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Watkins E, Chow CM, Lingohr-Smith M, Lin J, Yong C, Tangirala K, Collins K, Li J, Brooks R, Amico J. Bacterial Vaginosis Treatment Patterns, Associated Complications, and Health Care Economic Burden of Women With Medicaid Coverage in the United States. Ann Pharmacother 2024; 58:480-493. [PMID: 37589369 DOI: 10.1177/10600280231190701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/18/2023] Open
Abstract
BACKGROUND Bacterial vaginosis (BV) is a highly prevalent vaginal infection. OBJECTIVES Primary objectives of this study were to examine treatment patterns among female patients with Medicaid coverage who were diagnosed with incident BV, the frequency of BV-associated complications, and health care resource utilization (HCRU) and associated costs of incident BV and its recurrence. Secondary objectives were to identify predictors of total all-cause health care costs and number of treatment courses. METHODS Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication were selected from the Merative MarketScan Medicaid database (2017-2020). Additional treatment courses were evaluated during a ≥12-month follow-up period, in which new cases of BV-associated complications and HCRU and the associated costs were also measured. Generalized linear models were used to identify baseline predictors of total all-cause health care costs and number of treatment courses. RESULTS An incident vaginitis diagnosis and ≥1 BV medication claim were present in 114 313 patients (mean age: 28.4 years; 48.6% black). During the follow-up, 56.6% had 1 treatment course, 24.9% had 2, 10.2% had 3, and 8.3% had ≥4; 43.4% had BV recurrence. Oral metronidazole (88.5%) was the most frequently prescribed medication. Nearly 1 in 5 had a new occurrence of a BV-associated complication; most (76.6%) were sexually transmitted infections (STIs). Total all-cause and BV-related costs averaged $5794 and $300, respectively, per patient; both increased among those with more treatment courses. Older age, pregnancy, comorbidity, any STIs, postprocedural gynecological infection (PGI), and infertility were predictive of higher total all-cause health care costs, while race/ethnicity other than white was predictive of lower costs. Older age, black race, any STIs, pelvic inflammatory disease, and PGI were predictive of >1 treatment courses. CONCLUSION AND RELEVANCE The high recurrence of BV represents an unmet need in women's health care and better treatments are necessary.
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Affiliation(s)
| | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
| | | | | | | | | | - Roy Brooks
- Capital Women's Care Division 64, Laurel, MD, USA
- Holy Cross Hospital, Silver Spring, MD, USA
| | - Jennifer Amico
- Robert Wood Johnson Medical School, Rutgers, New Brunswick, NJ, USA
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Watkins E, Chow CM, Lingohr-Smith M, Lin J, Yong C, Tangirala K, Collins K, Li J, Brooks R, Amico J. Treatment patterns and economic burden of bacterial vaginosis among commercially insured women in the USA. J Comp Eff Res 2024; 13:e230079. [PMID: 38099520 PMCID: PMC10842271 DOI: 10.57264/cer-2023-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 12/06/2023] [Indexed: 01/06/2024] Open
Abstract
Aim: Bacterial vaginosis (BV) is a common vaginal dysbiosis associated with adverse clinical sequelae, most notably, increased risk of sexually transmitted infections (STIs). The aims of this study were to estimate the frequency of BV recurrence, treatment patterns, other gynecological (GYN) conditions, and the associated healthcare resource utilization (HCRU) and costs among commercially insured patients in the USA. Patients & methods: Female patients aged 12-49 years with an incident vaginitis diagnosis and ≥1 pharmacy claim for a BV medication (fungal treatment only excluded) were selected from the Merative™ MarketScan commercial database (2017-2020). During a minimum 12-month follow-up, additional treatment courses, treatment patterns, frequency of other GYN conditions, and HCRU and costs were assessed. Generalized linear models were used to identify baseline predictors of total all-cause healthcare costs and number of treatment courses. Results: The study population included 140,826 patients (mean age: 31.5 years) with an incident vaginitis diagnosis and ≥1 BV medication claim. During the follow-up, 64.2% had 1 treatment course, 22.0% had 2, 8.1% had 3, and 5.8% had ≥4; 35.8% had a BV recurrence (≥2 BV medication claims). The most commonly prescribed BV medication was oral metronidazole (73.6%). Approximately 12% (n = 16,619) of patients had a new diagnosis of another GYN condition in the follow-up; 8.2% had a new STI, which were more common among patients with ≥4 treatment courses (12.9%). During follow-up, total all-cause healthcare costs averaged $8987 per patient per year (PPPY) of which $470 was BV-related. BV-related healthcare costs increased from $403 PPPY among those with 1 treatment course to $806 PPPY among those with ≥4 with nearly half the costs attributed to outpatient office visits. Conclusion: BV recurrence among this population represented a substantial clinical and healthcare economic burden warranting improvements in women's healthcare.
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Affiliation(s)
- Eren Watkins
- Organon, 30 Hudson Street, Jersey City, NJ 07302, USA
| | - Clifton M Chow
- Actu-real, 221 Roswell Street, Suite 150 Alpharetta, GA 30009, USA
| | | | - Jay Lin
- Novosys Health, 288 Route 22 West, Suite G-H, Green Book, NJ 08812, USA
| | - Candice Yong
- Organon, 30 Hudson Street, Jersey City, NJ 07302, USA
| | | | - Kevin Collins
- Organon, 30 Hudson Street, Jersey City, NJ 07302, USA
| | - James Li
- Organon, 30 Hudson Street, Jersey City, NJ 07302, USA
| | - Roy Brooks
- Capital Women's Care, 7350 Van Dusen Road, Laurel, MD 20707, USA
- Holy Cross Hospital, 1500 Forest Glen Rd, Silver Spring, MD 20910, USA
| | - Jennifer Amico
- Robert Wood Johnson Medical School, Rutgers, 303 George Street #629, New Brunswick, NJ 08901, USA
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Di Fusco M, Lin J, Vaghela S, Lingohr-Smith M, Nguyen JL, Scassellati Sforzolini T, Judy J, Cane A, Moran MM. COVID-19 vaccine effectiveness among immunocompromised populations: a targeted literature review of real-world studies. Expert Rev Vaccines 2022; 21:435-451. [PMID: 35112973 PMCID: PMC8862165 DOI: 10.1080/14760584.2022.2035222] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Introduction From July through October of 2021, several countries issued recommendations for increased COVID-19 vaccine protection for individuals with one or more immunocompromised (IC) conditions. It is critically important to understand the vaccine effectiveness (VE) of COVID-19 vaccines among IC populations as recommendations are updated over time in response to the evolving COVID-19 pandemic. Areas covered A targeted literature review was conducted to identify real-world studies that assessed COVID-19 VE in IC populations between December 2020 and September 2021. A total of 10 studies from four countries were identified and summarized in this review. Expert opinion VE of the widely available COVID-19 vaccines, including BNT162b2 (Pfizer/BioNTech), mRNA-1273 (Moderna), Ad26.COV2.S (Janssen), and ChAdOx1 nCoV-19 (Oxford/AstraZeneca), ranged from 64% to 90% against SARS-CoV-2 infection, 73% to 84% against symptomatic illness, 70% to 100% against severe illness, and 63% to 100% against COVID-19-related hospitalization among the fully vaccinated IC populations included in the studies. COVID-19 VE for most outcomes in the IC populations included in these studies were lower than in the general populations. These findings provide preliminary evidence that the IC population requires greater protective measures to prevent COVID-19 infection and associated illness, hence should be prioritized while implementing recommendations of additional COVID-19 vaccine doses.
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Affiliation(s)
| | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Zhang Q, O'Hara M, McCormick C, Lingohr-Smith M, Borentain S, Mathews M, Joshi K, Anjo J, Lin J. Patient profiles, initial hospital encounter characteristics, and hospital re-encounters of patients with a hospital emergency department visit or inpatient admission for major depressive disorder. J Med Econ 2022; 25:172-181. [PMID: 35048772 DOI: 10.1080/13696998.2022.2031202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To gain a better understanding of the characteristics of patients with a hospital encounter for major depressive disorder (MDD) and evaluate associated hospital resource utilization, hospital charges and costs, and hospital re-encounters. METHODS Adult patients with a hospital encounter (i.e. emergency department [ED] visit only or inpatient admission) with MDD as the primary discharge diagnosis (index event) during July 2018‒March 2019 were selected from the Premier Healthcare Database. Patient characteristics, hospital resource utilization, and hospital charges and costs were evaluated during index events. During a 12-month follow-up, hospital re-encounters (MDD-related and all-cause ED visit only or inpatient readmissions) were examined. RESULTS The study population included 77,178 patients with an index hospital encounter (ED visit only: 49.9%; inpatient admission: 50.1%) for MDD. The most common secondary mental health-related diagnosis was suicidal ideation/behavior, which was recorded in 51.8% of patients. The mean age was 38.2 years, 53.0% were female, and 72.1% were Caucasian. Among patients with an ED visit only, the mean index hospital charges and costs were $3,608 and $639, respectively. Among those with inpatient admissions, the mean length of stay was 4.9 days, and the mean index hospital charges and costs were $17,107 and $6,095, respectively. During the 12-month follow-up, 13.3% of patients in the overall study population had an MDD-related hospital re-encounter (primary or secondary discharge diagnosis code indicating MDD); nearly one-third (31.3%) occurred within 30 days post-discharge. During the follow-up, 28.1% had an all-cause hospital re-encounter with 29.7% having occurred within 30 days post-discharge. LIMITATIONS Due to constraints of the Premier Healthcare Database, healthcare resource utilization and costs outside of the hospital could not be evaluated. CONCLUSIONS Patients with a hospital encounter for MDD are relatively young, commonly have suicidal ideation/behavior, utilize substantial hospital resources, and have a high risk for a hospital re-encounter in the 30 days post-discharge.
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Affiliation(s)
- Qiaoyi Zhang
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Marguerite O'Hara
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Carter McCormick
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | | | - Stephane Borentain
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Global Services, LLC, Global Market Access; Global Medical Affairs, Titusville, NJ, USA
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Value and Evidence, Titusville, NJ, USA
| | - Joana Anjo
- Janssen Portugal, Health Economics, Market Access, and Reimbursement, Porto Salvo, Portugal
| | - Jay Lin
- Novosys Health, Health Economics & Outcomes Research, Green Brook, NJ, USA
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McComsey GA, Lingohr-Smith M, Rogers R, Lin J, Donga P. Real-World Adherence to Antiretroviral Therapy Among HIV-1 Patients Across the United States. Adv Ther 2021; 38:4961-4974. [PMID: 34390465 PMCID: PMC8363866 DOI: 10.1007/s12325-021-01883-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/03/2021] [Indexed: 01/19/2023]
Abstract
Introduction Recent changes in antiretroviral therapies (ARTs) may have affected medication adherence of people living with human immunodeficiency virus-1 (HIV-1). In this study adherence to ART regimens among patients with HIV-1 (PWH) across the US during a recent time period was examined and study findings were stratified by US region and state. Methods A retrospective observational study using the Symphony Health Solution Integrated Dataverse database was conducted. Patients ≥ 18 years of age who had a diagnosis of HIV-1 (without an HIV-2 diagnosis) and who were treated with ART between July 2017 and September 2018 (first pharmacy record: index date) were selected from the data source. Both patients who had not been previously treated with ART and those who were treatment experienced were included. Patients were required to have ≥ 1 medical/pharmacy record ≥ 12 months after their index date (follow-up period). Patient characteristics were examined during a 12-month pre-index period. During the follow-up, medication adherence, measured as the proportion of days covered (PDC), was examined for all patients and stratified by US region and state. Results Among 206,474 adult PWH treated with ART, mean age was 47.9 years, 73.4% were male, and 30.0% were Caucasian. The most prevalent comorbid conditions were hyperlipidemia (25.1%), depressive disorders (14.8%), and type 2 diabetes (12.1%). During the follow-up period, mean (standard deviation) PDC was 74.1% (25.9%) among PWH across the US [Midwest: 74.4% (25.5%); Northeast: 74.3% (26.1%); South: 73.2% (26.3%); West: 76.4% (24.8%)]. Across all US regions, > 60% of PWH had adherence < 90% and > 40% had adherence < 80%; the West had the highest adherent population. Conclusions Among PWH treated with ART across the US, a majority had suboptimal adherence. Implementation of strategies to improve ART adherence, including clinical consideration of ARTs with high genetic barriers to resistance, is needed in the US. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01883-8.
