, especially among racial minorities. Historical mistrust, structural racism within the US medical system, and misinformation contributed to lower immunization rates among minorities, especially Black Americans. To address the critical need to increase knowledge and trust in vaccination, 2 community-based educational interventions were tested: a pharmacist-led didactic session (PHARM) and a peer-led educational workshop (PEER). OBJECTIVE: To determine and compare the effectiveness and costs of PEER and PHARM community-based education models in improving knowledge and trust in vaccinations. METHODS: The Motivating Older adults to Trust Information about Vaccines And Their Effects (MOTIVATE) study was a cluster-randomized trial conducted in the greater Delaware Valley Region sites from 2017 to 2020. The included sites (7 senior centers, 3 housing units, 1 church, and 1 neighborhood family center) predominantly served Black communities. Participants were randomized to either PHARM or PEER sessions covering influenza, pneumococcal disease, herpes zoster, and beliefs related to vaccines. Peer leaders facilitated smaller workshops (5-10 participants), whereas pharmacists conducted larger didactic lectures with 15-43 participants. Outcomes were captured through a self-administered survey at baseline, postprogram, and 1 month after the program. Intervention costs were measured in 2017 US dollars. RESULTS: 287 participants were included. Their mean age was 74.5 years (SD = 8.94), 80.5% were women, 64.2% were Black, and 48.1% completed some college. Knowledge scores within groups for all 3 diseases significantly increased postprogram for both PEER and PHARM and were sustained at 1 month. Between-group knowledge differences were significant only for influenza (PEER participants had significantly larger improvement vs PHARM). Vaccination trust significantly increased in both groups. Total program costs were $11,411 for PEER and $5,104 for PHARM. CONCLUSIONS: Both interventions significantly improved knowledge and trust toward vaccination and retained their effect 1 month after the program. The 2 effective community-based education models should be expanded to ensure timely and trusted information is available to educate older adults about vaccine-preventable diseases. Further research is encouraged to assess the long-term cost-effectiveness of these models' utilization on a larger scale. DISCLOSURES: Dr Schafer is an employee of Merck; however, at the time of the project, he was a professor at Thomas Jefferson University. The other authors have no conflicts of interest to disclose. This study was supported in part by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp. The opinions expressed in this article are those of the authors and do not necessarily represent those of Merck Sharp & Dohme Corp. The sponsor played no role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; or in the preparation, review, or approval of the article. Study Registration Number: NCT03239665.
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Affiliation(s)
- Katherine M Prioli
- Center for Health Outcomes, Policy and Economics, Ernest Mario School of Pharmacy, Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, NJ
| | - Ayse Akincigil
- School of Social Work, Rutgers University, New Brunswick, NJ
| | - Tarlan Namvar
- Center for Health Outcomes, Policy and Economics, Ernest Mario School of Pharmacy, Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, NJ
| | | | - Jason J Schafer
- Thomas Jefferson University, Philadelphia, PA, now with Global Medical & Scientific Affairs, Merck & Co., Inc, Upper Gwynedd, PA
| | | | | | - Megan McCoy
- Department of Social Work, College of Social and Behavioral Sciences, Northern Arizona University, Flagstaff
| | - Ronald Vertsman
- Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | | | - Laura T Pizzi
- Center for Health Outcomes, Policy and Economics, Ernest Mario School of Pharmacy, Department of Pharmacy Practice and Administration, Rutgers University, Piscataway, NJ
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Pizzi LT, Willke RJ. EUreccA 2025: A Multistakeholder Effort to Further Real-World Evidence in Healthcare Decision Making. Value Health 2023; 26:1-2. [PMID: 36958515 DOI: 10.1016/j.jval.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 05/06/2023]
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Pizzi LT, Prioli KM, Jutkowitz E, Piersol CV, Lyketsos CG, Abersone I, Marx KA, Gitlin LN. Economic Analysis of the Tailored Activity Program: A Nonpharmacological Approach to Improve Quality of Life in People Living With Dementia and their Caregivers. J Appl Gerontol 2023:7334648231158091. [PMID: 36814387 DOI: 10.1177/07334648231158091] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
We investigated costs of delivering the Tailored Activity Program (TAP) and cost savings from two perspectives (health sector and societal) for people living with dementia (PLWD) and their caregivers (dyads) compared to attention control (AC) using data from a randomized controlled trial. The evaluation assessed intervention delivery costs and caregiver reported health care utilization. The total intervention cost of TAP was $1707/dyad versus $864/dyad for AC, and total costs over 6 months for TAP dyads as compared to AC were $1299 (CI: -$10,496, $7898) less from the healthcare perspective, and $761 (CI: -$10,133, $8611) less from the societal perspective. TAP cost savings are driven by lower use of healthcare services among participating dyads, but further analyses with larger samples is warranted to confirm its financial impact.
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Affiliation(s)
- Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, 242612Rutgers University, Piscataway, NJ, USA
| | - Katherine M Prioli
- Center for Health Outcomes, Policy, and Economics, 242612Rutgers University, Piscataway, NJ, USA
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA.,Center for Innovation in Long Term Services and Supports, 20100Providence VA Medical Center, Providence, RI, USA
| | - Catherine V Piersol
- Center for Innovation in Long Term Services and Supports, 20100Providence VA Medical Center, Providence, RI, USA
| | - Constantine G Lyketsos
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Ilze Abersone
- Center for Health Outcomes, Policy, and Economics, 242612Rutgers University, Piscataway, NJ, USA
| | - Katherine A Marx
- Department of Psychiatry and Behavioral Sciences, 23238Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Laura N Gitlin
- Center for Innovative Care in Aging, 15851Johns Hopkins School of Nursing, Baltimore, MD, USA.,College of Nursing and Health Professions, AgeWell Collaboratory, Drexel University, PA, USA
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Hark LA, Horowitz JD, Gorroochurn P, Park L, Wang Q, Diamond DF, Harizman N, Auran JD, Maruri SC, Henriquez DR, Carrion J, Muhire RSM, Kresch YS, Pizzi LT, Jutkowitz E, Sapru S, Sharma T, De Moraes CG, Friedman DS, Liebmann JM, Cioffi GA. Manhattan Vision Screening and Follow-up Study (NYC-SIGHT): Baseline Results and Costs of a Cluster-Randomized Trial. Am J Ophthalmol 2023; 251:12-23. [PMID: 36690289 DOI: 10.1016/j.ajo.2023.01.019] [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] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/22/2023]
Abstract
PURPOSE To describe the 15-month baseline results and costs of the Manhattan Vision Screening and Follow-up Study, which aims to investigate whether innovative community-based eye health screening can improve early detection and management of glaucoma and other eye diseases among high-risk populations. DESIGN 5-year prospective, cluster-randomized controlled trial. METHODS Individuals age 40+ were recruited from public housing buildings in New York City for an eye health screening (visual acuity (VA) with correction, intraocular pressure measurements (IOP), and fundus photography). Participants with VA 20/40 or worse, IOP 23-29 mmHg, or an unreadable fundus image failed the screening and were scheduled for an optometric exam at the same location; those with an abnormal image were referred to ophthalmology. A cost analysis was conducted alongside the study. RESULTS 708 participants were screened; mean age 68.6±11.9 years, female (65.1%), African American (51.8%) and Hispanic (42%). 78.4% (n = 555) failed the eye health screening; 35% (n= 250) had an abnormal image and were also referred to ophthalmology. 308 participants attended the optometric exam; 218 were referred to ophthalmology. Overall, 66.1% were referred to ophthalmology. The cost per participant to deliver the eye health screening and optometric exam was $180.88. The cost per case of eye disease detected was $273.64. CONCLUSIONS This innovative study in public housing developments targeted high-risk populations, provided access to eye-care, and improved early detection of ocular diseases in New York City. The study has identified strategies to overcoming barriers to eye care to reduce eye health disparities.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York.
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W. 168(th) Street, New York, NY 10032
| | - Lisa Park
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Qing Wang
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Daniel F Diamond
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Noga Harizman
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - James D Auran
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Desiree R Henriquez
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Jailine Carrion
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Remy S Manzi Muhire
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - Yocheved S Kresch
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York; Kresge Eye Institute, Wayne State University School of Medicine, 4717 St Antoine, Detroit, MI 48201
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, 21 S. Main Street, Providence, RI 02903
| | - Saloni Sapru
- Westat Public Health and Epidemiology Practice, 1600 Research Blvd., Rockville, MD 20850
| | - Tarun Sharma
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - David S Friedman
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Glaucoma Service, 243 Charles Street, Boston, MA 02114
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
| | - George A Cioffi
- Department of Ophthalmology, Columbia University, Vagelos College of Physicians and Surgeons, 630 W. 168(th) Street, New York, NY 10032; Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, 635 West 165(th) Street, New York, New York
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Prioli KM, Abersone I, Kopko PM, Herman JH, Custer B, Pizzi LT. Economic implications of FDA platelet bacterial guidance compliance options: Comparison of single-step strategies. Transfusion 2022; 62:365-373. [PMID: 34997763 PMCID: PMC9303536 DOI: 10.1111/trf.16778] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 11/11/2021] [Accepted: 11/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bloodborne pathogens pose a major safety risk in transfusion medicine. To mitigate the risk of bacterial contamination in platelet units, FDA issues updated guidance materials on various bacterial risk control strategies (BRCS). This analysis presents results of a budget impact model updated to include 5- and 7-day pathogen reduced (PR) and large volumed delayed sampling (LVDS) BRCS. STUDY DESIGN AND METHODS Model base-case parameter inputs were based on scientific literature, a survey distributed to 27 US hospitals, and transfusion experts' opinion. The outputs include hospital budget and shelf-life impacts for 5- and 7-day LVDS, and 5- and 7-day PR units under three different scenarios: (1) 100% LVDS, (2) 100% PR, and (3) mix of 50% LVDS - and 50% PR. RESULTS Total annual costs from the hospital perspective were highest for 100% LVDS platelets (US$2.325M) and lowest for 100% PR-7 units (US$2.170M). Net budget impact after offsetting annual costs by outpatient reimbursements was 5.5% lower for 5-day PR platelets as compared to 5-day LVDS (US$1.663 vs. US$1.760M). A mix of 7-day LVDS and 5-day PR platelets had net annual costs that were 1.3% lower than for 100% 7-day LVDS, but 1.3% higher than for 100% 5-day PR. 7-day PR platelets had the longest shelf life (4.63 days), while 5-day LVDS had the shortest (2.00 days). DISCUSSION The model identifies opportunities to minimize transfusion center costs for 5- and 7-day platelets. Budget impact models such as this are important for understanding the financial implications of evolving FDA guidance and new platelet technologies.