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Affiliation(s)
- Grace A. McComsey
- University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH USA
| | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ USA
| | - Prina Donga
- Janssen Scientific Affairs LLC, Titusville, NJ USA
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Aly A, Lingohr-Smith M, Lin J, Seal B. Locoregional therapy patterns and healthcare economic burden of patients with hepatocellular carcinoma in the USA. Hepat Oncol 2021; 8:HEP37. [PMID: 34408847 PMCID: PMC8369525 DOI: 10.2217/hep-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
Aim: To examine the locoregional therapy (LRT) patterns and the healthcare economic burden of patients with hepatocellular carcinoma (HCC) in the USA. Patients & methods: Patients with newly diagnosed HCC were identified from the MarketScan® databases (1 July 2015–31 May 2018). The LRTs received and all-cause and HCC-related healthcare costs were measured. Results: Among 2101 patients with HCC, most received embolization therapy as their first LRT treatment (57.8%, n = 1215); 17.1% (n = 360) received ablative therapy and 8.7% (n = 182) radiation therapy; 16.4% (n = 344) received multiple LRTs. After patients received their first LRT treatment, total all-cause healthcare costs averaged $20,316 per patient per month; 70.7% ($14,359) were HCC related. Conclusion: Among newly diagnosed HCC patients treated with LRT in the USA, the economic burden is high.
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Affiliation(s)
- Abdalla Aly
- AstraZeneca Pharmaceuticals LP, US Medical Affairs: Evidence Generation, Gaithersburg, MD 20878, USA
| | | | - Jay Lin
- Novosys Health, Green Brook, NJ 08812, USA
| | - Brian Seal
- AstraZeneca Pharmaceuticals LP, US Medical Affairs: Evidence Generation, Gaithersburg, MD 20878, USA
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Neslusan C, Voelker J, Lingohr-Smith M, Lin J. Characteristics of hospital encounters and associated economic burden of patients with major depressive disorder and acute suicidal ideation or behavior. Hosp Pract (1995) 2021; 49:176-183. [PMID: 33719813 DOI: 10.1080/21548331.2021.1886496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Relatively little is known about the hospital experience among patients with major depressive disorder (MDD) and acute suicidal ideation or behavior (MDSI). The objectives of this study were to examine hospital encounter characteristics, including the associated economic burden and risk of subsequent hospital encounters of patients with MDSI in the US. METHODS In this retrospective analysis, patients ≥18 years of age with a hospital encounter (emergency department [ED] visit or inpatient admission) were selected from the de-identified Premier Hospital database between 1 January 2017 and 30 September 2018. Patients were required to have MDD as the primary and acute suicidal ideation or behavior as a secondary discharge diagnosis or vice versa. Patient demographics and characteristics of hospital encounters were examined. Rates and costs of subsequent all-cause and MDD-related hospital encounters 6 months following initial discharge were also evaluated. RESULTS The study population consisted of 123,179 patients with a hospital encounter for MDSI (mean age: 38 years, 50.9% female, 74.6% White); 50.2% were treated in the ED only (mean ± standard deviation cost: $693±$630), while 49.8% were admitted as inpatients ($6,478±$7,001). Among those with ED visits, very few (7.0%) received an antidepressant (AD). Among those with an inpatient admission, 87.2% received ≥1 AD and 39.0% received AD augmentation. Overall rates and costs of subsequent all-cause and MDD-related hospital encounters were 22.3% ($5,136±$11,791) and 12.0% ($3,722±$9,621), respectively; nearly half of subsequent encounters (41.3% and 44.3%, respectively) occurred in the first month following initial discharge. CONCLUSIONS This analysis of patients with MDSI presenting to US hospitals shows heterogeneity in treatment and a concentration of costly subsequent hospital encounters within 1-month post discharge, suggesting that healthcare systems may benefit from examination of current care pathways for this vulnerable patient population.
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Affiliation(s)
- Cheryl Neslusan
- US Real World Value & Evidence, Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | - Jennifer Voelker
- US Real World Value & Evidence, Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | - Jay Lin
- Health Economics & Outcomes Research, Novosys Health, Green Brook, NJ, USA
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Seal B, Abdulhalim AM, Lingohr-Smith M, Lin J. The lines of loco-regional therapies received and the healthcare economic burden of patients newly diagnosed with hepatocellular carcinoma in the United States. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.3_suppl.286] [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: 11/20/2022] Open
Abstract
286 Background: Hepatocelluar carcinoma (HCC) is one of the fastest growing causes of cancer-related deaths in the US. The objectives of this study were to examine the lines of loco-regional therapies received and the healthcare economic burden of patients newly diagnosed with HCC in the US. Methods: Patients (≥18 years of age) diagnosed with HCC who received ≥1 loco-regional therapy (index date) after diagnosis were identified from the MarketScan Commercial and Medicare Supplemental databases (July 1, 2013-May 31, 2018). Patients were required to have ≥6 months of continuous insurance enrollment before the index date and ≥1 month after (follow-up period). The follow-up period was censored when patients received any systemic therapy. During the follow-up periods, the number of patients who received radiation therapy, ablative therapy, and embolization procedures (transarterial embolization/chemoembolization [TAE] and radioembolization [TARE]) were examined. All-cause and HCC-related healthcare costs (total and patient out-of-pocket [OOP] payments per patient per month [PPPM]) were also measured. Results: Among the 2,101 patients newly diagnosed with HCC who received ≥1 loco-regional therapy, median age was 64 years and 75.0% were male; the mean follow-up duration was 11.5 months. During the follow-up periods, 28.1% (n = 590) received radiation therapy, 27.3% (n = 574) ablative therapy, and 77.3% (n = 1,623) embolization therapy (TAE: 68.7% [n = 1,443]; TARE: 20.7% [n = 434]); 30.9% of patients received multiple loco-regional therapies. During the follow-up periods, total all-cause healthcare costs were a mean of $20,316 (OOP: $378) PPPM, of which 70.7% ($14,359; OOP: $227 PPPM) were HCC-related. The breakdown of healthcare costs is shown in the table. Conclusions: According to the findings of this large-scale real-world analysis of patients newly diagnosed with HCC in the US, a vast majority received at least one embolization procedure. The monthly healthcare economic burden of patients with HCC treated with local-regional therapies is relatively high. [Table: see text]
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Affiliation(s)
- Brian Seal
- AstraZeneca Pharmaceuticals LP, U.S. Medical Affairs: Evidence Generation, Gaithersburg, MD
| | - Abdulla M. Abdulhalim
- AstraZeneca Pharmaceuticals LP, U.S. Medical Affairs: Evidence Generation, Gaithersburg, MD
| | | | - Jay Lin
- Novosys Health, Green Brook, NJ
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Deitelzweig S, Dhamane AD, Di Fusco M, Russ C, Rosenblatt L, Lingohr-Smith M, Lin J. Utilization of anticoagulants and predictors of treatment among hospitalized patients with atrial fibrillation in the USA. J Med Econ 2020; 23:1389-1400. [PMID: 33021129 DOI: 10.1080/13696998.2020.1832099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate utilization of anticoagulants (ACs) and the predictors of treatment of patients with a diagnosis of atrial fibrillation (AF) during a hospital stay in the USA. METHODS Patients (≥18 years of age) who had a primary or secondary discharge diagnosis code of AF during a hospitalization (without a diagnosis of venous thromboembolism) were identified from the Premier Hospital database (1 January 2016-30 September 2017). AC treatments were examined during hospitalizations to assign AF patients into 3 study cohorts: those who received an oral AC (OAC), those who received parenteral AC only, and those who did not receive AC therapy. Multivariable logistic regression analyses were carried out to evaluate potential predictors of receiving parenteral AC only vs. OAC therapy, no AC therapy vs. OAC therapy, as well as the specific OAC drug choices. RESULTS Of the patients hospitalized with an AF diagnosis (n = 482,729; mean age: 74.7 years; 46.8% female; 82.9% White; 79.4% with Medicare), 42.6% received OAC therapy (most commonly, warfarin or apixaban), 35.3% parenteral AC only, and 22.2% no AC therapy. A key predictor of not receiving OAC therapy was having an AF diagnosis in the second position (applicable to 87.4% of study population). Greater comorbidity level and prior baseline bleeding were strong predictors of receiving parenteral AC only or not receiving any AC therapy vs. receiving OAC therapy. Predictors of receiving warfarin vs. apixaban included higher stroke risk and prior baseline bleeding. LIMITATIONS OAC utilization may have been underestimated since outpatient OAC utilization was not included in the analysis. CONCLUSIONS A substantial portion of hospitalized AF patients did not receive any AC therapy, particularly those patients with an AF diagnosis in the second position on hospital records. The predictors of inpatient AC treatment that were identified may be helpful in the clinical decision-making process for patients who are hospitalized with AF.
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Affiliation(s)
- Steven Deitelzweig
- Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
- Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | | | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Fermann GJ, Lovelace B, Christoph MJ, Lingohr-Smith M, Lin J, Deitelzweig SB. Major bleed costs of atrial fibrillation patients treated with factor Xa inhibitor anticoagulants. J Med Econ 2020; 23:1409-1417. [PMID: 33054507 DOI: 10.1080/13696998.2020.1837502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the healthcare economic burden of atrial fibrillation (AF) patients treated with factor Xa inhibitor (FXaI) anticoagulants who were hospitalized in the US with a major bleed (MB). METHODS Adult AF patients treated with FXaIs and hospitalized with an MB were selected from MarketScan databases (1 January 2015-30 April 2018). Patients were grouped into cohorts based on type of MB: intracranial hemorrhage (ICH), gastrointestinal (GI), other types of MB. Healthcare costs in 2019 USD were evaluated for index hospitalizations and during a variable follow-up period in unadjusted and adjusted analyses. RESULTS Of the overall AF patient population treated with FXaIs and hospitalized with an MB (n = 7,577), 9.9% had ICH (mean age: 77.9 years; 58% male), 55.9% had GI (mean age: 76.8 years; 52% male), and 34.2% had other types of MB (mean age: 74.4 years; 61% male). Mean index hospitalization costs for ICH, GI, and other type of MB were $54,163, $26,901, and $36,645, respectively; from adjusted analyses, patients with ICH vs. GI spent 1.6 more days in the hospital; mean cost was $15,630 higher. Patients with other types of MB vs. GI spent 0.6 more days in the hospital; mean cost was $5,859 higher. Index hospitalization cost in addition to total all-cause healthcare costs incurred in the follow-up period were $34,522 higher per ICH patient and $11,584 higher per other type of MB patient vs. a GI MB patient. LIMITATIONS Since this study was a retrospective observational study using a claims database analysis, a causal relationship between treatment with FXaIs and MB events cannot be established. CONCLUSIONS Although all of the evaluated MB types were associated with high hospitalization costs, ICH was associated with the most substantial short- and long-term healthcare economic burden.
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Affiliation(s)
- Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
| | - Steven B Deitelzweig
- Department of Medicine, University of Queensland and Ochsner Clinical School, New Orleans, LA, USA
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Fermann G, Lovelace B, McNeil-Posey K, Lingohr-Smith M, Lin J, Deitelzweig S. 12 The Burden of Major Bleeds among Atrial Fibrillation Patients Treated With Direct-acting Oral Anticoagulants in the United States. Ann Emerg Med 2020. [DOI: 10.1016/j.annemergmed.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Deitelzweig SB, Lovelace B, Christoph M, Lingohr-Smith M, Lin J, Fermann GJ. Evaluation of the Incremental Healthcare Economic Burden of Patients with Atrial Fibrillation Treated with Direct-Acting Oral Anticoagulants and Hospitalized for Major Bleeds in the USA. Adv Ther 2020; 37:3942-3953. [PMID: 32699994 DOI: 10.1007/s12325-020-01440-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Direct-acting oral anticoagulants (DOACs) are associated with risk of major bleeding. This study evaluated the incremental healthcare economic burden of patients with atrial fibrillation (AF) treated with DOACs and hospitalized with a major bleed (MB). METHODS Adult patients with AF treated with DOACs and hospitalized with MB or no MB hospitalizations during January 1, 2015-April 30, 2018 were extracted from MarketScan claims databases. The index date was defined as the first MB hospitalization for patients with MB and a random date during DOAC usage for patients without MB. Healthcare resource utilization and costs were evaluated for index hospitalizations of patients with MB and during the 6-month period prior to index dates and a variable follow-up period of 1-12 months for both patients with and those without MB. Multivariable regression analyses were performed to evaluate the incremental burden of MB vs. non-MB status on all-cause hospital days and healthcare costs. RESULTS Of the overall AF patient population using DOACs (N = 152,305), 7577 (5.0%) had a hospitalization for MB. Greater proportions of those who had an MB hospitalization were older and female compared to patients without MB (mean age 76.1 vs. 70.1 years; 44.1% vs. 40.5% female, respectively). For index MB hospitalizations, mean length of stay (LOS) was 5.3 days and cost was $32,938. In adjusted analyses, patients with MB had 3.6 more hospital days, $10,609 higher inpatient cost, $9613 higher outpatient medical cost, and $18,910 higher total healthcare costs for all causes per patient during follow-up (all p < 0.001). Including index MB hospitalization costs in the follow-up, all-cause total adjusted healthcare costs were almost two times higher for patients with vs. without MB ($96,590 vs. $49,091, p < 0.001). CONCLUSIONS Among a large US nationally representative sample of patients with AF treated with DOACs, the cost of MB hospitalization was substantial. Furthermore, healthcare costs following MB events were nearly 40% higher compared to those of patients with AF without an MB.