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Affiliation(s)
- Katherine M Prioli
- Center for Health Outcomes, Policy and Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Ilze Abersone
- Center for Health Outcomes, Policy and Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Patricia M Kopko
- Division of Transfusion Medicine, University of California San Diego, San Diego, California, USA
| | - Jay H Herman
- Division of Transfusion Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA.,Department of Laboratory Medicine, UCSF, San Francisco, California, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy and Economics, Rutgers University, Piscataway, New Jersey, USA
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Willke RJ, Pizzi LT. CHEERS to Updated Guidelines for Reporting Health Economic Evaluations! Value Health 2022; 25:1-2. [PMID: 35031087 DOI: 10.1016/j.jval.2021.11.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 06/14/2023]
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Pizzi LT, Jutkowitz E, Prioli KM, Lu E(Y, Babcock Z, McAbee-Sevick H, Wakefield DB, Robison J, Molony S, Piersol CV, Gitlin LN, Fortinsky RH. Cost-Benefit Analysis of the COPE Program for Persons Living With Dementia: Toward a Payment Model. Innov Aging 2021; 6:igab042. [PMID: 35047708 PMCID: PMC8763605 DOI: 10.1093/geroni/igab042] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is a critical need for effective interventions to support quality of life for persons living with dementia and their caregivers. Growing evidence supports nonpharmacologic programs that provide care management, disease education, skills training, and support. This cost-benefit analysis examined whether the Care of Persons with Dementia in their Environments (COPE) program achieves cost savings when incorporated into Connecticut's home- and community-based services (HCBS), which are state- and Medicaid-funded. RESEARCH DESIGN AND METHODS Findings are based on a pragmatic trial where persons living with dementia and their caregiver dyads were randomly assigned to COPE with HCBS, or HCBS alone. Cost measures included those relevant to HCBS decision makers: intervention delivery, health care utilization, caregiver time, formal care, and social services. Data sources included care management records and caregiver report. RESULTS Per-dyad mean cost savings at 12 months were $2 354 for those who received COPE with a mean difference-in-difference of -$6 667 versus HCBS alone (95% CI: -$15 473, $2 734; not statistically significant). COPE costs would consume 5.6%-11.3% of Connecticut's HCBS annual spending limit, and HCBS cost-sharing requirements align with participants' willingness to pay for COPE. DISCUSSION AND IMPLICATIONS COPE represents a potentially cost-saving dementia care service that could be financed through existing Connecticut HCBS. HCBS programs represent an important, sustainable payment model for delivering nonpharmacological dementia interventions such as COPE.
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Affiliation(s)
- Laura T Pizzi
- Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Eric Jutkowitz
- Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- Center of Innovation in Long Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Katherine M Prioli
- Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Ember (Yiwei) Lu
- Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, New Jersey, USA
| | - Zachary Babcock
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | | | | | - Julie Robison
- Center on Aging, University of Connecticut, Farmington, Connecticut, USA
| | - Sheila Molony
- School of Nursing, Quinnipiac University, Hamden, Connecticut, USA
| | - Catherine V Piersol
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions and AgeWell Collaboratory, Drexel University, Philadelphia, Pennsylvania, USA
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Nightingale G, Scopelliti EM, Casten R, Woloshin M, Xiao S, Kelley M, Chang AM, Hollander JE, Leiby BE, Peterson AM, Pizzi LT, Rising KL, White N, Rovner B. Polypharmacy and Potentially Inappropriate Medication Use in Older Blacks with Diabetes Mellitus Presenting to the Emergency Department. J Aging Health 2021; 34:499-507. [PMID: 34517775 DOI: 10.1177/08982643211045546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Medication-related problems in older Blacks with diabetes mellitus (DM) are not well established. Objectives: To describe the frequency of medication-related problems in older Blacks with DM presenting to the emergency department (ED). Methods: The study was a cross-sectional analysis of baseline data from a randomized controlled trial evaluating Blacks aged ≥60 years of age presenting to the ED. Polypharmacy, potentially inappropriate medication (PIM) use, and anticholinergic score were evaluated. Results: Of 168 patients (median age = 68, range 60-92), most (n = 164, 98%) were taking ≥5 medications, and 67 (39.9%) were taking a PIM. A majority (n = 124, 74%) were taking a medication with an anticholinergic score ≥1. Number of medications was correlated with number of PIMs (r = .22, p = .004) and anticholinergic score (r = .50, p < .001). Conclusion: Polypharmacy and PIM use was common in older Blacks with DM.
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Affiliation(s)
- Ginah Nightingale
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Emily M Scopelliti
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Robin Casten
- Department of Psychiatry and Human Behavior, Sidney Kimmel Medical College, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Monica Woloshin
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Shu Xiao
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Megan Kelley
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna Marie Chang
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Judd E Hollander
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrew M Peterson
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Kristin L Rising
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Neva White
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry Rovner
- Department of Pharmacy Practice, Jefferson College of Pharmacy, 114062Thomas Jefferson University, Philadelphia, PA, USA
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LaFontaine PR, Yuan J, Prioli KM, Shah P, Herman JH, Pizzi LT. Economic Analyses of Pathogen-Reduction Technologies in Blood Transfusion: A Systematic Literature Review. Appl Health Econ Health Policy 2021; 19:487-499. [PMID: 33555572 DOI: 10.1007/s40258-020-00612-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Technologies used in the processing of whole blood and blood component products, including pathogen reduction, are continuously being adopted into blood transfusion workflows to improve process efficiencies. However, the economic implications of these technologies are not well understood. With the advent of these new technologies and regulatory guidance on bacterial risk-control strategies, an updated systematic literature review on this topic was warranted. OBJECTIVE The objective of this systematic literature review was to summarize the current literature on the economic analyses of pathogen-reduction technologies (PRTs). METHODS A systematic literature review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines to identify newly published articles in PubMed, MEDLINE Complete, and EconLit from 1 January 2000 to 17 July 2019 related to economic evaluations of PRTs. Only full-text studies in humans published in English were included in the review. Both budget-impact and cost-effectiveness studies were included; common outcomes included cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). RESULTS The initial searches identified 433 original abstracts, of which 16 articles were included in the final data extraction and reporting. Seven articles presented cost-effectiveness analyses and nine assessed budget impact. The introduction of PRT increased overall costs, and ICER values ranged widely across cost-effectiveness studies, from below $US150,000/QALY to upwards of $US20,000,000/QALY. This wide range of results was due to a multitude of factors, including comparator selection, target patient population, and scenario analyses included. CONCLUSIONS Overall, the results of economic evaluations of bacterial risk-control strategies, regardless of mechanism, were highly dependent on the current screening protocols in place. The optimization of blood transfusion safety may not result in decisions made at the willingness-to-pay thresholds commonly seen in pharmaceutical evaluations. Given the critical public health role of blood products, and the potential safety benefits introduced by advancements, it is important to continue building this body of evidence with more transparency and data source heterogeneity. This updated literature review provides global context when making local decisions for the coverage of new and emerging bacterial risk-control strategies.
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Affiliation(s)
- Patrick R LaFontaine
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ, 08854, USA
| | - Jing Yuan
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ, 08854, USA
| | - Katherine M Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA
| | - Priti Shah
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA
| | - Jay H Herman
- Emeritus Director of Transfusion Medicine, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Piscataway, NJ, 08854, USA.
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12
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Chung SA, Snitzer M, Prioli KM, Pizzi LT, Zhang Q, Levin AV. Reducing the Costs of an Eye Care Adherence Program for Underserved Children Referred Through Inner-City Vision Screenings. Am J Ophthalmol 2021; 227:18-24. [PMID: 33582091 DOI: 10.1016/j.ajo.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We previously reported costs and outcomes of the Children's Eye Care Adherence Program (CECAP1), a social worker intervention designed to improve adherence to eye care for underserved children in urban Philadelphia. Using cost findings from CECAP1, we revised the intervention to reduce costs. The aim of this study was to evaluate costs and effectiveness of the revised intervention (CECAP2). DESIGN Retrospective cohort study. METHODS Records of children needing ophthalmic follow-up after 2 community-based vision screening programs were reviewed. We modified CECAP1 to prioritize children more likely to visit, decreased phone calls and scheduling attempts, better documented children already followed by other doctors, and constricted our geographic catchment area for better accessibility. Cost was calculated using time spent executing CECAP2 by our salaried social worker. Effectiveness was defined as the percentage of patients completing at least 1 follow-up visit within the recommended time frame. RESULTS Of 462 children referred to CECAP2 from our in-school and on-campus screening programs, 242 (52.4%) completed subsequent recommended eye examinations, a proportion identical to our prior report (52.3%). Social worker time per patient was 0.8 hours; a significant reduction from the previous 2.6 hours (P < .01). Cost per patient was $32.73; a significant reduction compared to the previous $77.20 (P < .01). CONCLUSIONS Programmatic changes to reduce social worker intervention time and target potential patients by likelihood to attend along with constriction of the catchment area led to reduced costs by more than 50%, without impairing CECAP effectiveness.
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Hark LA, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Stidham EM, Banks AZ, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-up Study in Vulnerable Populations (NYC-SIGHT): Design and Methodology. J Glaucoma 2021; 30:388-394. [PMID: 33492894 DOI: 10.1097/ijg.0000000000001795] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022]
Abstract
PRCIS The Manhattan Vision Screening and Follow-up Study in Vulnerable Populations is a 5-year prospective, cluster-randomized study to improve detection and management of glaucoma and other eye diseases in vulnerable populations living in affordable housing developments. PURPOSE To describe the study design and methodology of the Manhattan Vision Screening and Follow-up Study in Vulnerable Populations, which aims to investigate whether community-based vision screenings can improve detection and management of glaucoma, vision impairment, cataract, and other eye diseases among vulnerable populations living in affordable housing developments in upper Manhattan. MATERIALS AND METHODS This 5-year prospective, cluster-randomized, controlled trial consists of vision screening and referral for follow-up eye care among eligible residents aged 40 and older. Visual acuity, intraocular pressure (IOP), and fundus photography are measured. Participants with visual worse than 20/40, or IOP 23 to 29 mm Hg, or unreadable fundus images fail the screening and are scheduled with the on-site optometrist. Those with an abnormal image and/or IOP ≥30 mm Hg, are assigned as "fast-track" and referred to ophthalmology. Participants living in 7 developments randomized to the Enhanced Intervention Group who fail the screening and need vision correction receive complimentary eyeglasses. Those referred to ophthalmology receive enhanced support with patient navigators to assist with follow-up eye care. Participants living in 3 developments randomized to the Usual Care Group who fail the screening and need vision correction are given an eyeglasses prescription only and a list of optical shops. No enhanced support is given to the Usual Care Group. All participants referred to ophthalmology are assisted in making their initial eye exam appointment. CONCLUSION This study targets vulnerable populations where they live to ensure improved access to and utilization of eye care services in those who are least likely to seek eye care.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Yocheved S Kresch
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Carlos Gustavo De Moraes
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jason D Horowitz
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Lisa Park
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - James D Auran
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | | | - Aisha Z Banks
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA
| | | | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ
| | - Saloni Sapru
- Westat, Public Health and Epidemiology Practice, Rockville, MD
| | - Simani Price
- Westat, Public Health and Epidemiology Practice, Rockville, MD
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, Columbia University
| | - George A Cioffi
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Vagelos College of Physicians and Surgeons
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center
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14
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Hark LA, Tan CS, Kresch YS, De Moraes CG, Horowitz JD, Park L, Auran JD, Gorroochurn P, Stempel S, Maruri SC, Besagar S, Saaddine JB, Lambert BC, Pizzi LT, Sapru S, Price S, Williams OA, Cioffi GA, Liebmann JM. Manhattan Vision Screening and Follow-Up Study in Vulnerable Populations: 1-Month Feasibility Results. Curr Eye Res 2021; 46:1597-1604. [PMID: 33726583 DOI: 10.1080/02713683.2021.1905000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Purpose/Aim: In the United States, high rates of vision impairment and eye disease disproportionately impact those who lack access to eye care, specifically vulnerable populations. The objective of our study was to test instruments, implement protocols, and collect preliminary data for a larger 5-year study, which aims to improve detection of eye diseases and follow-up eye care in vulnerable populations using community health workers (CHW) and patient navigators. In the study, trained CHWs conducted vision screening and patient navigators scheduled on-site eye exams and arranged appointments for those referred to ophthalmology to improve adherence to follow-up eye care.Materials and Methods: Eligible individuals age 40-and-older were recruited from the Riverstone Senior Center in Upper Manhattan, New York City. Participants underwent on-site vision screening (visual acuity with correction, intraocular pressure measurements, and fundus photography). Individuals who failed the vision screening were scheduled with an on-site optometrist for an eye exam; those with ocular pathologies were referred to an ophthalmologist. Participants were also administered the National Eye Institute Visual Function Questionnaire-8 (NEI-VFQ-8) and Stopping Elderly Accidents, Deaths, and Injuries (STEADI) test by community health workers.Results:Participants (n = 42) were predominantly older adults, with a mean age of 70.0 ± 9.8, female (61.9%), and Hispanic (78.6%). Most individuals (78.6%, n = 33) failed vision screening. Of those who failed, 84.8% (n = 28) attended the on-site eye exam with the optometrist. Ocular diagnoses: refractive error 13/28 (46.4%), glaucoma/glaucoma suspect 9/28 (32.1%), cataract 7/28 (25.0%), retina abnormalities 6/28 (21.4%); 13 people required eyeglasses.Conclusion: This study demonstrates the feasibility of using CHWs and patient navigators for reducing barriers to vision screening and optometrist-based eye exams in vulnerable populations, ultimately improving early detection of eye disease and linking individuals to additional eye care appointments. The full five-year study aims to further examine these outcomes.