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Affiliation(s)
- Steven B Deitelzweig
- Department of Hospital Medicine, University of Queensland and Ochsner Clinical School, New Orleans, LA, USA.
| | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
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Deitelzweig S, Baker CL, Dhamane AD, Mardekian J, Dina O, Rosenblatt L, Russ C, Poretta T, Lingohr-Smith M, Lin J. Comparison of readmissions among hospitalized nonvalvular atrial fibrillation patients treated with oral anticoagulants in the United States. J Drug Assess 2020; 9:87-96. [PMID: 32489717 PMCID: PMC7241468 DOI: 10.1080/21556660.2020.1750418] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/30/2020] [Indexed: 12/21/2022] Open
Abstract
Objectives To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Methods Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013–30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1 month of discharge were evaluated and the associated length of stay (LOS) and costs compared. Results NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02–1.08; p < .001), MB-related (OR: 1.28; CI: 1.16–1.42; p < .001), and stroke-related (OR: 1.33; CI: 1.11–1.58; p = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02–1.09; p = .001) and MB-related (OR = 1.62; CI = 1.44–1.83; p < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. Conclusion In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden.
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Affiliation(s)
- Steven Deitelzweig
- Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA.,Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | | | | | | | | | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Deitelzweig S, Hlavacek P, Mardekian J, Rosenblatt L, Russ C, Tuell K, Lingohr-Smith M, Lin J, Guo JD. Comparison of inpatient admission rates of patients treated with apixaban vs. warfarin for venous thromboembolism in the emergency department. Hosp Pract (1995) 2020; 48:41-48. [PMID: 31976776 DOI: 10.1080/21548331.2020.1718925] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/17/2020] [Indexed: 06/10/2023]
Abstract
Objectives: This study evaluated inpatient admission status, hospitalization length of stay (LOS), hospital costs, and readmissions of patients who were diagnosed with venous thromboembolism (VTE) and treated with apixaban or warfarin in the emergency department (ED).Methods: Patients (≥18 years) with an ED visit with a primary discharge diagnosis code of VTE were identified from the Premier Hospital database (8/1/2014-5/31/2018). Patients who received apixaban or warfarin during the ED visit were selected and grouped into two treatment cohorts. Outcomes of ED disposition (discharged or admitted to the inpatient setting), hospital LOS, hospital cost of index event, and rate of 1-month readmissions were compared for the study cohorts.Results: Of the overall study population, 30.5% (n = 12,174; mean age: 59.7 years) received apixaban and 69.5% (n = 27,767; mean age: 59.3 years) received warfarin for VTE in the ED. After adjusting for patient and hospital characteristics, the regression analysis showed that apixaban was associated with a significantly lower likelihood of admission to the inpatient setting vs. warfarin (Odds Ratio [OR]: 0.12, 95% Confidence Interval [CI]: 0.12 to 0.13; p < 0.001). Correspondingly, mean index hospital LOS was 1.42 days shorter (95% CI: -1.47 to -1.36; p < 0.001) and mean index event hospital cost per patient was significantly lower by $4,276 ($3,732 [95% CI: $3,565 to $3,907] vs. $8,008 [95% CI: $7,676 to $8,355]; p < 0.001). Also, the likelihood of all-cause 1-month readmission was significantly lower for patients treated with apixaban vs. warfarin (OR: 0.85, 95% CI: 0.79 to 0.92; p < 0.001).Conclusions: In the real-world setting, VTE patients with an ED visit who were treated with apixaban vs. warfarin had a lower likelihood of being admitted to the inpatient setting, which was reflected in shorter average LOS and lower average index event cost. Additionally, the risk of 1-month readmission was also lower for patients treated with apixaban vs. warfarin.
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Affiliation(s)
- Steven Deitelzweig
- Ochsner Clinic Foundation, Department of Hospital Medicine, The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA
| | | | | | | | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Jabbour EJ, Mendiola MF, Lingohr-Smith M, Lin J, Makenbaeva D. Economic modeling to evaluate the impact of chronic myeloid leukemia therapy management on the oncology care model in the US. J Med Econ 2019; 22:1113-1118. [PMID: 31074658 DOI: 10.1080/13696998.2019.1618316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To develop an economic model to evaluate changes in healthcare costs driven by restricting usage of branded tyrosine kinase inhibitors (TKIs) through substitution with generic imatinib among chronic myeloid leukemia (CML) patients in a typical Oncology Care Model (OCM) practice, and examine the impact on Performance-Based Payment (PBP) eligibility. Methods: An Excel-based economic model of an OCM practice with 1,000 cancer patients during a 6-month episode of care was developed. Cancer types and proportions of patients treated in the practice were estimated from an OCM report. All-cause healthcare costs were obtained from published literature. It was assumed that if a practice restricts usage of branded TKIs for newly-diagnosed CML patients, 80% of the market share of branded imatinib and 50% of the market shares of 2nd-gen TKIs would shift to generic imatinib. Among established TKI-treated patients, it was assumed that 80% of the market share of branded imatinib and no patients treated with 2nd-gen TKIs would shift to the generic. Results: Four CML patients were estimated for a 1,000-cancer patient OCM practice with a total baseline healthcare cost of $51,345,812 during a 6-month episode. If the practice restricts usage of branded TKIs, the shift from 2nd-gen TKIs to generic imatinib would reduce costs by $12,970, while shifting from branded to generic imatinib lowers costs by $25,250 during a 6-month episode. Minimum reductions of $3,013,832 in a one-sided risk model and $2,372,010 in a two-sided risk model are required for PBP eligibility; the shift from 2nd-gen TKIs to generic imatinib would account for 0.4% and 0.5% of the savings required for a PBP, respectively. Conclusions: This analysis indicates that the potential cost reduction associated with restricting branded TKI usage among CML patients in an OCM setting will represent only a small proportion of the cost reduction needed for PBP eligibility.
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Affiliation(s)
- Elias J Jabbour
- The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | | | | | - Jay Lin
- Novosys Health , Green Brook , NJ , USA
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Amin A, Deitelzweig S, Bucior I, Lin J, Lingohr-Smith M, Menges B, Neuman WR. Frequency of hospital readmissions for venous thromboembolism and associated hospital costs and length of stay among acute medically ill patients in the US. J Med Econ 2019; 22:1119-1125. [PMID: 31084383 DOI: 10.1080/13696998.2019.1618862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study evaluated the frequency of hospital readmissions for venous thromboembolism (VTE) and the associated costs and length of stay (LOS) among acute medically ill patients in the US using a real-world claims database analysis. Methods: Patients (≥40 years of age) at risk of VTE due to hospitalization for acute medical illnesses, based on primary hospital discharge diagnosis codes, were identified from the MarketScan databases between July 1, 2011 and March 31, 2015. Patients were required to have continuous insurance enrollment in the 6 months prior to initial (index) hospitalizations (baseline period) and in the 6 months after hospital discharge (follow-up period). The proportions of patients with VTE-related (diagnosis at any position) and VTE as primary diagnosis hospital readmissions during the follow-up period were evaluated. The associated costs and LOS for such readmissions were also determined, as well as time to VTE-related readmissions. Results: Of the study population (n = 12,785; mean age = 68.3 years), most were hospitalized primarily for infectious diseases (35.2%), followed by respiratory diseases (27.9%), cancer (15.7%), heart failure (11.8%), ischemic stroke (8.1%), and rheumatic diseases (1.4%). Of the overall study population, 2.1% (n = 268) had a VTE-related hospital readmission in the 6 months following discharge of their index hospitalization, of which 36.6% (n = 98) were for a primary diagnosis of VTE. Approximately 25.4% of the VTE-related hospital readmissions occurred within the first 30 days of discharge and 58.2% within 90 days. The mean cost for a hospital readmission with a primary diagnosis of VTE was $18,681 (mean LOS = 5.0 days); for readmissions with a primary diagnosis of DVT and PE, mean costs were $14,719 and $23,305, respectively. Conclusions: Among this study population of patients hospitalized for acute medical illnesses, some experienced a VTE event requiring re-hospitalization, with 25% occurring within the first 30 days after hospital discharge.
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Affiliation(s)
- Alpesh Amin
- School of Medicine, University of California, Irvine , Irvine , CA , USA
| | - Steven Deitelzweig
- Ochsner Clinic Foundation, Department of Hospital Medicine, Ochsner Clinical School, The University of Queensland School of Medicine , New Orleans , LA , USA
| | - Iwona Bucior
- Portola Pharmaceuticals , South San Francisco , CA , USA
| | - Jay Lin
- Novosys Health , Green Brook , NJ , USA
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Dhamane AD, Baker CL, Rajpura J, Mardekian J, Dina O, Russ C, Rosenblatt L, Lingohr-Smith M, Lin J. Continuation with apixaban treatment is associated with lower risk for hospitalization and medical costs among elderly patients. Curr Med Res Opin 2019; 35:1769-1776. [PMID: 31120309 DOI: 10.1080/03007995.2019.1623187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: To compare the risk of hospitalization and costs associated with major bleeding (MB) or stroke/systemic embolism (SE) among elderly patients with nonvalvular atrial fibrillation (NVAF) who initiated apixaban then switched to another oral anticoagulant (OAC) vs. those who continued with apixaban treatment. Methods: NVAF patients (≥65 years) initiating apixaban were identified from the Humana database (1 January 2013-30 September 2017) and grouped into switcher and continuer cohorts. For switchers, the earliest switch from apixaban to another OAC was defined as the index event/date. A random date during apixaban treatment was selected as the index date for continuers. Patients were followed from index date to health plan disenrollment or 31 December 2017, whichever was earlier. Multivariable regression analyses were used to examine the association of switchers vs. continuers with risk of MB-related or stroke/SE-related hospitalization and healthcare costs during follow-up. Results: Of 7858 elderly NVAF patients included in the study, 14% (N = 1110; mean age: 78 years) were switchers; 86% (N = 6748; mean age: 79 years) were continuers. Apixaban switchers vs. continuers had significantly greater risk of MB-related hospitalization (hazard ratio [HR]: 2.00; 95% CI: 1.52-2.64; p < .001) during follow-up; risk of stroke/SE hospitalization did not differ significantly (HR: 1.36, 95% CI: 0.89-2.06, p = .154). MB- and stroke/SE-related medical costs were higher for switchers vs. continuers, although total all-cause healthcare costs were similar. Conclusion: Elderly patients with NVAF in the US who continued with apixaban treatment had a lower risk of MB-related hospitalization and lower MB- and stroke/SE-related medical costs compared to patients who switched to another OAC.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jay Lin
- Novosys Health , Green Brook , NJ , USA
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Baker CL, Dhamane AD, Rajpura J, Mardekian J, Dina O, Russ C, Rosenblatt L, Lingohr-Smith M, Lin J. Switching to Another Oral Anticoagulant and Drug Discontinuation Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Different Direct Oral Anticoagulants. Clin Appl Thromb Hemost 2019; 25:1076029619870249. [PMID: 31418293 PMCID: PMC6829636 DOI: 10.1177/1076029619870249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We compared the risks of switching to another oral anticoagulant (OAC) and discontinuation of direct oral anticoagulants (DOACs) among elderly patients with nonvalvular atrial fibrillation (NVAF) who were prescribed rivaroxaban or dabigatran versus apixaban. Patients (≥65 years of age) with NVAF prescribed DOACs (January 1, 2013 to September 30, 2017) were identified from the Humana research database and grouped into DOAC cohorts. Cox regression analyses were used to evaluate whether the risk for switching to another OAC or discontinuing index DOACs differed among cohorts. Of the study population (N = 38 250), 55.9% were prescribed apixaban (mean age: 78.6 years; 49.8% female), 37.3% rivaroxaban (mean age: 77.4 years; 46.7% female), and 6.8% dabigatran (mean age: 77.0 years; 44.0% female). Compared to patients prescribed apixaban, patients prescribed rivaroxaban (hazard ratio [HR]: 2.08; 95% confidence interval [CI], 1.92-2.25; P < .001) or dabigatran (HR: 3.74; 95% CI, 3.35-4.18, P < .001) had a significantly higher risk of switching to another OAC during the follow-up; compared to patients prescribed apixaban, the risks of discontinuation were also higher for patients treated with rivaroxaban (HR: 1.10; 95% CI, 1.07-1.13, P < .001) or dabigatran (HR: 1.29; 95% CI, 1.23-1.35, P < .001).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jay Lin
- 3 Novosys Health, Green Brook, NJ, USA
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Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Venous Thromboembolism Prophylaxis and Risk for Acutely Medically Ill Patients Stratified by Different Ages and Renal Disease Status. Clin Appl Thromb Hemost 2019; 25:1076029618823287. [PMID: 30808218 PMCID: PMC6714996 DOI: 10.1177/1076029618823287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The objectives of this study were to examine venous thromboembolism (VTE) prophylaxis
patterns and risk for VTE events during hospitalization and in the outpatient continuum of
care among patients hospitalized for acute illnesses in the United States with
stratification by different age groups and renal disease status. Acutely ill hospitalized
patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015) and
grouped by age (<65, 65-74, ≥75 years old) and whether or not they had a baseline
diagnosis of renal disease, separately. Of acutely ill hospitalized patients, 60.1% (n =
10 748) were <65 years old, 15.7% (n = 2803) were 65 to 74 years old, and 24.3% (n =
4344) were ≥75 years old; 32.9% (n = 5892) had baseline renal disease. Among the study
cohorts, the majority of patients received no VTE prophylaxis regardless of age or
baseline renal status (52.1%-63.6%). Rates of VTE during hospitalization and in the 6
months postdischarge were 4.7%, 4.6%, and 4.5% for patients <65, 65 to 74, and ≥75
years old, respectively, and 6.3% and 3.8% for patients with and without baseline renal
disease. The risk for VTE was elevated for 30 to 40 days after index admission regardless
of age and renal disease status.
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Affiliation(s)
- Alpesh Amin
- 1 Irvine School of Medicine, Univeristy of California, Irvine, CA, USA
| | | | | | | | - Jay Lin
- 3 Novosys Health, Green Brook, NJ, USA
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Baker CL, Dhamane AD, Rajpura J, Mardekian J, Dina O, Russ C, Rosenblatt L, Lingohr-Smith M, Lin J. Abstract 210: Rates of Drug Switching and Discontinuation among Nonvalvular Atrial Fibrillation Elderly Patients Treated with Direct Oral Anticoagulants in the US. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
While many studies have demonstrated the efficacy of direct-acting oral anticoagulants (DOACs) for stroke risk reduction among nonvalvular atrial fibrillation (NVAF) patients, there is little information regarding drug switching and discontinuation patterns in real-world settings, particularly in older adults. Thus, we evaluated rates of switching and discontinuation among elderly NVAF patients who initiated any of the three most commonly prescribed DOACs in the US.
Methods:
Patients ≥65 years who initiated apixaban, rivaroxaban or dabigatran (index event/date) were identified from the Humana database (1/1/2013-9/30/2017) and grouped into cohorts by index DOAC. Patients were required to have an NVAF diagnosis and continuous health plan enrollment for ≥12 months prior to the index date and ≥3 months during the follow-up period after the index date. Percentages of patients in each study cohort who switched to any other DOAC or warfarin or discontinued their index DOAC were evaluated. Multivariable Cox regression analyses were carried out to evaluate the impact of index DOAC treatments on the likelihood of switching or discontinuation while controlling for differences in patient characteristics.
Results:
Of the final study population (n=38,250), 56% initiated apixaban (n=21,376; mean age: 78.6 years), 37% rivaroxaban (n=14,277; mean age: 77.4 years), and 7% dabigatran (n=2,597; mean age: 77.0 years). During follow-up, the switching rate was lowest for patients treated with apixaban at 5.2%, followed by patients treated with rivaroxaban (10.6%), and patients treated with dabigatran (16.9%, p<0.001 across the 3 cohorts). Patients treated with apixaban also had the lowest discontinuation rate (63.2% vs. 68.7% vs. 71.7%, p<0.001). After controlling for patient differences, those treated with rivaroxaban and dabigatran had significantly greater likelihood of switching treatment than patients treated with apixaban (Figure A). Also, rivaroxaban and dabigatran treated patients were significantly more likely to discontinue DOAC treatment (Figure B).
Conclusion:
Of the DOACs evaluated in this real-world study, apixaban was associated with the lowest rates of switching and discontinuation among elderly NVAF patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ
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Deitelzweig SB, Baker C, Dhamane A, Mardekian J, Dina O, Rosenblatt L, Russ C, Poretta T, Lingohr-Smith M, Lin J. COMPARISON OF MAJOR BLEEDING- AND STROKE-RELATED HOSPITAL READMISSIONS AMONG HOSPITALIZED NONVALVULAR ATRIAL FIBRILLATION PATIENTS TREATED WITH WARFARIN AND APIXABAN IN THE US. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Amin A, Deitelzweig S, Lin J, Lingohr-Smith M, Menges B, Neuman WR. Abstract WP385: Burden of Rehospitalizations for Venous Thromboembolism Among Patients With Ischemic Stroke. Stroke 2019. [DOI: 10.1161/str.50.suppl_1.wp385] [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: 11/16/2022]
Abstract
Introduction:
Patients hospitalized for ischemic stroke are at risk for venous thromboembolism (VTE) that remains high after discharge. Without adequate VTE prophylaxis covering the entire risk period, including after discharge, patients are at risk of VTE-related rehospitalization. The goal of this study was to analyze the frequency and associated cost of VTE-related readmissions among patients with ischemic stroke in the US.
Methods:
Patients hospitalized for ischemic stroke, based on the primary hospital discharge diagnosis codes, were identified from the MarketScan databases (7/1/2011 to 3/31/2015). Eligible patients were ≥40 y and had continuous insurance enrollment ≤6 mo prior to initial (index) hospitalizations (baseline period) and >6 mo after discharge (follow-up period). The study endpoints were: the proportion of patients readmitted for the primary VTE or any position VTE (VTE-related) during the follow-up period, and the associated resources and costs of readmissions.
Results:
For this retrospective analysis, data from 1,030 patients hospitalized for ischemic stroke were available; mean age: 71.6 y (66.2% were ≥65 y), 52.1% female, mean Charlson Comorbidity Index score: 3.3. For index hospitalization, 55.3% of patients were hospitalized for 1-3 d, and 33.3% for 4-7 d. During index hospitalization, 1.3% of patients had a VTE. In the 6 months following discharge, 1.4% had a VTE-related hospital readmission, of which 50% were for a primary diagnosis of VTE. Over one-third (35.7%) of the VTE-related readmissions occurred ≤30 d of discharge. For VTE-related readmissions, mean length of hospital stay (LOS) was 14.9 d and the mean total cost for a hospital readmission was $39,692. For primary VTE readmissions, the mean LOS was 4.9 d and the mean total cost of a readmission was $12,384.
Conclusions:
In this real-world study, 1.4% of patients hospitalized for ischemic stroke had a VTE-related hospital readmission, and of these, one-third were readmitted ≤30 d of discharge. The economic burden of VTE-related or primary VTE hospital readmissions was substantial. Improvement in VTE prophylaxis across the inpatient/outpatient care continuum may reduce the clinical and economic burden of VTE and associated rehospitalizations in these patients.
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Affiliation(s)
- Alpesh Amin
- Univeristy of California, Irvine, Sch of Medicine, Irvine, CA
| | - Steven Deitelzweig
- Ochsner Clinic Foundation, Dept of Hosp Medicine and The Univ of Queensland Sch of Medicine, Ochsner Clinical Sch, New Orleans, LA
| | - Jay Lin
- Novosys Health, Green Brook, NJ
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Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Influence of the duration of hospital length of stay on frequency of prophylaxis and risk for venous thromboembolism among patients hospitalized for acute medical illnesses in the USA. Drugs Context 2019; 8:212568. [PMID: 30719052 PMCID: PMC6344107 DOI: 10.7573/dic.212568] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/29/2022] Open
Abstract
Background We evaluated whether the duration of hospital stay influences venous thromboembolism (VTE) prophylaxis patterns and VTE risk during hospitalization and post-discharge among patients hospitalized for acute illnesses in the USA. Methods Patients hospitalized for acute illnesses were identified from the US MarketScan Commercial and Medicare databases (January 1, 2012–June 30, 2015). Patients were stratified by index hospital length of stay (LOS), with study groups with 1–3 day, 4–6 day, and ≥7 day LOSs. Use of VTE prophylaxis and VTE event rates during and after hospitalization (6-month follow-up) were evaluated. Results Of the overall population, 8647 had a 1–3 day LOS, 5551 had a 4–6 day LOS, and 3697 had a ≥7 day LOS. A greater proportion of patients with a 1–3 day LOS (66.2%) did not receive any VTE prophylaxis in comparison to patients with a 4–6 day LOS (55.0%) and ≥7 day LOS (48.8%; p<0.001). Proportions of patients with VTE events during the index hospitalization increased with longer hospital LOS (1–3 day LOS: 0.5%; 4–6 day LOS: 1.3%; ≥7 day LOS: 5.4%), as did proportions of patients with VTE events during the 6-month follow-up (1–3 day LOS: 2.4%; 4–6 day LOS: 2.7%; ≥7 day LOS: 4.2%). Conclusion Among this study population of hospitalized acutely ill patients in the USA, VTE pharmacologic prophylaxis was underutilized, regardless of the duration of hospital stay. However, the risk for VTE events was substantial, with nearly 10% of those with a ≥7 day LOS having suffered a VTE event within 6 months.
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Affiliation(s)
- Alpesh Amin
- Univeristy of California, Irvine, School of Medicine, Irvine, CA, USA
| | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Patil SA, Flasar MH, Lin J, Lingohr-Smith M, Skup M, Wang S, Chao J, Cross RK. Reduced Imaging Radiation Exposure and Costs Associated with Anti-Tumor Necrosis Factor Therapy in Crohn's Disease. Dig Dis Sci 2019; 64:60-67. [PMID: 30311154 DOI: 10.1007/s10620-018-5322-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/03/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Radiation exposure from diagnostic imaging may increase cancer risk of Crohn's disease (CD) patients, who are already at increased risk of certain cancers. AIM To compare imaging radiation exposure and associated costs in CD patients during the year pre- and post-initiation of anti-tumor necrosis factor (anti-TNF) agents or corticosteroids. METHODS Adults were identified from a large US claims database between 1/1/2005 and 12/31/2009 with ≥ 1 abdominal imaging scan and 12 months of enrollment before and after initiating therapy with anti-TNF or corticosteroids. Imaging utilization, radiation exposure, and healthcare costs pre- and post-initiation were examined. RESULTS Anti-TNF-treated patients had significantly fewer imaging examinations the year prior to initiation than corticosteroid-treated patients. Cumulative radiation doses before initiation were significantly higher for corticosteroid patients compared to anti-TNF patients (22.3 vs. 17.7 millisieverts, P = 0.0083). After therapy initiation, anti-TNF-treated patients had significantly fewer imaging examinations (2.9 vs. 5.2, P < 0.0001) and less radiation exposure (7.4 vs. 15.4 millisieverts, P <0.0001) than corticosteroid-treated patients in the follow-up period. Reductions in imaging costs adjusted for 1000 patient-years after initiation of therapy were - $275,090 and - $121,960 (P = 0.0359) for anti-TNF versus corticosteroid patients, respectively. CONCLUSIONS This analysis demonstrated that patients treated with anti-TNF agents have fewer imaging examinations, less radiation exposure, and lower healthcare costs associated with imaging than patients treated with corticosteroids. These benefits do not account for additional long-term benefits that may be gained from reduced radiation exposure.