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Affiliation(s)
- Lisa A Hark
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Camille S Tan
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Yocheved S Kresch
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - C Gustavo De Moraes
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason D Horowitz
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Park
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - James D Auran
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Prakash Gorroochurn
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Stella Stempel
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Stefania C Maruri
- Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Sonya Besagar
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jinan B Saaddine
- Centers for Disease Control and Prevention, Vision Health Initiative, Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Bianca C Lambert
- Department of General Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, New Brunswick, New Jersey, USA
| | - Saloni Sapru
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Simani Price
- Public Health and Epidemiology Practice, Westat, Inc., Rockville, Maryland, USA
| | - Olajide A Williams
- Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
| | - George A Cioffi
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey M Liebmann
- Department of Ophthalmology, Columbia Univertsity, Vagelos College of Physicians and Surgeons, New York, New York, USA.,Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York, USA
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Schafer JJ, McRae J, Prioli KM, Harris LF, McCoy M, Cannon-Dang E, Pizzi LT. Exploring beliefs about pneumococcal vaccination in a predominantly older African American population: the Pharmacists' Pneumonia Prevention Program (PPPP). Ethn Health 2021; 26:364-378. [PMID: 30175602 DOI: 10.1080/13557858.2018.1514450] [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] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
Objectives: To assess the association of the Pharmacists' Pneumonia Prevention Program (PPPP) with changes in beliefs related to pneumonia vaccination (PV) in a predominately older African American population.Methods: PPPP was an educational intervention delivered using a senior center model of care consisting of a formal pharmacist presentation, live skit, small group action planning, and optional PV. A 15-item instrument assessed participants' beliefs at baseline, post-test, and three months across four domains: pharmacists and pharmacies, vaccination, pneumococcal disease, and physicians. Friedman tests and pairwise Wilcoxon signed rank tests were used to determine the statistical significance of the mean change in belief responses across timepoints.Results: 190 older adults participated; the sample was majority female (76.3%) and African American (80.5%), and had a mean age of 74.3 years. Statistically significant improvements in beliefs at post-test were observed in the following domains: pharmacists and pharmacies, vaccination, and the pneumococcal disease; however, some of these gains were incompletely sustained at three months.Conclusion: PPPP positively impacted beliefs post-program regarding the pneumococcal disease, pharmacists and pharmacies, and vaccination; however, sustained efforts may be needed to reinforce these gains.Policy implications: Support for pharmacist educational services in senior centers should be considered.
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Affiliation(s)
- Jason J Schafer
- Department of Pharmacy Practice, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jacquelyn McRae
- Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, School of Pharmacy, Baltimore, MD, USA
| | - Katherine M Prioli
- Center for Health Outcomes, Policy, & Economics, Rutgers University, Piscataway, NJ, USA
| | - Lynn Fields Harris
- Grant Research and Development, Center in the Park, Philadelphia, PA, USA
| | - Megan McCoy
- Grant Research and Development, Center in the Park, Philadelphia, PA, USA
| | | | - Laura T Pizzi
- Center for Health Outcomes, Policy, & Economics, Rutgers University, Piscataway, NJ, USA
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16
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Pizzi LT, Leiby B, Chu DS, Gower EW, Ailani H, Shovlin J, Prioli KM, Shukla S, Patterson BJ, Rausch DA, Buck PO, Murchison AP. 1716. Prospective Multicenter Observational Cohort Study to Assess the Burden of Herpes Zoster Disease in the Eye: Baseline Results of Initial Patients. Open Forum Infect Dis 2020. [PMCID: PMC7777780 DOI: 10.1093/ofid/ofaa439.1894] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Herpes Zoster Ophthalmicus (HZO) affects 10-20% of adults with herpes zoster; ≥ 50% of these cases manifest as serious ocular diseases. This 1-year prospective observational cohort study aims to determine patient-reported HZO symptoms as well as economic and quality of life burden among 300 HZO patients from 6 major US ophthalmology practices. Here, we report baseline data from 13 initial enrollees.
Methods
Inclusion criteria were: participants ≥ 18 years, diagnosis of clinically active HZO, English or Spanish speaking, be willing and able to respond to study assessments, not be enrolled in a concurrent interventional HZO trial. Information are collected via 1) a clinical assessment form completed by the practice (baseline) and 2) patient questionnaires (baseline, 3, 6, and 12 months) on symptoms, medications, healthcare use, vision function, depression, and work productivity impact. Baseline results are presented for patients recruited during the first 6 months of enrollment from the first 4 sites to go live: diagnoses, and patient-reported symptoms and outcomes (eight-item Patient Health Questionnaire [PHQ-8] for depressive symptoms, National Eye Institute 25-item Visual Function Questionnaire [NEI-VFQ-25] for vision-related quality of life, and Zoster Brief Pain Inventory [ZBPI] for pain).
Results
The mean age of participants is 71 years; 11 are female and 9 are retired. Seven participants are college graduates or hold other degrees. All have health insurance coverage, with most (10) having primary insurance through Medicare. HZO diagnoses (Table 1) were: keratitis (4), iridocyclitis (4), conjunctivitis (1), other HZO diagnosis (3), other ocular diagnosis (6). Patient-reported symptoms (Table 2) were: pain above the eye, sensitivity to light, redness, feeling of sand/grit in the eye (9 each). The mean overall PHQ-8 and NEI-VFQ-25 scores were 5.9 (Standard Deviation [SD]:4.5) and 74.6 (SD:13.9), respectively; the mean ZBPI score for worst pain severity was 3.3 (SD:3.8) (Table 3).
Table 1. HZO Diagnosis at Baseline based on Clinical Assessment Form (N=13)
Table 2. Patient-reported Symptoms in the HZO-Affected Eye at Baseline (N=13)
Table 3. Patient-reported Outcomes: Depressive Symptoms, Vision-Related Quality of Life, and Herpes Zoster Pain at Baseline (N=13)
Conclusion
This study represents the first large scale effort to quantify HZO burden. Findings will inform development of a formal patient-reported symptom scale for use in research and clinical practice.
Funding
GlaxoSmithKline Biologicals SA (GSK study identifiers: 209235/HO-17-17967)
Disclosures
Laura T. Pizzi, PharmD, MPH, ORCID: 0000-0002-7366-7661, GlaxoSmithKline (Research Grant or Support) Soham Shukla, PharmD, ORCID: 0000-0002-4139-0856, GSK (Employee)Rutgers University (Employee) Brandon J. Patterson, PharmD, PhD, GSK (Employee, Shareholder) Debora A. Rausch, MD, ORCID: 0000-0001-9759-2687, GSK (Employee) Philip O. Buck, PhD, MPH, ORCID: 0000-0002-3898-3669, GSK (Employee, Shareholder) Ann P. Murchison, MD, MPH, GSK (Grant/Research Support)
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Affiliation(s)
| | | | - David S Chu
- Metropolitan Eye Research and Surgery Institute, Palisades Park, New Jersey
| | | | - Haresh Ailani
- Eye Consultants of Northern Virginia, Springfield, Virginia
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Pizzi LT, Prioli KM, Babcock Z, McAbee‐Sevick H, Wakefield D, Jutkowitz E, Fortinsky RH. Costs of the Care for Older Persons with Dementia in their Environment (COPE) intervention when delivered through the Connecticut state Medicaid waiver program. Alzheimers Dement 2020. [DOI: 10.1002/alz.047584] [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: 11/08/2022]
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18
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Fortinsky RH, Gitlin LN, Pizzi LT, Piersol CV, Grady J, Robison JT, Molony S, Wakefield D. Effectiveness of the Care of Persons With Dementia in Their Environments Intervention When Embedded in a Publicly Funded Home- and Community-Based Service Program. Innov Aging 2020; 4:igaa053. [PMID: 33367114 PMCID: PMC7745768 DOI: 10.1093/geroni/igaa053] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In the absence of effective pharmacotherapy, there is an urgent need to test evidence-based dementia care interventions using pragmatic trial approaches. We present results from a study in which an evidence-based, nonpharmacologic intervention for persons living with Alzheimer's disease and related dementia (ADRD) and their informal caregivers, Care of Persons with Dementia in their Environments (COPE), was tested in a Medicaid and state revenue-funded home and community-based service (HCBS) program. RESEARCH DESIGN AND METHODS Using pragmatic trial design strategies, persons living with ADRD and their caregivers were randomly assigned as dyads to receive COPE plus usual HCBS (COPE; n = 145 dyads) or usual HCBS only (Usual Care or UC; n = 146 dyads). Outcomes were measured prerandomization, and 4 and 12 months postrandomization. Outcomes for persons living with ADRD included functional independence, activity engagement, self-reported quality of life, and behavioral and psychological symptoms. Caregiver outcomes included perceived well-being, confidence using dementia management strategies, and degree of distress caused by behavioral and psychological symptoms. RESULTS After 4 months, caregivers receiving COPE reported greater perceived well-being (least squares mean = 3.2; 95% CI: 3.1-3.3) than caregivers receiving UC (3.0; 2.9-3.0; p < .001), and persons living with ADRD receiving COPE, compared to those receiving UC, showed a strong trend toward experiencing less frequent and less severe behavioral and psychological symptoms (9.7; 5.2-14.2 vs 12.7; 8.3-17.1; p = .07). After 12 months, persons living with ADRD receiving COPE were more engaged in meaningful activities (2.1; 2.0-2.1 vs 1.9; 1.9-2.0; p = .02) than those receiving UC. DISCUSSION AND IMPLICATIONS Embedding COPE in a publicly funded HCBS program yielded positive immediate effects on caregivers' well-being, marginal positive immediate effects on behavioral and psychological symptoms, and long-term effects on meaningful activity engagement among persons living with ADRD. Findings suggest that COPE can be effectively integrated into this service system, an important step towards widespread adoption. CLINICAL TRIALS REGISTRATION NUMBER NCT02365051.