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Affiliation(s)
- Seema A Patil
- University of Maryland, 685 W. Baltimore St., Suite 8-00, Baltimore, MD, 21201, USA.,Veterans Affairs, Maryland Health Care System, Baltimore, MD, USA
| | - Mark H Flasar
- Anne Arundel Gastroenterology Associates, 820 Bestgate Rd, Annapolis, MD, 21401, USA
| | - Jay Lin
- Novosys Health, 7 Crestmont Court, Flemington, NJ, 08822-6933, USA
| | | | - Martha Skup
- AbbVie, Inc, 1 N Waukegan Road, North Chicago, IL, 60064, USA
| | - Song Wang
- AbbVie, Inc, 1 N Waukegan Road, North Chicago, IL, 60064, USA
| | - Jingdong Chao
- AbbVie, Inc, 1 N Waukegan Road, North Chicago, IL, 60064, USA.,, 27 Barker Ave, Apt 616, White Plains, NY, 10601, USA
| | - Raymond K Cross
- University of Maryland, 685 W. Baltimore St., Suite 8-00, Baltimore, MD, 21201, USA.
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Amin A, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Venous Thromboembolism Prophylaxis and Risk in the Inpatient and Outpatient Continuum of Care Among Hospitalized Acutely Ill Patients in the US: A Retrospective Analysis. Adv Ther 2019; 36:59-71. [PMID: 30543037 DOI: 10.1007/s12325-018-0846-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a leading cause of preventable morbidity and mortality among hospitalized patients in the US. The objectives of this study were to examine VTE prophylaxis patterns and risk for VTE events during hospitalization and post-discharge among patients hospitalized for acute illnesses in the US. METHODS Acutely ill hospitalized patients were identified from the MarketScan databases (January 1, 2012-June 30, 2015). Proportions of patients that received inpatient and/or outpatient VTE prophylaxis were determined. VTE rates were calculated for the overall study population and for each subpopulation with each acute illness type. Risk for VTE events after the index admission was determined by Kaplan-Meier analysis. RESULTS Of the acutely ill patients (n = 17,895, mean age: 58.4 years), most were hospitalized for infectious diseases (40.6%), followed by respiratory diseases (31.0%), cancer (10.7%), heart failure (10.4%), ischemic stroke (6.4%), and rheumatic diseases (0.9%). Among the entire study population, 59.1% did not receive any VTE prophylaxis, and only 7.1% received both inpatient and outpatient prophylaxis. Among the overall study population, cumulative VTE rate, including during index admission and within 6 months post-discharge, was 4.6%. VTE risk in the inpatient and outpatient continuum of care remained elevated up to 30-40 days after hospital admission, with 60.1% of VTEs occurring within 40 days of hospital admission. CONCLUSION In this retrospective analysis of nearly 18,000 patients hospitalized for acute illnesses, 59.1% did not receive any VTE prophylaxis and only 7.1% received VTE prophylaxis in both the inpatient and outpatient continuum of care, despite significant VTE risk extending from hospitalization into the post-discharge period. FUNDING Portola Pharmaceuticals.
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Affiliation(s)
- Alpesh Amin
- School of Medicine, University of California, Irvine, CA, USA.
| | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Deitelzweig S, Guo JD, Hlavacek P, Lin J, Wygant G, Rosenblatt L, Gupta A, Pan X, Mardekian J, Lingohr-Smith M, Menges B, Marshall A, Nadkarni A. Hospital Resource Utilization and Costs Associated With Warfarin Versus Apixaban Treatment Among Patients Hospitalized for Venous Thromboembolism in the United States. Clin Appl Thromb Hemost 2018; 24:261S-268S. [PMID: 30433823 PMCID: PMC6714861 DOI: 10.1177/1076029618800806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/20/2023] Open
Abstract
A real-world US database analysis was conducted to evaluate the hospital resource
utilization and costs of patients hospitalized for venous thromboembolism (VTE) treated
with warfarin versus apixaban. Additionally, 1-month readmissions were evaluated. Of 28
612 patients with VTE identified from the Premier Hospital database (August 2014-May
2016), 91% (N = 26 088) received warfarin and 9% (N = 2524) received apixaban. Outcomes
were assessed after controlling for key patient/hospital characteristics. For index
hospitalizations, the average length of stay (LOS) was longer (3.8 vs 3.1 days,
P < .001; difference: 0.7 days) and mean hospitalization cost higher
(US$3224 vs US$2,740, P < .001; difference: US$484) for warfarin
versus apixaban-treated patients. During the 1-month follow-up period, warfarin treatment
was associated with a greater risk of all-cause readmission (odds ratio [OR]: 1.27; 95%
confidence interval [CI]: 1.09-1.48, P = .003), major bleeding
(MB)-related readmission (OR: 2.10; 95% CI: 1.03-4.27, P = .04), and any
bleeding-related readmission (OR: 1.67; 95% CI: 1.09-2.56, P = .02)
versus apixaban. The results of this real-world analysis show that compared to warfarin,
apixaban treatment was associated with shorter index hospital stays, lower index
hospitalization costs, and reduced risk of MB-related readmissions among hospitalized
patients with VTE.
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Affiliation(s)
- Steven Deitelzweig
- Ochsner Clinic Foundation, Department of Hospital Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
| | - Gail Wygant
- Bristol-Myers Squibb, Lawrenceville, NJ, USA
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Jabbour EJ, Siegartel LR, Lin J, Lingohr-Smith M, Menges B, Makenbaeva D. Economic value of regular monitoring of response to treatment among US patients with chronic myeloid leukemia based on an economic model. J Med Econ 2018; 21:1036-1040. [PMID: 30071761 DOI: 10.1080/13696998.2018.1508023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Regular molecular monitoring with reverse-transcription quantitative PCR (RT-qPCR) analysis of BCR-ABL1 transcripts is associated with reduced disease progression among patients with chronic myeloid leukemia (CML). Molecular monitoring assists in the timely detection of primary or secondary resistance to tyrosine kinase inhibitor (TKI) therapy and is a recommended practice by the National Comprehensive Cancer Network guidelines. An economic model was developed to estimate the potential impact of CML monitoring vs lack of monitoring on patient healthcare costs. METHODS An Excel-based decision-analytic economic model was developed from a US payer perspective. The model was used to estimate the expected healthcare cost differences between regular molecular monitoring of CML patients and lack of monitoring. CML progression rates among patients with vs without monitoring, the annual cost of CML progression, the average number of monitoring tests per year, and the average cost per RT-qPCR monitoring test were incorporated into the model. Univariate and multivariable sensitivity analyses were conducted. RESULTS Based on estimates in published literature, disease progression to the accelerated/blast phase occurs among 0.35% of patients with monitoring and 5.12% of patients without monitoring, and the annual cost of CML progression is $136,308 per patient year. The analysis found that total healthcare costs, including the costs associated with CML progression and RT-qPCR monitoring tests (three tests per year), were $1,142 for patients with monitoring and $6,982 for patients without monitoring (difference = $5,840). In a hypothetical cohort of 100 patients with CML, achieving a 100% monitoring rate was associated with a total cost-savings of $584,005 compared to a 0% monitoring rate. This cost-savings remained consistent under both univariate and multivariable sensitivity analyses. CONCLUSION Regular CML monitoring was associated with improved outcomes among CML patients and, consequently, reduced healthcare costs.
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MESH Headings
- Blast Crisis/economics
- Blast Crisis/physiopathology
- Decision Support Techniques
- Disease Progression
- Drug Resistance, Neoplasm
- Health Expenditures/statistics & numerical data
- Humans
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/economics
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/physiopathology
- Models, Economic
- Protein-Tyrosine Kinases/antagonists & inhibitors
- Reverse Transcriptase Polymerase Chain Reaction/economics
- United States
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Affiliation(s)
- Elias J Jabbour
- a The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | | | - Jay Lin
- c Novosys Health , Green Brook , NJ , USA
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Dasta JF, Sundar S, Chase S, Lingohr-Smith M, Lin J. Economic impact of tolvaptan treatment vs. fluid restriction based on real-world data among hospitalized patients with heart failure and hyponatremia. Hosp Pract (1995) 2018; 46:197-202. [PMID: 30045645 DOI: 10.1080/21548331.2018.1505180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/28/2022]
Abstract
OBJECTIVES To estimate the cost difference associated with tolvaptan treatment vs. fluid restriction (FR) among hospitalized patients with heart failure (HF) and hyponatremia (HN) based on a real-world registry of HN patients. METHODS An Excel-based economic model was developed to evaluate the cost impact of tolvaptan treatment vs. FR. Model input for hospital length of stay (LOS) was based on published data from the Hyponatremia Registry (HNR). Based on HNR data, tolvaptan-treated patients had a 2-day (median) shorter LOS compared to FR. Real-world effectiveness of tolvaptan treatment from the HNR was applied to a national sample of inpatients visits from the Premier Hospital database to estimate the potential LOS-related cost difference between tolvaptan treatment and FR. A one-way sensitivity and multivariable Monte Carlo sensitivity analysis were conducted. RESULTS Economic modeling results of the base-case analysis indicated that among hospitalized patients with HF, the hospital cost per admission, not including HN drug cost, was $3453 lower among patients treated with tolvaptan vs. FR, due to the shorter LOS associated with tolvaptan treatment. At wholesale acquisition cost of $362 per day and an average treatment duration of 3.2 days, the pharmacy cost of tolvaptan treatment per admission was estimated at $1157. Thus, after factoring the decrease in hospital medical costs and increase in pharmacy costs associated with tolvaptan treatment, results indicated a cost-offset opportunity of -$2296 per admission for patients treated with tolvaptan versus FR. Results of the sensitivity analyses were consistent with the base-case analysis. LIMITATIONS The model derives inputs from real-world observational data. No causal relationship can be inferred from this analysis. CONCLUSIONS Based on this economic analysis, tolvaptan treatment vs. FR among hospitalized patients with HF and HN may be associated with lower hospital-related costs, which offset the increase in pharmacy costs associated with tolvaptan treatment.
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Affiliation(s)
- Joseph F Dasta
- a College of Pharmacy, Ohio State University , Columbus , OH , USA.,b College of Pharmacy, University of Texas , Austin , TX , USA
| | - Shirin Sundar
- c Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | - Sandra Chase
- c Otsuka Pharmaceutical Development & Commercialization Inc. , Princeton , NJ , USA
| | | | - Jay Lin
- d Health Economics and Outcomes Research , Green Brook , NJ , USA
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Wu JJ, Feldman SR, Rastogi S, Menges B, Lingohr-Smith M, Lin J. Comparison of the cost-effectiveness of biologic drugs used for moderate-to-severe psoriasis treatment in the United States. J DERMATOL TREAT 2018; 29:769-774. [DOI: 10.1080/09546634.2018.1466022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Jashin J. Wu
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | | | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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Feldman SR, Wu JJ, Rastogi S, Menges B, Lingohr-Smith M, Lin J. The budget impact of brodalumab for the treatment of moderate-to-severe plaque psoriasis on US commercial health plans. J Med Econ 2018; 21:537-541. [PMID: 29357713 DOI: 10.1080/13696998.2018.1431920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Brodalumab is a new biologic approved by the US Food and Drug Administration in 2017 for the treatment of moderate-severe psoriasis. This study evaluated the impact of the introduction of brodalumab on the pharmacy budget on US commercial health plans. METHODS An Excel-based health economic decision analytic model with a US health plan perspective was developed. The model incorporated published moderate-to-severe psoriasis prevalence data; market shares of common biologic drugs, including adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept, used for the treatment of moderate-severe psoriasis; 2017-year Wholesale Acquisition Costs for the biologic drugs; drug dispensing fee; patient co-pay; and drug contracting discount. Total annual health plan costs for the biologic drugs were estimated. Scenarios with different proportions of patients treated with brodalumab were compared to a control scenario when no brodalumab was used. RESULTS In a hypothetical commercial health plan covering two million members, 7,038 moderate-to-severe psoriasis patients were estimated to be eligible for treatment with brodalumab. Prior to brodalumab approval, the proportions of patients treated by other biologics were estimated at 50.8% for adalimumab, 13.5% for ustekinumab, 14.1% for secukinumab, 4.4% for ixekizumab, and 17.2% for etanercept. With a 20% drug price discount applied to all biologics, the annual health plan costs for brodalumab, adalimumab, ustekinumab, secukinumab, ixekizumab, and etanercept were estimated at $37,224, $49,166, $55,084, $56,061, $64,396, and $57,170, respectively. When no brodalumab is used, the total annual pharmacy budget for the biologics used among these patients was estimated at $414,362,647. Among scenarios where the proportions of brodalumab usage were 3%, 8%, 16%, and 30%, the total annual pharmacy cost was estimated to be reduced by $3,698,129, $9,861,677, $19,723,355, and $36,981,290, respectively. CONCLUSION Based on the economic model, brodalumab has the potential to substantially reduce pharmacy expenditures for the treatment of patients with moderate-to-severe plaque psoriasis in the US.
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Affiliation(s)
| | - Jashin J Wu
- b Kaiser Permanente Los Angeles Medical Center , Los Angeles , CA , USA
| | | | | | | | - Jay Lin
- d Novosys Health , Green Brook , NJ , USA
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Amin AN, Neuman WR, Lingohr-Smith M, Menges B, Lin J. PROPHYLAXIS FOR VENOUS THROMBOEMBOLISM IN THE CONTINUUM OF CARE AMONG PATIENTS WITH ACUTE HEART FAILURE IN THE UNITED STATES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lin J, Vo L, Wygant G, Hlavacek P, Rosenblatt L, Gupta A, Pan X, Mardekian J, Lingohr-Smith M, Menges B, Tuell K, Guo J. REAL-WORLD EVALUATION OF HOSPITAL LENGTH OF STAY AND COST FOR APIXABAN VERSUS WARFARIN TREATMENT OF HOSPITALIZED VENOUS THROMBOEMBOLISM PATIENTS IN THE US. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32583-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Amin AN, Neuman WR, Lingohr-Smith M, Menges B, Lin J. DOES AGE MATTER? EVALUATION OF PROPHYLAXIS FOR VENOUS THROMBOEMBOLISM IN THE REAL-WORLD SETTINGS AMONG HOSPITALIZED ACUTELY MEDICALLY ILL PATIENTS OF DIFFERENT AGE GROUPS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32649-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Wen L, Divers C, Lingohr-Smith M, Lin J, Ramsey S. Improving quality of care in oncology through healthcare payment reform. Am J Manag Care 2018; 24:e93-e98. [PMID: 29553283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To provide an overview of alternative payment models (APMs) and describe how leading national organizations involved with oncology care and payment are linking quality improvement initiatives and payment reform. STUDY DESIGN Literature review. METHODS For this review, we summarized the literature on APMs and their goals of improving healthcare quality while jointly controlling the cost of care. We described the types of APMs that have been examined in the real-world setting, specifically in the area of oncology, and how they have affected the quality of oncology care. RESULTS Currently, the following types of APMs are actively being explored by public- and private-sector insurers, specifically in oncology: accountable care organizations, bundled payments, clinical pathways, and patient-centered medical homes. To a great extent, the driving force behind implementing APMs tied to quality can be attributed to the initiatives of several leading national organizations, including the National Academy of Medicine, the American Society of Clinical Oncology, the National Committee for Quality Assurance, HHS, and CMS. Real-world evidence of APMs shows that progress is being made toward improving the quality of oncology care in the United States while simultaneously reducing costs. CONCLUSIONS The effective pairing of quality initiatives with healthcare reimbursement structures will likely be key to the long-term success of such APMs.
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Affiliation(s)
- Lonnie Wen
- Bayer U.S. LLC Pharmaceuticals, 100 Bayer Blvd, Whippany, NJ 07981.
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Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Curtice T, Hlavacek P, Lingohr-Smith M, Menges B, Lin J. All-Cause, Stroke/Systemic Embolism-, and Major Bleeding-Related Health-Care Costs Among Elderly Patients With Nonvalvular Atrial Fibrillation Treated With Oral Anticoagulants. Clin Appl Thromb Hemost 2018; 24:602-611. [PMID: 29363999 PMCID: PMC6714709 DOI: 10.1177/1076029617750269] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In this study, all-cause, stroke/systemic embolism (SE)-related, and major bleeding
(MB)-related health-care costs among elderly patients with nonvalvular atrial fibrillation
(NVAF) initiating treatment with different oral anticoagulants (OACs) were compared.
Patients ≥65 years of age initiating OACs, including apixaban, rivaroxaban, dabigatran,
and warfarin, were identified from the Humana Research Database between January 1, 2013,
and September 30, 2015. Propensity score matching was used to separately match the
different OAC cohorts with the apixaban cohort. All-cause health-care costs and
stroke/SE-related and MB-related medical costs per patient per month (PPPM) were compared
using generalized linear or 2-part regression models. Compared to apixaban, rivaroxaban
was associated with significantly higher all-cause health-care costs (US$2234 vs US$1846
PPPM, P < .001) and MB-related medical costs (US$106 vs US$47 PPPM,
P < .001), dabigatran was associated with significantly higher
all-cause health-care costs (US$1980 vs US$1801 PPPM, P = .007), and
warfarin was associated with significantly higher all-cause health-care costs (US$2386 vs
US$1929 PPPM, P < .001), stroke/SE-related medical costs (US$42 vs
US$18 PPPM, P < .001), and MB-related medical costs (US$132 vs US$51
PPPM, P < .001). Among elderly patients with NVAF, other OACs were
associated with higher all-cause health-care costs than apixaban.
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Affiliation(s)
- Steve Deitelzweig
- 1 Ochsner Clinic Foundation, Department of Hospital Medicine, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | | | | | | | | | | | | | | | - Jay Lin
- 4 Novosys Health, Green Brook, NJ, USA
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Amin A, Neuman R, Lingohr-Smith M, Menges B, Lin J. Abstract TP284: The Risk of Venous Thromboembolism Among Patients Hospitalized for Acute Ischemic Stroke in the US. Stroke 2018. [DOI: 10.1161/str.49.suppl_1.tp284] [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: 11/16/2022]
Abstract
Introduction:
There is a high risk for venous thromboembolism (VTE) among patients hospitalized for acute ischemic stroke. Prophylactic anticoagulant therapy may reduce such risk. The aim of this study was to evaluate the receipt of VTE prophylaxis and VTE risk among patients hospitalized in the US for acute ischemic stroke.
Methods:
Patients hospitalized with acute ischemic stroke from 1/1/2012 to 6/30/2015 were identified from the MarketScan Commercial and Medicare databases. The first of such hospitalization to occur was defined as the index hospitalization. Patients were required to have continuous insurance coverage for the 6 months before (baseline period) and after (follow-up period) the index hospitalization. The proportion of patients who received VTE prophylaxis was determined. Additionally, Kaplan-Meier analysis was used to evaluate VTE risk following the index hospitalization.
Results:
Among patients hospitalized for acute ischemic stroke (n=1,148; mean age 69 years), 54.1% were female. During the index hospitalization, 48.4% (n=556) of patients received inpatient VTE prophylaxis. During the follow-up period, 15.9% (n=183) of patients received outpatient prophylaxis. Among these patients, 48.3% (n=554) did not receive any VTE prophylaxis and 12.6% (n=145) received both inpatient and outpatient VTE prophylaxis. Among this patient population, 1.1% (n=12) had a VTE event during the index hospitalization and 2.0% (n=23) had a VTE event after hospital discharge. The risk for VTE among such patients remained high for up to approximately 30-40 days after the index hospitalization (Figure).
Conclusions:
Despite a high risk for VTE, nearly half of patients hospitalized for acute ischemic stroke received no VTE prophylaxis therapy. Increased prophylaxis therapy may improve patient outcomes in this population.
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Affiliation(s)
- Alpesh Amin
- Univ of California Irvine Sch of Medicine, Irvine, CA
| | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ
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Deitelzweig S, Luo X, Gupta K, Mardekian J, Trocio JN, Curtice T, Lingohr-Smith M, Menges B, Lin J. Correction to: Steven Deitelzweig et al., Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients. Curr Med Res Opin 2018; 34:11-12. [PMID: 29095647 DOI: 10.1080/03007995.2017.1397989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Deitelzweig S, Neuman WR, Lingohr-Smith M, Menges B, Lin J. Incremental economic burden associated with major bleeding among atrial fibrillation patients treated with factor Xa inhibitors. J Med Econ 2017; 20:1217-1223. [PMID: 28760063 DOI: 10.1080/13696998.2017.1362412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate healthcare resource use and costs incurred during, as well as following hospitalization for major bleeding (MB), among atrial fibrillation (AF) patients treated with factor Xa inhibitors Methods: Patients with an AF diagnosis and MB hospitalization (index event) were identified from the MarketScan Commercial and Medicare databases (January 1, 2011-December 31, 2014). Patients were required to have ≥1 prescription for rivaroxaban or apixaban within 3 months prior to MB hospitalization. AF patients treated with Xa inhibitors, but who did not have any diagnosis of MB during the study period were identified. Hospital resource use and costs were evaluated for index MB hospitalizations. Healthcare resource use and associated costs were also evaluated for up to 12 months and compared between AF patients with and without MB. RESULTS Of the overall patient population with AF treated with factor Xa inhibitors (n = 92,949), 3,081 (3.3%) were identified as patients with MB and 89,868 without MB. The mean hospital length of stay and hospital cost for index MB hospitalizations were 5.3 days and $28,059, respectively. Total all-cause healthcare costs were higher during the 12 months of follow-up for AF patients with MB vs without ($63,866 vs $37,916, p < .001). After adjusting for differences in patient characteristics, mean total healthcare costs were estimated at $58,169 for patients with MB vs $41,241 for patients without MB. LIMITATIONS Since this was an observational study using a claims database analysis, a causal relationship between factor Xa inhibitor treatment and MB events cannot be inferred from the results of this study. CONCLUSION In the real-world setting, the cost of initial hospitalizations for MB was substantial, and the incremental burden of total healthcare costs within 1 year following MB hospitalization was high. Approaches to better manage the continuum of care of AF patients with factor Xa inhibitor-associated MB may reduce the healthcare economic burden.
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Affiliation(s)
- Steven Deitelzweig
- a Ochsner Clinic Foundation, Department of Hospital Medicine and The University of Queensland School of Medicine, Ochsner Clinical School , New Orleans , LA , USA
| | | | | | - Brandy Menges
- c Novosys Health, Health Economics and Outcomes Research , Green Brook , NJ , USA
| | - Jay Lin
- c Novosys Health, Health Economics and Outcomes Research , Green Brook , NJ , USA
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Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Curtice T, Lingohr-Smith M, Menges B, Lin J. Comparison of effectiveness and safety of treatment with apixaban vs. other oral anticoagulants among elderly nonvalvular atrial fibrillation patients. Curr Med Res Opin 2017; 33:1745-1754. [PMID: 28849676 DOI: 10.1080/03007995.2017.1334638] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the risk of stroke/systemic embolism (S/SE) and major bleeding (MB) of elderly (≥65 years of age) nonvalvular atrial fibrillation (NVAF) patients initiating apixaban vs. rivaroxaban, dabigatran, or warfarin. METHODS NVAF patients with Medicare Advantage coverage in the US initiating oral anticoagulants (OACs, index event) were identified from the Humana database (1 January 2013-30 September 2015) and grouped into cohorts depending on OAC initiated. Propensity score matching (PSM), 1:1, was conducted among patients treated with apixaban vs. each other OAC, separately. Rates of S/SE and MB were evaluated in the follow-up. Cox regressions were used to compare the risk of S/SE and MB between apixaban and each of the other OACs during the follow-up. RESULTS The matched pairs of apixaban vs. rivaroxaban (n = 13,620), apixaban vs. dabigatran (n = 4654), and apixaban vs. warfarin (n = 14,214) were well balanced for key patient characteristics. Adjusted risks for S/SE (hazard ratio [HR] vs. rivaroxaban: 0.72, p = .003; vs. warfarin: 0.65, p < .001) and MB (HR vs. rivaroxaban: 0.49, p < .001; vs. warfarin: 0.53, p < .001) were significantly lower during the follow-up for patients treated with apixaban vs. rivaroxaban and warfarin. Adjusted risks for S/SE (HR: 0.78, p = .27) and MB (HR: 0.82, p = .23) of NVAF patients treated with apixaban vs. dabigatran trended to be lower, but did not reach statistical significance. CONCLUSIONS In the real-world setting after controlling for differences in patient characteristics, apixaban is associated with significantly lower risk of S/SE and MB than rivaroxaban and warfarin, and a trend towards better outcomes vs. dabigatran among elderly NVAF patients in the US.