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Affiliation(s)
- Richard H Fortinsky
- Center on Aging, School of Medicine, University of Connecticut, Farmington, USA
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- Center for Health Outcomes Research, Rutgers University, Piscataway, New Jersey, USA
| | | | - James Grady
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, USA
| | - Julie T Robison
- Center on Aging, School of Medicine, University of Connecticut, Farmington, USA
| | - Sheila Molony
- School of Nursing, Quinnipiac University, North Haven, Connecticut, USA
| | - Dorothy Wakefield
- Center on Aging, School of Medicine, University of Connecticut, Farmington, USA
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Gerlach JA, Snow B, Prioli KM, Vertsman R, Patterson J, Pizzi LT. Analysis of Stakeholder Engagement in the Public Comments of ICER Draft Evidence Reports. Am Health Drug Benefits 2020; 13:136-142. [PMID: 33343812 PMCID: PMC7737724] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/18/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health technology assessment is becoming increasingly important to healthcare payers' decision-making. The Institute for Clinical and Economic Review (ICER) is the most established US-based research group performing value assessments. ICER provides opportunities for stakeholder engagement, including a window of opportunity for public comments on the draft evidence report. Those public comments were reviewed in this study. OBJECTIVES To determine which stakeholders are most often commenting on ICER technology appraisal reports and to examine what aspects of the reports are the topics of these comments. METHOD We reviewed 7 ICER reports, which were used to extract stakeholder comments. All the identified comments were evaluated by 2 trained reviewers independently for stakeholder type, comment nature (positive or negative), and focus of comments (eg, methodology, data, real-world experience). Statistical analyses were used to analyze the reports for any associations between the frequency of the comments and the stakeholder type by therapeutic area. RESULTS A total of 463 comments were identified within the 55 letter submissions identified across the 7 ICER reviews that were included in the study. The quantity of the comments generally reflected the quantity of therapies that were included in the review. Drug manufacturers (63.1%), patients or patient advocacy groups (18.1%), and providers or provider groups (9.7%) were the stakeholders most often engaged in the public comments. The comments most often addressed the methodology of the value assessment (53.8%). Comments about missing data (14%), general criticism (8.2%), and general support (2.2%) were less common. CONCLUSION ICER is committed to engaging stakeholders in their value assessment process and adapting their strategies to improve such communications. Although ICER aims to influence payer decision-making, drug manufacturers were the most involved stakeholder in the assessment process, and they were most concerned with ICER's methodology. These results show the impact that ICER may have on decision-making in healthcare, emphasize the incentives that ICER drives for certain stakeholders, and highlight areas for further investigation.
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Affiliation(s)
- Jean A Gerlach
- PharmD Candidate, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ
| | - Brian Snow
- Biologic Programs Associate, Regeneron Pharmaceuticals, Tarrytown, PA
| | - Katherine M Prioli
- Senior Research Analyst, Center for Health Outcomes, Policy, & Economics, Rutgers University, Piscataway, NJ
| | - Ronald Vertsman
- Medical Student, Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ
| | - Julie Patterson
- Assistant Professor, Virginia Commonwealth University School of Pharmacy, Department of Pharmacotherapy and Outcomes Science
| | - Laura T Pizzi
- Professor and Director, Center for Health Outcomes, Policy & Economics, Rutgers University, Piscataway, NJ
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Pizzi LT, Onukwugha E, Corey R, Albarmawi H, Murray J. Competencies for Professionals in Health Economics and Outcomes Research: The ISPOR Health Economics and Outcomes Research Competencies Framework. Value Health 2020; 23:1120-1127. [PMID: 32940228 DOI: 10.1016/j.jval.2020.04.1834] [Citation(s) in RCA: 1] [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: 10/21/2019] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 06/11/2023]
Abstract
The need for Health Economics and Outcomes Research (HEOR) has expanded globally, fueling demand for professionals trained in the discipline. By leveraging the expertise and perspectives of its members, the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) established a set of competencies for HEOR professionals. The resulting 41 competencies were organized into 13 topic domains that collectively comprise the ISPOR Health Economics and Outcomes Research Competencies Framework. In this article, we explain the collaborative process used by the ISPOR Institutional Council and Faculty Advisor Council to identify and validate the framework. This process entailed expertise from the council members combined with natural language processing to examine competencies included in ISPOR Career Center HEOR job postings, qualitative input from a focused Institutional Council-Faculty Advisor Council workgroup, and quantitative input from 3 surveys of mutually exclusive member groups: a general member survey to assess importance and relevance of each competency, a faculty member survey to assess the extent to which HEOR graduate degree programs cover each of the competencies, and a student member survey to assess exposure to each of the competencies. Organization of the competencies into topic domains was achieved by engaging the Education Council, which applied a taxonomy consistent with ISPOR's educational programming. The resulting ISPOR Health Economics and Outcomes Research Competencies Framework has the important potential of serving as a tool to guide academic curricula, fellowships, and continuing education programs, and assessment of job candidates. As the HEOR field advances, so do the job types and the breadth of topics in which professionals must demonstrate competence. Future work will entail revisiting the competencies to ensure their currency and comprehensiveness, and tailoring the framework according to major specialty areas.
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Affiliation(s)
- Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA.
| | - Ebere Onukwugha
- Pharmaceutical Research Computing, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Husam Albarmawi
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - James Murray
- Global Patient Outcomes and Real-World Evidence, Eli Lilly and Company, Indianapolis, IN, USA
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21
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Mayro EL, Murchison AP, Hark LA, Silverstein M, Wang OY, Gilligan JP, Leiby BE, Pizzi LT, Casten RJ, Rovner BW, Haller JA. Prevalence of depressive symptoms and associated factors in an urban, ophthalmic population. Eur J Ophthalmol 2020; 31:740-747. [PMID: 31983234 DOI: 10.1177/1120672120901701] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of depressive symptoms in an adult ophthalmic patient population and to delineate correlates. DESIGN Cross-sectional study. PARTICIPANTS Adult patients (⩾18 years) were approached in general and sub-specialty cornea, retina, and glaucoma ophthalmic clinics. A total of 367 patients from the four clinics were enrolled. METHODS Depressive symptoms were assessed using the Patient Health Questionnaire-9. A cut-off score of ⩾10 was used to indicate clinically significant depressive symptoms. Patient Health Questionnaire-9 scores were used to evaluate bivariate relationships between depressive symptoms and distance visual acuity, ocular diagnosis, diabetes status, smoking status, demographic information, and medications. RESULTS The majority of patients were female (52.9%) and Caucasian (48.6%). The mean age was 52.0 years (standard deviation: 16.7). Clinically significant depressive symptoms were present in 19.9% of patients overall; this rate varied slightly by clinic. Patients with low vision and blindness (visual acuity worse than 20/60) were more likely to have depressive symptoms (odds ratio = 2.82; 95% confidence interval: 1.90-4.21). Smoking and diabetes were also associated with depressive symptoms (odds ratio = 3.11 (2.66-3.64) and 3.42 (1.90-6.16), respectively). CONCLUSION In a sample of urban ophthalmic adult patients, depressive symptoms were highly associated with low vision, smoking, and diabetes. This information can be used to target interventions to those at greatest risk of depressive symptoms.
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Affiliation(s)
- Eileen L Mayro
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
| | - Lisa A Hark
- Wills Eye Hospital, Philadelphia, PA, USA.,Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA.,Vagelos College of Physicians and Surgeons and Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, NY, USA
| | - Marlee Silverstein
- Department of Ophthalmology, The Ohio State University, Columbus, OH, USA
| | - Olivia Y Wang
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - John P Gilligan
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Benjamin E Leiby
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ, USA
| | - Robin J Casten
- Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barry W Rovner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Psychiatry & Human Behavior, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Department of Neurology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Wills Eye Hospital, Philadelphia, PA, USA
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22
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LaFontaine PR, Vogenberg FR, Pizzi LT. From Then Until Now: A Top-Down View Of The Affordable Care Act. P T 2019; 44:467-493. [PMID: 31447533 PMCID: PMC6679949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
How does the Patient Protection and Affordable Care Act (ACA) of 2010 differ from the act as it stands today? Many changes have occurred, in Medicaid expansion, private insurance coverage, the American Health Benefit Exchanges, and the individual mandate.
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23
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Pizzi LT, Prioli KM, Herman JH. Authors' Reply to Mintz: "Economic Implications of Pathogen Reduced and Bacterially Tested Platelet Components: A US Hospital Budget Impact Model". Appl Health Econ Health Policy 2019; 17:259-261. [PMID: 30680700 DOI: 10.1007/s40258-018-00459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ, USA.
| | - Katherine M Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ, USA
| | - Jay H Herman
- Transfusion Medicine, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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24
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Jutkowitz E, Scerpella D, Pizzi LT, Marx K, Samus Q, Piersol CV, Gitlin LN. Dementia Family Caregivers' Willingness to Pay for an In-home Program to Reduce Behavioral Symptoms and Caregiver Stress. Pharmacoeconomics 2019; 37:563-572. [PMID: 30877638 PMCID: PMC6465140 DOI: 10.1007/s40273-019-00785-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Our objective was to determine whether family caregivers of people with dementia (PwD) are willing to pay for an in-home intervention that provides strategies to manage behavioral symptoms and caregiver stress and to identify predictors of willingness-to-pay (WTP). METHODS During baseline interviews of a randomized trial and before treatment assignment, caregivers were asked how much they were willing to pay per session for an eight-session program over 3 months. We stratified the sample into those who refused to provide a WTP, those willing to pay $US0, and those willing to pay > $US0. We used a two-part model, controlling for demographic characteristics, to predict adjusted mean WTP and to examine associations between WTP, clinical features (cognition, function, behavioral symptoms), and time spent assisting PwD with daily activities. First, we used logistic regression to model the probability a caregiver was willing to pay > $US0. Second, we used a generalized linear model (log link and Gamma distribution) to estimate the amount caregivers were willing to pay conditional on WTP > $US0. RESULTS Of 250 dyads enrolled, 226 (90%) had complete data and were included in our analyses. Of 226 dyads, 26 (11%) refused to provide a WTP value, 72 (32%) were willing to pay $US0, and 128 (57%) were willing to pay > $US0. In the combined model, mean adjusted WTP was $US36.00 (95% confidence interval [CI] 26.72-45.27) per session. Clinical features were not significantly associated with WTP. One additional hour providing PwD assistance was associated with a $US1.64 (95% CI 0.23-3.04) increase in WTP per session. CONCLUSION As caregivers spend more time assisting with daily activities, they are willing to pay more for a supportive program. CLINICAL TRIAL REGISTRATION NUMBER NCT01892579.