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Affiliation(s)
- Steven Deitelzweig
- a Ochsner Clinic Foundation , Department of Hospital Medicine and The University of Queensland School of Medicine , Ochsner Clinical School , New Orleans , LA , USA
| | | | - Kiran Gupta
- c Bristol-Myers Squibb , Plainsboro , NJ , USA
| | | | | | | | | | | | - Jay Lin
- d Novosys Health , Green Brook , NJ , USA
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Lin J, Trocio J, Gupta K, Mardekian J, Lingohr-Smith M, Menges B, You M, Nadkarni A. Major bleeding risk and healthcare economic outcomes of non-valvular atrial fibrillation patients newly-initiated with oral anticoagulant therapy in the real-world setting. J Med Econ 2017; 20:952-961. [PMID: 28604139 DOI: 10.1080/13696998.2017.1341902] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS This study compared the risk for major bleeding (MB) and healthcare economic outcomes of patients with non-valvular atrial fibrillation (NVAF) after initiating treatment with apixaban vs rivaroxaban, dabigatran, or warfarin. METHODS NVAF patients who initiated apixaban, rivaroxaban, dabigatran, or warfarin were identified from the IMS Pharmetrics Plus database (January 1, 2013-September 30, 2015). Propensity score matching (PSM) was used to balance differences in patient characteristics between study cohorts: patients treated with apixaban vs rivaroxaban, apixaban vs dabigatran, and apixaban vs warfarin. Risk of hospitalization and healthcare costs (all-cause and MB-related) were compared between matched cohorts during the follow-up. RESULTS During the follow-up, risks for all-cause (hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.2-1.7) and MB-related (HR = 1.57, 95% CI = 1.0-2.4) hospitalizations were significantly greater for patients treated with rivaroxaban vs apixaban. Adjusted total all-cause healthcare costs were significantly lower for patients treated with apixaban vs rivaroxaban ($3,950 vs $4,333 per patient per month [PPPM], p = .002) and MB-related medical costs were not statistically significantly different ($100 vs $233 PPPM, p = .096). Risk for all-cause hospitalization (HR = 1.98, 95% CI = 1.6-2.4) was significantly greater for patients treated with dabigatran vs apixaban, although total all-cause healthcare costs were not statistically different. Risks for all-cause (HR = 2.22, 95% CI = 1.9-2.5) and MB-related (HR = 2.05, 95% CI = 1.4-3.0) hospitalizations were significantly greater for patients treated with warfarin vs apixaban. Total all-cause healthcare costs ($3,919 vs $4,177 PPPM, p = .025) and MB-related medical costs ($96 vs $212 PPPM, p = .026) were significantly lower for patients treated with apixaban vs warfarin. LIMITATIONS This retrospective database analysis does not establish causation. CONCLUSIONS In the real-world setting, compared with rivaroxaban and warfarin, apixaban is associated with reduced risk of hospitalization and lower healthcare costs. Compared with dabigatran, apixaban is associated with lower risk of hospitalizations.
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Affiliation(s)
- Jay Lin
- a Novosys Health , Green Brook , NJ , USA
| | | | - Kiran Gupta
- c Bristol-Myers Squibb , Lawrenceville , NJ , USA
| | | | | | | | - Min You
- c Bristol-Myers Squibb , Lawrenceville , NJ , USA
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Jabbour EJ, Lin J, Siegartel LR, Lingohr-Smith M, Menges B, Makenbaeva D. Evaluation of healthcare resource utilization and incremental economic burden of patients with chronic myeloid leukemia after disease progression to blast phase. J Med Econ 2017; 20:1007-1012. [PMID: 28681664 DOI: 10.1080/13696998.2017.1345750] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIMS To evaluate healthcare resource utilization and economic burden of patients with chronic myeloid leukemia (CML) progression to the blast phase. METHODS Patients (≥ 18 years) with ≥1 inpatient or ≥2 outpatient CML diagnoses were identified from the MarketScan Commercial and Medicare databases (January 1, 2007-June 30, 2015). CML patients were grouped into two study cohorts, those with evidence of disease progression to the blast phase and those without. Patients were required to have continuous medical and prescription coverage during a 12-month baseline period, in which demographics and clinical characteristics were evaluated. All-cause healthcare resource utilization and costs were evaluated during the baseline period, and a variable follow-up period, lasting ≥1 day and up to 1 year. Generalized linear models (GLM) were used to compare the incremental costs of CML patients with vs without progression. RESULTS Of the overall study population, 587 (7%) experienced disease progression and 7,504 (93%) did not. On the index date, of patients with progression, ∼ 31% were treated with allogeneic hematopoietic cell transplant and 69% with chemotherapy. During the baseline period, mean total healthcare costs, including costs for hospitalizations and outpatient costs, were significantly greater for CML patients with progression as compared to those without progression ($143,778 vs $53,143, p < .001). During the follow-up, mean total healthcare costs, costs for hospitalizations, and outpatient medical service costs were substantially greater for patients with progression as compared to those without progression; however, costs for outpatient prescriptions were less for patients who progressed. When patient characteristics were controlled for, mean incremental 1-year cost for CML patients with vs without progression was $270,925 (confidence interval = $235,290-$311,958, p < .001). CONCLUSIONS The healthcare burden, in terms of healthcare resource utilization and costs, of patients with CML progression is substantial. Healthcare providers and payers should consider various strategies to minimize the rate of CML progression.
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Affiliation(s)
- Elias J Jabbour
- a The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Jay Lin
- b Novosys Health , Green Brook , NJ , USA
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Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Curtice T, Lingohr-Smith M, Menges B, Lin J. Effect of Apixaban Versus Warfarin Use on Health Care Resource Utilization and Costs Among Elderly Patients with Nonvalvular Atrial Fibrillation. J Manag Care Spec Pharm 2017; 23:1191-1201. [PMID: 29083968 PMCID: PMC10397614 DOI: 10.18553/jmcp.2017.17060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The clinical trial ARISTOTLE showed that apixaban was superior to warfarin in reducing the risks of stroke and bleeding among patients with nonvalvular atrial fibrillation (NVAF). Further study of the effect of apixaban versus warfarin use on health care resource utilization (HCRU) and associated costs in the real-world setting is warranted, especially among elderly patients who are at higher risk of stroke and bleeding. OBJECTIVE To compare HCRU and costs among elderly NVAF patients treated with apixaban versus warfarin in the United States. METHODS Elderly patients (aged ≥ 65 years) with Medicare coverage who initiated apixaban or warfarin were identified from the Humana research database during January 1, 2013-September 30, 2015. Patients were required to have 12 months of continuous insurance coverage before drug initiation (baseline period) and an atrial fibrillation diagnosis during the baseline period or on the date of drug initiation. NVAF patients were grouped into cohorts depending on the drug initiated. Propensity score matching (PSM) was conducted to control for differences in demographics and clinical characteristics of study cohorts. Patients were followed after the index date for a variable length of follow-up. All-cause and disease-specific HCRU and costs during the follow-up were evaluated before and after PSM and reported as per patient per year. RESULTS Of the overall (unmatched) population, 8,250 patients (mean age: 78.0 years) initiated apixaban and 14,051 patients (mean age: 78.2 years) initiated warfarin. Among NVAF patients who initiated apixaban versus those who initiated warfarin, mean Charlson Comorbidity Index (CCI) scores (3.0 vs. 3.4, P < 0.001); stroke risk scores, including CHADS2 (2.7 vs. 2.9, P < 0.001) and CHA2DS2-VASc (4.6 vs. 4.7, P < 0.001); and bleeding risk scores, including HAS-BLED (3.1 vs. 3.2, P < 0.001), were lower. Additionally, total annual all-cause health care costs were lower during the baseline period for patients treated with apixaban versus warfarin ($17,077 vs. $20,236, P < 0.001). After PSM, 14,214 patients were matched, with 7,107 in each cohort. Mean age, CCI score, and stroke and bleeding risks were similar between matched cohorts, as were total all-cause health care costs during the baseline period. During the follow-up among matched cohorts, apixaban versus warfarin treatment was associated with higher annual pharmacy costs ($5,159 vs. $2,867, P < 0.001) but lower annual inpatient ($8,327 vs. $14,296, P < 0.001), outpatient ($9,655 vs. $11,469, P < 0.001), and total all-cause health care costs ($23,141 vs. $28,633, P < 0.001), which were reflective of lower inpatient, outpatient, and all-cause HCRU among apixaban-treated patients. Furthermore, bleeding-related ($2,101 vs. $3,963, P < 0.001) and stroke-related ($652 vs. $1,178, P = 0.001) annual medical costs were lower for patients treated with apixaban versus warfarin. CONCLUSIONS After controlling for differences in patient characteristics, in the real-world setting apixaban versus warfarin use was associated with less HCRU and lower total all-cause health care costs and costs for bleeding- and stroke-related medical services, but greater pharmacy costs, among elderly NVAF patients. DISCLOSURES This study was sponsored by Pfizer and Bristol-Myers Squibb. Deitelzweig is a consultant for Pfizer and Bristol-Myers Squibb and has served on their advisory boards and received speaker fees. Deitelzweig also serves as consultant and advisory board member to Portola and Janssen. Luo, Trocio, and Mardekian are employees of Pfizer and own stock in the company. Gupta and Curtice are employees of Bristol-Myers Squibb and own stock in the company. Lingohr-Smith, Menges, and Lin are employees of Novosys Health, which received research funds from Pfizer and Bristol-Myers Squibb to conduct this study and develop the manuscript. Study concept and design were primarily contributed by Deitelzweig, Luo, and Gupta, along with Trocio, Mardekian, Curtice, and Lin. Lin, Menges, and Lingohr-Smith took the lead in data collection, with assistance from the other authors. Data interpretation was performed by Deitelzweig, Menges, and Lin, with assistance from the other authors. The manuscript was written by Lingohr-Smith and Menges, along with the other authors, and revised by all the authors. Some aspects of this study were presented at the American Heart Association Scientific Sessions in New Orleans, Louisiana, November 12-16, 2016.
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Affiliation(s)
- Steven Deitelzweig
- 1 Ochsner Clinic Foundation, Department of Hospital Medicine, New Orleans, Louisiana, and The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, Louisiana
| | | | - Kiran Gupta
- 3 Bristol-Myers Squibb, Plainsboro, New Jersey
| | | | | | | | | | | | - Jay Lin
- 4 Novosys Health, Green Brook, New Jersey
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Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Curtice T, Lingohr-Smith M, Menges B, Lin J. 5721Comparison of stroke and major bleeding risk of treatment with apixaban vs. rivaroxaban and dabigatran among elderly nonvalvular atrial fibrillation patients in the United States. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.5721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lin J, Makenbaeva D, Lingohr-Smith M, Bilmes R. Healthcare and economic burden of adverse events among patients with chronic myelogenous leukemia treated with BCR-ABL1 tyrosine kinase inhibitors. J Med Econ 2017; 20:687-691. [PMID: 28287043 DOI: 10.1080/13696998.2017.1302947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES BCR-ABL1 tyrosine kinase inhibitors (TKIs) are established treatments for chronic myelogenous leukemia (CML); however, they are associated with infrequent, but clinically serious adverse events (AEs). The objective of this analysis was to assess healthcare resource utilization and costs associated with AEs, previously identified using the FDA Adverse Event Reporting System (FAERS) in another study, among TKI-treated patients. METHODS Adult patients with ≥1 inpatient or ≥2 outpatient ICD-9-CM diagnosis codes for CML and ≥1 claim for a TKI treatment between January 1, 2006 and September 30, 2012 were identified from the Commercial and Medicare MarketScan databases. The first claim for a TKI was designated as the index event. Patients were required to have no TKI treatment during a 12-month baseline period. Healthcare resource utilization and costs associated with select AEs having the strongest association with TKI treatment (femoral arterial stenosis [FAS], peripheral arterial occlusive disease [PAOD], intermittent claudication, coronary artery stenosis [CAS], pericardial effusion, pleural effusion, malignant pleural effusion, conjunctival hemorrhage) were evaluated during a 12-month follow-up period. RESULTS The study sample included 2,005 CML patients receiving TKI therapy (mean age = 56 years; 56% male). Among all evaluated AEs, the highest mean inpatient healthcare costs were observed for FAS ($16,800 per patient) and PAOD ($14,263 per patient), which had total mean medical costs (inpatient + outpatient) of $17,015 and $15,154 per patient, respectively. Mean outpatient healthcare costs were highest for CAS ($1,861 per patient), followed by intermittent claudication ($947 per patient), PAOD ($891 per patient), and pleural effusion ($890 per patient). Total mean medical costs for fluid retention-related AEs, including pericardial effusion and pleural effusion, were $2,797 and $1,908 per patient, respectively. CONCLUSIONS The healthcare costs of AEs identified in the FAERS as having the strongest association with TKI treatment are substantial. Vascular stenosis-related AEs, including FAS and PAOD, have the highest cost burden.