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Affiliation(s)
- Eric Jutkowitz
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Box G-S121-6, 121 S. Main Street, 6th Floor, Providence, RI, 02912, USA.
| | - Danny Scerpella
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
| | - Laura T Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University Ernest Mario School of Pharmacy, Piscataway, NJ, USA
| | - Katherine Marx
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Laura N Gitlin
- Johns Hopkins University Center for Innovative Care in Aging, Baltimore, MD, USA
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
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25
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Hark LA, Myers JS, Ines A, Jiang A, Rahmatnejad K, Zhan T, Leiby BE, Hegarty S, Fudemberg SJ, Mantravadi AV, Waisbourd M, Henderer JD, Burns C, Divers M, Molineaux J, Pizzi LT, Murchison AP, Saaddine J, Pasquale LR, Haller JA, Katz LJ. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: confirmation between eye screening and comprehensive eye examination diagnoses. Br J Ophthalmol 2019; 103:1820-1826. [PMID: 30770354 DOI: 10.1136/bjophthalmol-2018-313451] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 10/26/2018] [Revised: 01/09/2019] [Accepted: 01/16/2019] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate agreement between ocular findings of a telemedicine eye screening (visit 1) with diagnoses of a comprehensive eye examination (visit 2). METHODS A primary care practice (PCP)-based telemedicine screening programme incorporating fundus photography, intraocular pressure (IOP) and clinical information was conducted. Eligible individuals were African American, Hispanic/Latino or Asian over the age of 40; Caucasian individuals over age 65; and adults of any ethnicity over age 40 with a family history of glaucoma or diabetes. Participants with abnormal images or elevated IOP were invited back for a complete eye examination. Both visit 1 and visit 2 were conducted at participants' local PCP. Ocular findings at visit 1 and eye examination diagnoses at visit 2 are presented, including a cost analysis. RESULTS Of 906 participants who attended visit 1, 536 were invited to visit 2 due to ocular findings or unreadable images. Among the 347 (64.9%) who attended visit 2, 280 (80.7%) were diagnosed with at least one ocular condition. Participants were predominately women (59.9%) and African American (65.6%), with a mean age (±SD) of 60.6±11.0 years. A high diagnostic confirmation rate (86.0%) was found between visit 1 and visit 2 for any ocular finding. Of 183 with suspicious nerves at visit 1, 143 (78.1%) were diagnosed as glaucoma or glaucoma suspects at visit 2. CONCLUSIONS This screening model may be adapted and scaled nationally and internationally. Referral to an ophthalmologist is warranted if abnormal or unreadable fundus images are detected or IOP is >21 mm Hg. TRIAL REGISTRATION NUMBER NCT02390245.
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Affiliation(s)
- Lisa A Hark
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA .,Ophthalmology, Columbia University Irving Medical Center, New York, New York, USA
| | - Jonathan S Myers
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Ines
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alicia Jiang
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamran Rahmatnejad
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Tingting Zhan
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Benjamin E Leiby
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sarah Hegarty
- Division of Biostatistics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Scott J Fudemberg
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anand V Mantravadi
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Jeffrey D Henderer
- Ophthalmology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Christine Burns
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Meskerem Divers
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jeanne Molineaux
- Glaucoma Research Center, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
| | - Ann P Murchison
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Emergency Department, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Jinan Saaddine
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Vision Health Initiative, Atlanta, Georgia, USA
| | - Louis R Pasquale
- Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Julia A Haller
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Wills Eye Hospital, Ophthalmologist-in-Chief, Philadelphia, Pennsylvania, USA
| | - L Jay Katz
- Glaucoma Service, Wills Eye Hospital, Philadelphia, Pennsylvania, USA.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Prioli KM, Karp JK, Lyons NM, Chrebtow V, Herman JH, Pizzi LT. Economic Implications of Pathogen Reduced and Bacterially Tested Platelet Components: A US Hospital Budget Impact Model. Appl Health Econ Health Policy 2018; 16:889-899. [PMID: 30062464 PMCID: PMC6244623 DOI: 10.1007/s40258-018-0409-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND US FDA draft guidance includes pathogen reduction (PR) or secondary rapid bacterial testing (RT) in its recommendations for mitigating risk of platelet component (PC) bacterial contamination. An interactive budget impact model was created for hospitals to use when considering these technologies. METHODS A Microsoft Excel model was built and populated with base-case costs and probabilities identified through literature search and a survey of US hospital transfusion service directors. Annual costs of PC acquisition, testing, wastage, dispensing/transfusion, sepsis, shelf life, and reimbursement for a mid-sized hospital that purchases all of its PCs were compared for four scenarios: 100% conventional PCs (C-PC), 100% RT-PC, 100% PR-PC, and 50% RT-PC/50% PR-PC. RESULTS Annual total costs were US$3.64, US$3.67, and US$3.96 million when all platelets were C-PC, RT-PC, or PR-PC, respectively, or US$3.81 million in the 50% RT-PC/50% PR-PC scenario. The annual net cost of PR-PC, obtained by subtracting annual reimbursements from annual total costs, is 6.18% above that of RT-PC. Maximum usable shelf lives for C-PC, RT-PC, and PR-PC are 3.0, 5.0, and 3.6 days, respectively; hospitals obtain PR-PC components earliest at 1.37 days. CONCLUSION The model predicts minimal cost increase for PR-PC versus RT-PC, including cost offsets such as elimination of bacterial detection and irradiation, and reimbursement. Additional safety provided by PR, including risk mitigation of transfusion-transmission of a broad spectrum of viruses, parasites, and emerging pathogens, may justify this increase. Effective PC shelf life may increase with RT, but platelets can be available sooner with PR due to elimination of bacterial detection, depending on blood center logistics.
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Affiliation(s)
- Katherine M. Prioli
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ 08854 USA
| | - Julie Katz Karp
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107 USA
| | - Nina M. Lyons
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA 19107 USA
| | - Vera Chrebtow
- Global Marketing and Communications, Cerus Corporation, 2550 Stanwell Drive, Concord, CA 94520 USA
| | - Jay H. Herman
- Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA 19107 USA
| | - Laura T. Pizzi
- Center for Health Outcomes, Policy, and Economics, Rutgers University, 160 Frelinghuysen Road, Suite 417, Piscataway, NJ 08854 USA
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Mayro EL, Pizzi LT, Hark LA, Murchison AP, Wisner D, Koka A, Leiby BE, Dabbish N, Okulate A, Dessy A, Green C, Bailey R. A Proposed Intervention to Decrease Resident-Performed Cataract Surgery Cancellation in a Tertiary Eye Care Center. Am Health Drug Benefits 2018; 11:480-487. [PMID: 30746019 PMCID: PMC6322594] [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] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/15/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cataracts are the leading cause of preventable blindness globally. As a result, competence in cataract surgery is an important component of ophthalmology residency training. Residency programs must optimize the number of cataract surgery cases to train proficient physicians. However, the rate of cataract surgery cancellations is high, and some are canceled because of preventable causes. OBJECTIVE To evaluate the effect of mandatory on-site preadmission testing, including having a physical examination, on resident-performed cataract surgery cancellation rates. METHODS For this study, patients scheduled for cataract surgery at the Wills Eye Hospital resident cataract clinic between January 2015 and November 2015 were enrolled and randomized into 2 groups: usual care or intervention. The patients randomized to the usual care group were instructed to complete preadmission testing and to have a physical examination with their primary care physician. The patients randomized to the intervention group were escorted to a Wills Eye Hospital-affiliated cardiologist to complete preadmission testing and to have a physical examination. Patients in both groups received a reminder call before the cataract surgery. RESULTS A total of 441 patients were included in the study-240 patients in the usual care group and 201 patients in the intervention group. The overall cataract surgery cancellation rate was 14.5%; the rate was 12.4% in the intervention group and 16.3% in the usual care group (P = .28). The patients receiving the intervention were more likely to have preadmission testing and a physical examination than the patients in the usual care arm (P <.001). CONCLUSIONS Facilitating the completion of preadmission testing for patients decreased the rates of resident-performed cataract surgery cancellation at a Wills Eye Hospital resident clinic and has the potential to improve patient outcomes and prevent blindness.
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Affiliation(s)
- Eileen L Mayro
- Research Coordinator, Department of Research, Wills Eye Hospital, Philadelphia, PA, and Student, Sidney Kimmel Medical College, Thomas Jefferson University (TJU), Philadelphia
| | - Laura T Pizzi
- Professor and Director, Center for Health Outcomes, Policy, and Economics, Rutgers University, Piscataway, NJ
| | - Lisa A Hark
- Director, Department of Research, Wills Eye Hospital, and Professor of Ophthalmic Sciences (Ophthalmology), Columbia University Vegalos College of Physicians and Surgeons, New York, NY
| | - Ann P Murchison
- Attending Surgeon and Director, Emergency Department, Wills Eye Hospital, and Associate Professor of Ophthalmology, Sidney Kimmel Medical College, TJU
| | - Douglas Wisner
- Attending Surgeon, Cataract and Primary Eye Care Service, Wills Eye Hospital
| | - Anish Koka
- Attending Physician, Koka Cardiology, TJU
| | - Benjamin E Leiby
- Associate Professor and Director, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, TJU
| | - Nooreen Dabbish
- Biostatistician, Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, TJU
| | | | - Alexa Dessy
- Students, all at Sidney Kimmel Medical College, TJU
| | | | - Robert Bailey
- Attending Surgeon and Director, Cataract and Primary Eye Care Service, Wills Eye Hospital and Professor of Ophthalmology, Sidney Kimmel Medical College, TJU
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Fortinsky RH, Gitlin LN, Grady JA, Piersol CV, Pizzi LT, Robison JT. EMERGING FINDINGS FROM THE COPE-CT STUDY: COHORT CHARACTERISTICS & INTERVENTION EFFECTS ON OUTCOMES. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.3059] [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: 11/14/2022] Open
Affiliation(s)
- R H Fortinsky
- Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut, United States
| | - L N Gitlin
- College of Nursing and Health Professions, Drexel University, Philadelphia, PA, USA
| | - J A Grady
- Department of Community Medicine and Health Care, University of Connecticut School of Medicine, Farmington, CT, USA
| | - C V Piersol
- OTR/L, FAOTA, Jefferson School of Health Professions, Philadelphia, PA, USA
| | - L T Pizzi
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | - J T Robison
- UConn Center on Aging, University of Connecticut School of Medicine, Farmington, CT, USA
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Pizzi LT, Prioli KM, Fields Harris L, Cannon-Dang E, Marthol-Clark M, Alcusky M, McCoy M, Schafer JJ. Knowledge, Activation, and Costs of the Pharmacists' Pneumonia Prevention Program (PPPP): A Novel Senior Center Model to Promote Vaccination. Ann Pharmacother 2017; 52:446-453. [PMID: 29172664 DOI: 10.1177/1060028017745566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/17/2022] Open
Abstract
BACKGROUND Vaccination is the best way to prevent pneumococcal disease (PD), but 40% of older adults remain unvaccinated nationwide, with even greater nonvaccination rates among African Americans (AAs). Prior studies suggest that insufficient knowledge contributes to low vaccination rates. The Pharmacists' Pneumonia Prevention Program (PPPP) was designed to improve older adults' knowledge about PD and pneumococcal vaccination (PV). OBJECTIVE To measure PPPP's effect on knowledge and activation in a predominantly AA population and determine program costs. METHODS PPPP uses a senior center model with a pharmacist presentation, actors' skit, and small-group action planning. Knowledge about PD risk, transmission, symptoms, and PV side effects was assessed at baseline (BL), postintervention (PT), and 3 months (M3) and analyzed using an intention-to-treat (ITT) approach. Actions taken (got vaccinated, spoke to doctor or pharmacist, discussed with family/friends) were assessed at M3. PPPP costs ($US 2013) included staff time, PV, actor, and site fees. RESULTS Of 276 attending PPPP, 190 consented and were included in the ITT sample, which was largely black (80.5%) and female (76.3%) and had a mean age of 74.4 years. Knowledge improved by 46.8% (BL vs PT), with significant gains in all domains. At M3, knowledge improved by 54.2% vs BL, indicating sustained gains; 37.2% of previously unvaccinated participants reported receiving PV by M3. Program cost was $119 per attendee. CONCLUSION PPPP significantly improved PD and PV knowledge. It could be delivered more efficiently by holding larger events on fewer dates, staffing with volunteers where appropriate, and utilizing a local pharmacy to manage the vaccine supply.
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Affiliation(s)
| | | | | | | | | | - Matt Alcusky
- 4 University of Massachusetts Medical School, Worcester, MA, USA
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Hark LA, Katz LJ, Myers JS, Waisbourd M, Johnson D, Pizzi LT, Leiby BE, Fudemberg SJ, Mantravadi AV, Henderer JD, Zhan T, Molineaux J, Doyle V, Divers M, Burns C, Murchison AP, Reber S, Resende A, Bui TDV, Lee J, Crews JE, Saaddine JB, Lee PP, Pasquale LR, Haller JA. Philadelphia Telemedicine Glaucoma Detection and Follow-up Study: Methods and Screening Results. Am J Ophthalmol 2017; 181:114-124. [PMID: 28673747 DOI: 10.1016/j.ajo.2017.06.024] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe methodology and screening results from the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study. DESIGN Screening program results for a prospective randomized clinical trial. METHODS Individuals were recruited who were African-American, Hispanic/Latino, or Asian over age 40 years; white individuals over age 65 years; and any ethnicity over age 40 years with a family history of glaucoma or diabetes. Primary care offices and Federally Qualified Health Centers were used for telemedicine (Visit 1). Two posterior fundus photographs and 1 anterior segment photograph were captured per eye in each participant, using a nonmydriatic, autofocus, hand-held fundus camera (Volk Optical, Mentor, Ohio, USA). Medical and ocular history, family history of glaucoma, visual acuity, and intraocular pressure measurements using the ICare rebound tonometer (ICare, Helsinki, Finland) were obtained. Images were read remotely by a trained retina reader and a glaucoma specialist. RESULTS From April 1, 2015, to February 6, 2017, 906 individuals consented and attended Visit 1. Of these, 553 participants were female (61.0%) and 550 were African-American (60.7%), with a mean age of 58.7 years. A total of 532 (58.7%) participants had diabetes, and 616 (68%) had a history of hypertension. During Visit 1, 356 (39.3%) participants were graded with a normal image. Using image data from the worse eye, 333 (36.8%) were abnormal and 155 (17.1%) were unreadable. A total of 258 (28.5%) had a suspicious nerve, 62 (6.8%) had ocular hypertension, 102 (11.3%) had diabetic retinopathy, and 68 (7.5%) had other retinal abnormalities. CONCLUSION An integrated telemedicine screening intervention in primary care offices and Federally Qualified Health Centers detected high rate of suspicious optic nerves, ocular hypertension, and retinal pathology.
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Prioli KM, Pizzi LT, Kash KM, Newberg AB, Morlino AM, Matthews MJ, Monti DA. Costs and Effectiveness of Mindfulness-Based Art Therapy versus Standard Breast Cancer Support Group for Women with Cancer. Am Health Drug Benefits 2017; 10:288-295. [PMID: 28975012 PMCID: PMC5620510] [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] [Grants] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The results of several studies have demonstrated that women and men with a cancer diagnosis benefit from interventions to reduce distress and improve quality of life (QOL). However, little is known about the costs and effectiveness of such interventions. Identifying a stress-reduction program that is low cost and effective is important for payers, employers, and healthcare professionals, as well as for patients with cancer. OBJECTIVE To evaluate the direct costs and effectiveness of the mindfulness-based art therapy (MBAT) program compared with the cost and effectiveness of a breast cancer support group (BCSG). METHODS This economic pilot study evaluated the direct costs and effectiveness of a mindfulness-based intervention for stress reduction in patients with breast cancer who are receiving care versus the cost of a usual care support group used as the comparator. The cost variables for each cohort included the cost of program delivery (ie, staff and supplies), mileage reimbursements, medication costs, and healthcare utilization costs. Effectiveness was measured by a change in quality-adjusted life-year derived from the 36-Item Short-Form Health Survey (SF-36) QOL battery. RESULTS Overall, the cost for 191 participants in the MBAT intervention group was $992.49 per participant compared with $562.71 per participant for the BCSG intervention. Both interventions achieved a similar change in healthcare utilization based on the SF-36 QOL battery. Although the MBAT intervention was more costly than a BCSG intervention, sensitivity analysis showed that the cost-effectiveness of the MBAT intervention could achieve parity with that of a BCSG if some intervention-related costs, such as staff time and supplies, were reduced. CONCLUSION As psychosocial cancer care becomes more refined with time, it will be important to determine the best and most cost-effective interventions for patients with cancer, particularly in light of healthcare reform. Information from this study could help inform payers, employers, and other stakeholders regarding which interventions would be least costly and most effective for patients with cancer.
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Affiliation(s)
| | - Laura T Pizzi
- Professor and Director, Center for Health Outcomes, Policy, and Economics, Rutgers University
| | | | - Andrew B Newberg
- Professor, Myrna Brind Center of Integrative Medicine, Philadelphia, PA
| | | | | | - Daniel A Monti
- Professor and Director, Myrna Brind Center of Integrative Medicine
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Nightingale G, Hajjar E, Pizzi LT, Wang M, Pigott E, Doherty S, Prioli KM, Swartz K, Chapman AE. Implementing a pharmacist-led, individualized medication assessment and planning (iMAP) intervention to reduce medication related problems among older adults with cancer. J Geriatr Oncol 2017; 8:296-302. [DOI: 10.1016/j.jgo.2017.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 02/23/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
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Pizzi LT, Waisbourd M, Hark L, Sembhi H, Lee P, Crews JE, Saaddine JB, Steele D, Katz LJ. Costs of a community-based glaucoma detection programme: analysis of the Philadelphia Glaucoma Detection and Treatment Project. Br J Ophthalmol 2017; 102:225-232. [DOI: 10.1136/bjophthalmol-2016-310078] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/28/2017] [Accepted: 05/03/2017] [Indexed: 01/25/2023]
Abstract
BackgroundGlaucoma is the foremost cause of irreversible blindness, and more than 50% of cases remain undiagnosed. Our objective was to report the costs of a glaucoma detection programme operationalised through Philadelphia community centres.MethodsThe analysis was performed using a healthcare system perspective in 2013 US dollars. Costs of examination and educational workshops were captured. Measures were total programme costs, cost/case of glaucoma detected and cost/case of any ocular disease detected (including glaucoma). Diagnoses are reported at the individual level (therefore representing a diagnosis made in one or both eyes). Staff time was captured during site visits to 15 of 43 sites and included time to deliver examinations and workshops, supervision, training and travel. Staff time was converted to costs by applying wage and fringe benefit costs from the US Bureau of Labor Statistics. Non-staff costs (equipment and mileage) were collected using study logs. Participants with previously diagnosed glaucoma were excluded.Results1649 participants were examined. Mean total per-participant examination time was 56 min (SD 4). Mean total examination cost/participant was $139. The cost/case of glaucoma newly identified (open-angle glaucoma, angle-closure glaucoma, glaucoma suspect, or primary angle closure) was $420 and cost/case for any ocular disease identified was $273.ConclusionGlaucoma examinations delivered through this programme provided significant health benefit to hard-to-reach communities. On a per-person basis, examinations were fairly low cost, though opportunities exist to improve efficiency. Findings serve as an important benchmark for planning future community-based glaucoma examination programmes.
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Murchison AP, Hark L, Pizzi LT, Dai Y, Mayro EL, Storey PP, Leiby BE, Haller JA. Non-adherence to eye care in people with diabetes. BMJ Open Diabetes Res Care 2017; 5:e000333. [PMID: 28878930 PMCID: PMC5574424 DOI: 10.1136/bmjdrc-2016-000333] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/31/2017] [Accepted: 06/05/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Evaluate individual factors that impact adherence to eye care follow-up in patients with diabetes. DESIGN AND METHODS A 4-year retrospective chart review was conducted for 1968 patients with diabetes over age 40 from an urban academic center. Data collected included demographics, insurance, visual acuity, smoking status, medications, dates of dilated fundus examinations (DFE), and reported hemoglobin A1C and blood glucose levels. The primary outcome was timely DFE follow-up adherence following the initial eye exam visit. RESULTS Overall, 41.6% of patients adhered to initial follow-up eye care recommendations. Multivariable analysis demonstrated that patients with severe diabetic retinopathy (DR) were more adherent than patients with mild DR (OR 1.86). Other variables associated with increased adherence were visual impairment and reported A1C or blood glucose. Smoking was associated with decreased adherence. Ethnicity and insurance were also significantly associated with adherence. Longitudinal follow-up rates were influenced by additional factors, including ethnicity and neighborhood deprivation index. CONCLUSIONS Patients with moderate to severe DR and/or visual impairment were more likely to adhere to timely DFE follow-up. This could relate to the presence of visual symptoms and/or other systemic manifestations of diabetes. Smokers were less likely to adhere to timely DFE follow-up. One hypothesis is patients who smoke have other symptomatic health problems which patients prioritize over asymptomatic ocular disorders. In order to reduce vision loss from DR, practitioners should be aware that patients with mild and moderate DR, patients with normal vision, and smokers are at greater risk for poor follow-up eye care adherence.
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Affiliation(s)
- Ann P Murchison
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Lisa Hark
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Laura T Pizzi
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Dai
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Eileen L Mayro
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | - Philip P Storey
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
| | | | - Julia A Haller
- Department of Research, Wills Eye Hospital, Philadelphia, Pennsylvania, USA
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Winters D, Casten R, Rovner B, Murchison A, Leiby BE, Haller JA, Hark L, Weiss DM, Pizzi LT. Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes. Am J Med Qual 2016; 32:661-667. [DOI: 10.1177/1062860616680290] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.
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Affiliation(s)
| | - Robin Casten
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Barry Rovner
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | | | - Benjamin E. Leiby
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | | | - Lisa Hark
- Wills Eye Hospital, Philadelphia, PA
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Prioli KM, Pizzi LT, Karp JK, Galanis T, Herman JH. Cost of Purchased Versus Produced Plasma from Donor Recruitment Through Transfusion. Appl Health Econ Health Policy 2016; 14:609-617. [PMID: 27392967 DOI: 10.1007/s40258-016-0255-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Plasma is used to treat acquired coagulopathy or thrombotic thrombocytopenic purpura, or to reverse warfarin effect. Scant data are available, however, about its costs. OBJECTIVE To estimate total costs of plasma from production through administration, from the perspective of a US hospital blood donor center (BDC). STUDY DESIGN AND METHODS Six sequential decision analytic models were constructed and informed by primary and secondary data on time, tasks, personnel, and supplies for donation, processing, and administration. Expected values of the models were summed to yield the BDC's total cost of producing, preparing, and transfusing plasma. Costs ($US 2015) are reported for a typical patient using three units of plasma. Models assume plasma was obtained from whole blood donation and transfused in an inpatient setting. Univariate sensitivity analyses were performed to test the impact of changing inputs for personnel costs and adverse event (AE) rates and costs. RESULTS BDC production cost of plasma was $91.24/patient ($30.41/unit), a $30.16/patient savings versus purchased plasma. Administration and monitoring costs totaled $194.64/patient. Sensitivity analyses indicated that modifying BDC personnel costs during donation and processing has little impact on total plasma costs. However, the probability and cost of transfusion-associated circulatory overload (TACO) have a significant impact on costs. CONCLUSION Plasma produced by our BDC may be less costly than purchased plasma. Though plasma processes have multiple tasks involving staff time, these are not the largest cost driver. Major plasma-related AEs are uncommon, but are the biggest driver of total plasma costs.