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Affiliation(s)
- Jay Lin
- a Novosys Health , Green Brook , NJ , USA
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Divers C, Platt D, Wang E, Lin J, Lingohr-Smith M, Mathai SC. A Review of Clinical Trial Endpoints of Patients with Pulmonary Arterial Hypertension and Chronic Thromboembolic Pulmonary Hypertension and How They Relate to Patient Outcomes in the United States. J Manag Care Spec Pharm 2017; 23:92-104. [PMID: 28025931 PMCID: PMC10398058 DOI: 10.18553/jmcp.2017.23.1.92] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are subgroups of pulmonary hypertension and are considered rare diseases. Understanding how endpoints of clinical trials (and patient registry studies) of patients with PAH and CTEPH are associated with patient outcomes is important in order to address the concerns of patients, health care providers, decision makers, and payers. The purpose of this review was to examine how endpoints used in clinical trials and patient registry studies are associated with outcomes of patients with PAH and CTEPH. A PubMed literature search was conducted to retrieve published studies, including randomized phase III clinical trials and observational studies, from years 2000 to May 2015 that evaluated the associations between change in 6-minute walking distance (6MWD), 6MWD thresholds, change in World Health Organization functional class (WHO-FC), and time to clinical worsening with outcomes of patients with PAH and CTEPH. Based on this review of published literature, a reduction in 6MWD as a criterion for PAH worsening, a deterioration in WHO-FC, and delay in the time to clinical worsening are clinically meaningful trial endpoints and are associated with outcomes of patients with PAH and CTEPH. Utilization and standardization of these endpoints will be useful for comparing interventions of clinical trials and therapies. Hospitalizations are frequent among patients with PAH and CTEPH, and total health care costs are high. From a U.S. payer perspective, clinical worsening is an important composite endpoint in that it includes hospitalization, which can be transformed into a preventative cost value associated with efficacious treatment of patients with PAH and CTEPH. In view of the greater number of medications available to treat PAH, the introduction of the first approved therapy to treat CTEPH, and the increasing use of combination pharmacotherapy, reliable prognostic markers of treatment responsiveness are important to help guide appropriate management. As new clinical trials and observational studies are conducted, it will be important to maintain universal endpoints so that health care providers, decision makers, and payers can better understand the value of targeted pharmacotherapies and combination therapies for the treatment of patients with PAH and CTEPH. DISCLOSURES Sponsorship for this review and article processing charges were funded by Bayer HealthCare Pharmaceuticals. Divers and Platt are employees of Bayer HealthCare Pharmaceuticals. Wang is an employee of Bayer HealthCare Pharmaceuticals and owns stock in the company. Lin and Lingohr-Smith are employees of Novosys Health, which received research funds from Bayer HealthCare Pharmaceuticals in connection with conducting this review and developing this manuscript. Mathai is a consultant to Bayer HealthCare Pharmaceuticals and also reports consulting fees from Actelion and Gilead. Study concept and design were contributed by Divers, Platt, Lin, and Mathai. Lin and Lingohr-Smith collected the data, and data interpretation was performed by Divers, Platt, Wang, and Matthai. The manuscript was written primarily by Lingohr-Smith, with assistance from the other authors, and revised by Divers, Platt, Wang, and Mathai.
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Affiliation(s)
| | - David Platt
- 1 Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Edward Wang
- 1 Bayer HealthCare Pharmaceuticals, Whippany, New Jersey
| | - Jay Lin
- 2 Novosys Health, Green Brook, New Jersey
| | | | - Stephen C Mathai
- 3 Johns Hopkins University School of Medicine, Baltimore, Maryland
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Deitelzweig S, Luo X, Gupta K, Trocio J, Mardekian J, Cutice T, Lingohr-Smith M, Menges B, Lin J. REAL WORLD EVALUATION OF MAJOR BLEEDING RISK AND COSTS FOR ALL CAUSES AND BLEEDING-RELATED HEALTH SERVICES AMONG ELDERLY PATIENTS WITH NONVALVULAR ATRIAL FIBRILLATION TREATED WITH APIXABAN OR WARFARIN. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33701-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lin J, Siegartel LR, Lingohr-Smith M, Menges B, Makenbaeva D. Using Health Care Claims Data to Assess the Prevalence of Hodgkin Lymphoma and Relapsed or Refractory Hodgkin Lymphoma in the United States. Clin Ther 2017; 39:303-310. [DOI: 10.1016/j.clinthera.2016.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/22/2016] [Accepted: 12/13/2016] [Indexed: 01/09/2023]
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Deitelzweig SB, Evans M, Trocio J, Gupta K, Lingohr-Smith M, Menges B, Lin J. Impact of Warfarin Persistence on Health-Care Utilization and Costs Among Patients With Atrial Fibrillation Managed in Anticoagulation Clinics in the United States. Clin Appl Thromb Hemost 2017; 24:364-371. [PMID: 28135822 DOI: 10.1177/1076029616685427] [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: 01/30/2023] Open
Abstract
Warfarin is a recommended therapy to reduce the risk of stroke in patients with nonvalvular atrial fibrillation (NVAF). The objectives of this study were to identify potential factors associated with warfarin persistence and evaluate the impact of warfarin persistence on health-care resource utilization and costs among patients with NVAF in the United States. Patients (≥18 years) with ≥1 inpatient or ≥2 outpatient diagnoses of AF without valvular disease were identified from an electronic medical record database (January 1, 2004, to January 31, 2015). The patients with NVAF were grouped into 2 cohorts-persistent with warfarin therapy and not persistent (warfarin discontinuation in <365 days). A multivariable regression was used to identify potential predictors of warfarin persistence. Health-care costs were evaluated during a 12-month follow-up period for study cohorts. Among the study population, 52%, (n = 4086) were persistent with warfarin therapy and 48% (n = 3722) were not. Patients with NVAF with higher Charlson comorbidity index and CHADS2 scores versus those with scores of 0 were more likely to demonstrate persistence with warfarin therapy. After adjusting for patient characteristics, patients with NVAF persistent with warfarin therapy versus those who were not were 30% less likely to be hospitalized during the follow-up period ( P < .001). Additionally, total all-cause health-care costs (US $2183, P < .001) and stroke-related costs (US $788, P < .001) were significantly lower among patients persistent with warfarin therapy versus those who were not. Patients with NVAF who have greater comorbidity and stroke risk are more likely to be persistent with warfarin therapy. Patients with NVAF who are persistent with warfarin therapy versus those who are not have lower all-cause and stroke-related health-care costs.
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Affiliation(s)
- Steven B Deitelzweig
- 1 Department of Hospital Medicine, Ochsner Clinic Foundation, Ochsner Health System, New Orleans, LA, USA
| | - Michael Evans
- 2 Geisinger Health System, Enterprise Pharmacy, Danville, PA, USA
| | - Jeffrey Trocio
- 3 Global Health and Value, Outcomes and Evidence, Pfizer, Inc, New York, NY, USA
| | - Kiran Gupta
- 4 Health Economics and Outcomes Research, Bristol-Myers Squibb, Plainsboro, NJ, USA
| | | | - Brandy Menges
- 5 Health Economics and Outcomes Research, Novosys Health, Green Brook, NJ, USA
| | - Jay Lin
- 5 Health Economics and Outcomes Research, Novosys Health, Green Brook, NJ, USA
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Lin J, Lingohr-Smith M, Fan T. Real-world medication persistence and outcomes associated with basal insulin and glucagon-like peptide 1 receptor agonist free-dose combination therapy in patients with type 2 diabetes in the US. Clinicoecon Outcomes Res 2016; 9:19-29. [PMID: 28053550 PMCID: PMC5192057 DOI: 10.2147/ceor.s117200] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Free-dose combination treatment with basal insulin and short-acting glucagon-like peptide-1 receptor agonists (GLP-1 RAs) reduces hyperglycemia via complementary targeting of fasting and postprandial blood glucose levels, however, in the real world, due to injection burden and clinical inertia, the full efficacy may not be able to translate into clinical and economic benefits. Objective The aim of the study was to evaluate treatment persistence and associated outcomes in patients with type 2 diabetes (T2D) treated with a GLP-1 RA in free-dose combination with basal insulin. Methods Claims data were extracted on US adults with T2D with ≥1 prescription claim for both a GLP-1 RA and a basal insulin from July 1, 2008 to June 30, 2013, and continuous health plan coverage for 6 months prior to (baseline) and 12 months after the index date (follow-up period). Outcomes analyzed for patients stratified by treatment persistence included glycemic control, hypoglycemia, and health care costs and resource utilization. Multivariate analyses were used to examine factors associated with persistence or hypoglycemia. Results The analysis included 7,320 patients, of whom 16.9% were persistent with free-dose combination treatment. The median time to treatment discontinuation was 133 days. Compared with nonpersistent patients, persistent patients had greater glycated hemoglobin A1c (A1C) reductions (−0.80% vs −0.42%; P=0.032), were more likely to achieve A1C <7.0% (39% vs 22%; P<0.001), and were less likely to experience hypoglycemia (9.5% vs 6.8%; P=0.002). Persistent patients also had significantly fewer hospitalizations and shorter hospital stays. While prescription costs were significantly higher (all-cause: $14,691 vs $10,791; P<0.001; diabetes-related: $8,142 vs $5,124; P<0.001), total medical charges were significantly lower (all-cause: $28,405 vs $40,292; P=0.001; diabetes-related: $11,114 vs $15,203; P=0.003) for persistent patients compared with nonpersistent patients. Conclusion This retrospective claims study of US patients with T2D showed that, although persistence with concurrent GLP-1 RA and basal insulin treatment is low, improved treatment persistence is associated with greater A1C reductions and lower total medical charges.
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Affiliation(s)
- Jay Lin
- Health Economics and Outcomes Research, Novosys Health, Green Brook, NJ, USA
| | | | - Tao Fan
- North America Medical Affairs, Sanofi US, Inc., Bridgewater, NJ, USA
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Spyropoulos AC, Preblick R, Kwong WJ, Lingohr-Smith M, Lin J. Is Adherence to the American College of Chest Physicians Recommended Anticoagulation Treatment Duration Associated With Different Outcomes Among Patients With Venous Thromboembolism? Clin Appl Thromb Hemost 2016; 23:532-541. [DOI: 10.1177/1076029616680475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinical and economic outcomes associated with venous thromboembolism (VTE) patient adherence to the American College of Chest Physicians (ACCP) anticoagulant (AC) treatment guidelines are incompletely understood. Patients with ≥1 inpatient or ≥2 separate outpatient claims for deep vein thrombosis and/or pulmonary embolism, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes, were identified from the IMS PharMetrics Plus database. Patients had continuous insurance coverage for 12 months before (baseline) and after (follow-up) the index event (first VTE claim) but no baseline VTE claims. The ACCP recommends minimum AC treatment durations (3 or ≥6 months) dependent upon patient risk profiles. Patients were grouped into study cohorts based on their adherence status (adherent vs nonadherent) to the recommended minimum treatment durations. Patient baseline characteristics, health-care resource utilization, and associated costs were evaluated. The VTE recurrence and bleed-related hospitalization were measured during follow-up. Multivariate regression analysis was utilized to compare clinical and economic outcomes of cohorts. Of the 81 827 study patients, 74% (n = 60 550) were AC adherent. After controlling for key patient characteristics, risks for all-cause hospitalization (adjusted odds ratio [AOR]: 0.85, P < .0001), VTE recurrence (AOR = 0.92, P = .0014), and bleeding-related hospitalization (AOR = 0.74, P < .0001) were lower among adherent patients, as were all-cause health-care cost (−US$2121, P = .0003) and VTE-related (−US$2294, P < .0001) and bleed-related (−US$248, P < .0001) medical costs during the follow-up period. Approximately one-quarter of the study population was AC nonadherent; these nonadherent patients had more VTE recurrences, utilized more inpatient services, and had higher health-care costs.
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Affiliation(s)
- Alex C. Spyropoulos
- Department of Medicine, Hofstra Northwell Health School of Medicine, Northwell Health at Lenox Hill Hospital, New York, NY, USA
| | | | | | | | - Jay Lin
- Novosys Health, Green Brook, NJ, USA
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