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Affiliation(s)
- Katherine M Prioli
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA, 19107, USA.
| | - Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Suite 901, Philadelphia, PA, 19107, USA
| | - Julie Katz Karp
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Taki Galanis
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
| | - Jay H Herman
- Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA
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Fortinsky RH, Gitlin LN, Grady J, Piersol CV, Pizzi LT, Robison JT, Molony S. O2‐01‐02: Translating the Care of Persons With Dementia in Their Environments (COPE) Intervention for Use in Publicly Funded Home Care Programs in the United States. Alzheimers Dement 2016. [DOI: 10.1016/j.jalz.2016.06.2373] [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: 12/01/2022]
Affiliation(s)
| | | | - James Grady
- University of Connecticut School of MedicineFarmingtonCT USA
| | | | - Laura T. Pizzi
- Thomas Jefferson University College of PharmacyPhiladelphiaPA USA
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Fortinsky RH, Gitlin LN, Pizzi LT, Piersol CV, Grady J, Robison JT, Molony S. Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design. Contemp Clin Trials 2016; 49:155-65. [PMID: 27394383 PMCID: PMC4979745 DOI: 10.1016/j.cct.2016.07.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [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: 04/22/2016] [Revised: 07/03/2016] [Accepted: 07/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. METHODS The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. OUTCOMES The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide.
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Affiliation(s)
- Richard H Fortinsky
- Center on Aging, School of Medicine, University of Connecticut, United States.
| | - Laura N Gitlin
- School of Nursing, Johns Hopkins University, United States
| | - Laura T Pizzi
- College of Pharmacy, Thomas Jefferson University, United States
| | | | - James Grady
- Department of Community Medicine and Health Care, School of Medicine, University of Connecticut, United States
| | - Julie T Robison
- Center on Aging, School of Medicine, University of Connecticut, United States
| | - Sheila Molony
- School of Nursing, Quinnipiac University, United States
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Pizzi LT, Tran J, Shafa A, Waisbourd M, Hark L, Murchison AP, Dai Y, Mayro EL, Haller JA. Effectiveness and Cost of a Personalized Reminder Intervention to Improve Adherence to Glaucoma Care. Appl Health Econ Health Policy 2016; 14:229-40. [PMID: 26924099 DOI: 10.1007/s40258-016-0231-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Glaucoma is the leadi ng cause of irreversible blindness in the USA. Glaucomatous vision loss is preventable with proper eye care, including appointment adherence. Therefore, interventions that improve appointment adherence can reduce the number of patients with more severe glaucoma. OBJECTIVES The primary study aim was to determine the efficacy and cost-effectiveness of a multifaceted personal reminder intervention, which included a customized letter and personal telephone outreach, in improving appointment adherence of patients with glaucoma. A secondary study aim was to identify patient characteristics that were associated with non-adherence. METHODS This prospective, randomized, controlled study included a cost-effectiveness analysis completed using a decision analytic model. The subjects included 256 patients with glaucoma. Study measures included appointment adherence and incremental cost effectiveness ratios. RESULTS Patients in the intervention group were more likely to adhere to appointments (82.31 vs. 69.05 %; RR 1.23; 95 % CI 1.04-1.37, p < 0.012) than patients in the usual care group. Patients in the intervention group were 23 % more likely to adhere to appointments (RR 1.23; 95 % CI 1.08-1.41, p < 0.0021) than patients in the usual care group, when adjusting for age, secondary insurance, primary open angle glaucoma diagnosis, number of previous visits at Wills Eye Hospital, and follow-up recommendation using Poisson regression. Per-patient cost of the program was US$11.32, and cost per follow-up attended within the adherence window was US$73.56. CONCLUSIONS A low cost reminder intervention consisting of a personalized letter and telephone outreach significantly improved appointment adherence of patients with glaucoma.
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Affiliation(s)
- Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Room 911, Philadelphia, PA, 19107, USA.
| | - Judie Tran
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Anousheh Shafa
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Michael Waisbourd
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Lisa Hark
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Ann P Murchison
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Yang Dai
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Eileen L Mayro
- Wills Eye Hospital Glaucoma Research Center, 840 Walnut Street Suite 1140, Philadelphia, PA, USA
| | - Julia A Haller
- Wills Eye Hospital, 840 Walnut Street Suite 1500, Philadelphia, PA, USA
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Pizzi LT. The Institute for Clinical and Economic Review and Its Growing Influence on the US Healthcare. Am Health Drug Benefits 2016; 9:9-10. [PMID: 27066190 PMCID: PMC4822973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Laura T Pizzi
- Professor, Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA, and Deputy Editor, American Health & Drug Benefits
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Schafer JJ, Naples JG, Pizzi LT, DeSimone JA. The effects of a pharmacist-delivered patient education programme on retention in human immunodeficiency virus care: a pilot study. Journal of Pharmaceutical Health Services Research 2015. [DOI: 10.1111/jphs.12092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jason J. Schafer
- Department of Pharmacy Practice; Jefferson School of Pharmacy; Thomas Jefferson University; Philadelphia USA
| | - Jennifer Greene Naples
- Division of Geriatric Medicine; The University of Pittsburgh Medical Center; Pittsburgh PA USA
| | - Laura T. Pizzi
- Department of Pharmacy Practice; Jefferson School of Pharmacy; Thomas Jefferson University; Philadelphia USA
| | - Joseph A. DeSimone
- Jefferson Medical College; Division of Infectious Diseases; Thomas Jefferson University; Philadelphia USA
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Pizzi LT, Zangalli CS, Murchison AP, Hale N, Hark L, Dai Y, Leiby BE, Haller JA. Prospective randomized controlled trial comparing the outcomes and costs of two eyecare adherence interventions in diabetes patients. Appl Health Econ Health Policy 2015; 13:253-63. [PMID: 25786858 DOI: 10.1007/s40258-015-0159-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Diabetic retinopathy is one of the leading causes of vision impairment among adults in the USA. While it is suggested that diabetics receive annual dilated fundus examinations (DFE), many patients do not adhere to these recommendations. This paper investigates the outcomes and costs of an educational and telephone intervention on DFE follow-up adherence in patients with diabetes. METHODS In a prospective trial, 356 diabetic patients due for a DFE at an urban eye clinic were randomly assigned to usual care (UC; reference case), mailed intervention (MI), or telephone intervention (TI). UC patients (n = 119) received a standard form letter. MI patients (n = 117) received a personalized letter encouraging scheduling of an eye examination with an educational brochure about diabetic eye disease. TI patients (n = 120) received personal calls (up to three attempts) to schedule a follow-up with standard form letter. The primary outcome was obtaining a DFE within 90 days of suggested return. Costs (US$ 2013) included time costs for staff, phone charges, supplies, and postage. Since TI involved greater cost components compared to MI, univariate sensitivity analysis examined the impact of reducing phone costs. RESULTS Patients were mostly female (66 %) and African American (70 %) with a mean age of 61 years. TI patients were more likely to schedule DFE [65 vs. 42 %; relative risk (RR) 1.54; CI 1.20-1.96; P < 0.001] versus UC patients. Obtaining a DFE within 90 days of suggested return was also significantly higher among TI patients compared to UC patients (51 vs. 36 %, RR 1.41; CI 1.05-1.89; P = 0.024). MI patients were slightly less likely to schedule DFE versus UC patients (38 vs. 42 %, RR 0.90; CI 0.66-1.22; P = NSS) and obtain a DFE (32 vs. 36 %; RR 0.90; CI 0.63-1.28; P = NSS). The total cost of TI was US$798.28 or US$6.65/patient and the cost/follow-up DFE was US$26.05. Sensitivity analyses revealed that the cost/follow-up can be greatly reduced but remains greater compared to UC (US$2.76 if US$0.25/call, US$11.13 if $1/call; US$22.29 if US$2/call). CONCLUSIONS Personal phone assistance in scheduling DFE follow-up is more effective but also more costly. Follow-up research has been initiated to determine whether automated phone reminders can achieve similar effectiveness at a lower cost.
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Affiliation(s)
- Laura T Pizzi
- Jefferson School of Pharmacy, Thomas Jefferson University, 901 Walnut Street, Suite 911, Philadelphia, PA, 19107, USA,
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Pizzi LT, Snitzer M, Amos T, Prioli KM, Steele D, Levin AV. Cost and effectiveness of an eye care adherence program for Philadelphia children with significant visual impairment. Popul Health Manag 2015; 18:223-31. [PMID: 25647611 DOI: 10.1089/pop.2014.0090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The follow-up rate among children with vision problems in the authors' outreach programs has been <5%. The authors therefore developed a social worker (SW) intervention, the Children's Eye Care Adherence Program (CECAP), for Philadelphia school children. The objective of this study was to measure CECAP's effectiveness and cost, as well as to identify barriers to care through a conceptual framework and geomapping software. A SW reviewed records to identify children needing follow-up and phoned families to identify and resolve barriers to eye care and scheduled appointments. Effectiveness was defined as the percent completing ≥ 1 follow-up visit within the physician-recommended time frame. Cost was measured for SW time (SW wage rates+benefits) and additional materials (forms, postage, phone charges). Barriers were organized into a conceptual framework depicting predisposing factors, system factors, and financial factors. Geomapping software was used to illustrate follow-up rates. In all, 120 patients required additional pediatric ophthalmic care; 71 patients were contacted and returned for care (59.2%); 49 patients were contacted but did not return (40.8%). SW time was 3h rs/patient for those who returned and 2 hrs/patient for those who did not return. Based on the CECAP program total cost ($14,249) and the reimbursement payment ($6265.66), the net cost of the CECAP program was $7983.59. Predisposing factors were the primary barrier theme for patients who did not follow up. CECAP significantly improved adherence to eye care but comes at an additional cost. Future efforts should focus on reducing operational efficiencies and targeting CECAP based on predictors of follow-up.
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Affiliation(s)
- Laura T Pizzi
- 1Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Melanie Snitzer
- 2Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Tony Amos
- 3Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Katherine M Prioli
- 1Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Deon Steele
- 1Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alex V Levin
- 2Pediatric Ophthalmology and Ocular Genetics, Wills Eye Hospital, Philadelphia, Pennsylvania
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Pizzi LT, Jutkowitz E, Frick KD, Suh DC, Prioli KM, Gitlin LN. Cost-Effectiveness of a Community-Integrated Home-Based Depression Intervention in Older African Americans. J Am Geriatr Soc 2014; 62:2288-95. [DOI: 10.1111/jgs.13146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Laura T. Pizzi
- Jefferson School of Pharmacy; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Eric Jutkowitz
- Division of Health Policy and Management; University of Minnesota; Minneapolis Minnesota
| | - Kevin D. Frick
- The Johns Hopkins Carey Business School; Johns Hopkins University; Baltimore Maryland
| | - Dong-Churl Suh
- College of Pharmacy; Chung-Ang University; Seoul South Korea
| | - Katherine M. Prioli
- Jefferson School of Pharmacy; Thomas Jefferson University; Philadelphia Pennsylvania
| | - Laura N. Gitlin
- Department of Community Public Health; School of Nursing; Johns Hopkins University; Baltimore Maryland
- Division of Geriatrics and Gerontology; Department of Psychiatry; School of Medicine; Johns Hopkins University; Baltimore Maryland
- Center for Innovative Care in Aging; Johns Hopkins University; Baltimore Maryland
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Abstract
BACKGROUND Gout is the most common inflammatory arthritis in the United States. OBJECTIVE To evaluate the cost-effectiveness of urate-lowering treatment strategies for the management of gout. DESIGN Markov model. DATA SOURCES Published literature and expert opinion. TARGET POPULATION Patients for whom allopurinol or febuxostat is a suitable initial urate-lowering treatment. TIME HORIZON Lifetime. PERSPECTIVE Health care payer. INTERVENTION 5 urate-lowering treatment strategies were evaluated: no treatment; allopurinol- or febuxostat-only therapy; allopurinol-febuxostat sequential therapy; and febuxostat-allopurinol sequential therapy. Two dosing scenarios were investigated: fixed dose (80 mg of febuxostat daily, 0.80 success rate; 300 mg of allopurinol daily, 0.39 success rate) and dose escalation (≤120 mg of febuxostat daily, 0.82 success rate; ≤800 mg of allopurinol daily, 0.78 success rate). OUTCOME MEASURES Discounted costs, discounted quality-adjusted life-years, and incremental cost-effectiveness ratios. RESULTS OF BASE-CASE ANALYSIS In both dosing scenarios, allopurinol-only therapy was cost-saving. Dose-escalation allopurinol-febuxostat sequential therapy was more costly but more effective than dose-escalation allopurinol therapy, with an incremental cost-effectiveness ratio of $39 400 per quality-adjusted life-year. RESULTS OF SENSITIVITY ANALYSIS The relative rankings of treatments did not change. Our results were relatively sensitive to several potential variations of model assumptions; however, the cost-effectiveness ratios of dose escalation with allopurinol-febuxostat sequential therapy remained lower than the willingness-to-pay threshold of $109 000 per quality-adjusted life-year. LIMITATION Long-term outcome data for patients with gout, including medication adherence, are limited. CONCLUSION Allopurinol single therapy is cost-saving compared with no treatment. Dose-escalation allopurinol-febuxostat sequential therapy is cost-effective compared with accepted willingness-to-pay thresholds. PRIMARY FUNDING SOURCE Agency for Healthcare Research and Quality.
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Affiliation(s)
- Eric Jutkowitz
- From the University of Minnesota, Minneapolis, Minnesota; Harvard Medical School, Boston, Massachusetts; and Jefferson School of Pharmacy, Philadelphia, Pennsylvania
| | - Hyon K. Choi
- From the University of Minnesota, Minneapolis, Minnesota; Harvard Medical School, Boston, Massachusetts; and Jefferson School of Pharmacy, Philadelphia, Pennsylvania
| | - Laura T. Pizzi
- From the University of Minnesota, Minneapolis, Minnesota; Harvard Medical School, Boston, Massachusetts; and Jefferson School of Pharmacy, Philadelphia, Pennsylvania
| | - Karen M. Kuntz
- From the University of Minnesota, Minneapolis, Minnesota; Harvard Medical School, Boston, Massachusetts; and Jefferson School of Pharmacy, Philadelphia, Pennsylvania
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Zangalli CS, Murchison AP, Hale N, Hark LA, Pizzi LT, Dai Y, Leiby BE, Haller JA. An Education- and Telephone-Based Intervention to Improve Follow-up to Vision Care in Patients With Diabetes. Am J Med Qual 2014; 31:156-61. [DOI: 10.1177/1062860614552670] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
| | | | | | | | | | - Yang Dai
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Benjamin E. Leiby
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Pizzi LT, Seligman NS, Baxter JK, Jutkowitz E, Berghella V. Cost and cost effectiveness of vaginal progesterone gel in reducing preterm birth: an economic analysis of the PREGNANT trial. Pharmacoeconomics 2014; 32:467-478. [PMID: 24715602 DOI: 10.1007/s40273-014-0133-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Preterm birth (PTB) is a costly public health problem in the USA. The PREGNANT trial tested the efficacy of vaginal progesterone (VP) 8 % gel in reducing the likelihood of PTB among women with a short cervix. OBJECTIVE We calculated the costs and cost effectiveness of VP gel versus placebo using decision analytic models informed by PREGNANT patient-level data. METHODS PREGNANT enrolled 459 pregnant women with a cervical length of 10-20 mm and randomized them to either VP 8 % gel or placebo. We used a cost model to estimate the total cost of treatment per mother and a cost-effectiveness model to estimate the cost per PTB averted with VP gel versus placebo. Patient-level trial data informed model inputs and included PTB rates in low- and high-risk women in each study group at <28 weeks gestation, 28-31, 32-36, and ≥37 weeks. Cost assumptions were based on 2010 US healthcare services reimbursements. The cost model was validated against patient-level data. Sensitivity analyses were used to test the robustness of the cost-effectiveness model. RESULTS The estimated cost per mother was $US23,079 for VP gel and $US36,436 for placebo. The cost-effectiveness model showed savings of $US24,071 per PTB averted with VP gel. VP gel realized cost savings and cost effectiveness in 79 % of simulations. CONCLUSION Based on findings from PREGNANT, VP gel was associated with cost savings and cost effectiveness compared with placebo. Future trials designed to include cost metrics are needed to better understand the value of VP.
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Affiliation(s)
- Laura T Pizzi
- Thomas Jefferson University, 901 Walnut Street, Suite 911, Philadelphia, PA, 19107, USA,
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Storey P, Murchison AP, Dai Y, Hark L, Pizzi LT, Leiby BE, Haller JA. Comparing methodologies for imputing ethnicity in an urban ophthalmology clinic. Ophthalmic Epidemiol 2014; 21:106-10. [PMID: 24568574 DOI: 10.3109/09286586.2014.884603] [Citation(s) in RCA: 5] [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: 02/01/2023]
Abstract
PURPOSE To compare methodologies for imputing ethnicity in an urban ophthalmology clinic. METHODS Using data from 19,165 patients with self-reported ethnicity, surname, and home address, we compared the accuracy of three methodologies for imputing ethnicity: (1) a surname method based on tabulation from the 2000 US Census; (2) a geocoding method based on tract data from the 2010 US Census; and (3) a combined surname geocoding method using Bayes' theorem. RESULTS The combined surname geocoding model had the highest accuracy of the three methodologies, imputing black ethnicity with a sensitivity of 84% and positive predictive value (PPV) of 94%, white ethnicity with a sensitivity of 92% and PPV of 82%, Hispanic ethnicity with a sensitivity of 77% and PPV of 71%, and Asian ethnicity with a sensitivity of 83% and PPV of 79%. Overall agreement of imputed and self-reported ethnicity was fair for the surname method (κ 0.23), moderate for the geocoding method (κ 0.58), and strong for the combined method (κ 0.76). CONCLUSION A methodology combining surname analysis and Census tract data using Bayes' theorem to determine ethnicity is superior to other methods tested and is ideally suited for research purposes of clinical and administrative data.
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Thoma BN, Li J, McDaniel CM, Wordell CJ, Cavarocchi N, Pizzi LT. Clinical and economic impact of substituting dexmedetomidine for propofol due to a US drug shortage: examination of coronary artery bypass graft patients at an urban medical centre. Pharmacoeconomics 2014; 32:149-157. [PMID: 24254138 DOI: 10.1007/s40273-013-0116-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Propofol has reduced healthcare costs in coronary artery bypass graft (CABG) surgery patients by decreasing post-operative duration of mechanical ventilation. However, the US shortage of propofol necessitated the use of alternative agents. OBJECTIVE This study sought to evaluate clinical and economic implications of substituting dexmedetomidine for propofol in patients undergoing CABG surgery. METHODS This was a retrospective cohort study. Patients undergoing isolated, elective CABG surgery and sedated with either propofol or dexmedetomidine during the study period were included. The cohorts were matched 1:1 based on important characteristics. The primary outcome was the number of patients achieving a post-operative duration of mechanical ventilation ≤6 h. Secondary outcomes were post-operative intensive care unit (ICU) length of stay (LOS) ≤48 h, total post-operative LOS ≤5 days, the need for adjunctive opioid therapy and associated cost savings. Variables recorded included patient demographics, co-morbid medical conditions, health risks, sedation drug doses, post-operative medical complications and sedation-related adverse events. Univariate and multivariate analyses were completed to examine the relationship between these covariates and post-operative LOS. The cost analysis consisted of examination of the net financial benefit (or cost) of choosing dexmedetomidine versus propofol in the study population, with utilisation observed in the study converted to costs using institutional data from the Premier database. RESULTS Eighty-four patients were included, with 42 patients per cohort. Mechanical ventilation duration ≤6 h was achieved in 24 (57.1 %) versus 7 (16.7 %) in the dexmedetomidine and propofol cohorts, respectively (p < 0.001). More patients treated with dexmedetomidine achieved ICU LOS ≤48 h (p < 0.05) and total hospital LOS ≤5 days (p < 0.05), as compared with the propofol group. Multivariate analysis revealed that having one or more post-operative medical complication was the most significant predictor of increased post-operative LOS, whereas choosing dexmedetomidine was also significant in terms of reduced post-operative LOS. The estimated net financial benefit of choosing dexmedetomidine versus propofol was US$2,613 per patient (year 2012 value). CONCLUSIONS Findings suggest that use of dexmedetomidine as an alternative to propofol for sedation of CABG patients post-operatively contributes to reduced mechanical ventilation time, ICU LOS and post-operative LOS. Higher drug costs resulting from the propofol shortage were offset by savings in post-operative room and board costs. Additional savings may be possible by preventing medical complications to the extent possible.
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Affiliation(s)
- Brandi N Thoma
- Thomas Jefferson University Hospital, 111 South 11th Street, Suite 2260, Philadelphia, PA, 19107, USA,
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Law MG, Komura S, Murchison AP, Pizzi LT. Pharmacy staff opinions regarding diabetic retinopathy screenings in the community setting: findings from a brief survey. Am Health Drug Benefits 2013; 6:548-552. [PMID: 24991381 PMCID: PMC4031736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Diabetic retinopathy is a retinal vascular disorder that affects more than 4.1 million people in the United States. New methods of detecting and ensuring adequate follow-up of this life-altering disease are vital to improving patient outcomes. Wills Eye Hospital and the Centers for Disease Control and Prevention are conducting a collaborative study to initiate a novel diabetic retinopathy screening in the community setting. OBJECTIVE To evaluate the feasibility of a more widespread, large-scale implementation of this novel model of care for diabetic retinopathy screening in the community setting. METHODS A simple, self-administered survey was distributed to pharmacists, pharmacy technicians, student pharmacists, and Wills Eye Hospital interns. The survey consisted of open-ended questions and responders were given 1 week to respond. A total of 22 surveys were distributed and 16 were completed. The responses were culled and analyzed to assess the feasibility of implementing this novel screening model in the pharmacy. RESULTS The response rate to this pilot survey was 72%. The majority of the responding pharmacy staff members indicated that diabetic retinopathy screening in community pharmacies would greatly benefit patients and could improve patient care. However, they also noted barriers to implementing the screening, such as concerns about the cost of carrying out the screenings, the cost of the equipment needed to be purchased, and the lack of time and shortage of pharmacy staff. CONCLUSION The potential exists for pharmacists to positively influence diabetes care by implementing retinopathy care through the early detection of the disease and reinforcement of the need for follow-up; however, real-world barriers must be addressed before widespread adoption of such a novel model of care becomes feasible.
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Affiliation(s)
- Miranda G Law
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Stephanie Komura
- Jefferson School of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Ann P Murchison
- Codirector, Emergency Department, and Associate Professor of Ophthalmology, Wills Eye Hospital, Philadelphia, PA
| | - Laura T Pizzi
- Associate Professor, Department of Pharmacy Practice, Jefferson School of Pharmacy, Thomas Jefferson University
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