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Yoo M, Nelson RE, Haaland B, Dougherty M, Cutshall ZA, Kohli R, Beckstead R, Kohli M. Cost-effectiveness analysis of 7 treatments in metastatic hormone-sensitive prostate cancer: a public-payer perspective. J Natl Cancer Inst 2023; 115:1374-1382. [PMID: 37436697 PMCID: PMC10637034 DOI: 10.1093/jnci/djad135] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Recently, several new treatment regimens have been approved for treating metastatic hormone-sensitive prostate cancer, building on androgen deprivation therapy alone. These include docetaxel androgen deprivation therapy, abiraterone acetate-prednisone androgen deprivation therapy, apalutamide androgen deprivation therapy, enzalutamide androgen deprivation therapy, darolutamide-docetaxel androgen deprivation therapy, and abiraterone-prednisone androgen deprivation therapy with docetaxel. There are no validated predictive biomarkers for choosing a specific regimen. The goal of this study was to conduct a health economic outcome evaluation to determine the optimal treatment from the US public sector (Veterans Affairs). METHODS We developed a partitioned survival model in which metastatic hormone-sensitive prostate cancer patients transitioned between 3 health states (progression free, progressive disease to castrate resistance state, and death) at monthly intervals based on Weibull survival model estimated from published Kaplan-Meier curves using a Bayesian network meta-analysis of 7 clinical trials (7208 patients). The effectiveness outcome in our model was quality-adjusted life-years (QALYs). Cost input parameters included initial and subsequent treatment costs and costs for terminal care and for managing grade 3 or higher drug-related adverse events and were obtained from the Federal Supply Schedule and published literature. RESULTS Average 10-year costs ranged from $34 349 (androgen deprivation therapy) to $658 928 (darolutamide-docetaxel androgen deprivation therapy) and mean QALYs ranged from 3.25 (androgen deprivation therapy) to 4.57 (enzalutamide androgen deprivation therapy). Treatment strategies docetaxel androgen deprivation therapy, enzalutamide androgen deprivation therapy docetaxel, apalutamide androgen deprivation therapy, and darolutamide-docetaxel androgen deprivation therapy were eliminated because of dominance (ie, they were more costly and less effective than other strategies). Of the remaining strategies, abiraterone acetate-prednisone androgen deprivation therapy was the most cost-effective strategy at a willingness-to-pay threshold of $100 000/QALY (incremental cost-effectiveness ratios = $21 247/QALY). CONCLUSIONS Our simulation model found abiraterone acetate-prednisone androgen deprivation therapy to be an optimal first-line treatment for metastatic hormone-sensitive prostate cancer from a public (Veterans Affairs) payer perspective.
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Affiliation(s)
- Minkyoung Yoo
- Division of Epidemiology, Department of Internal Medicine, University of Utah (UT) School of Medicine, Salt Lake City, UT, USA
| | - Richard E Nelson
- Division of Epidemiology, Department of Internal Medicine, University of Utah (UT) School of Medicine, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Department of Population Health Sciences, University of UT, Salt Lake City, UT, USA
| | - Maura Dougherty
- Department of Economics, University of UT, Salt Lake City, UT, USA
| | | | - Rhea Kohli
- Case Western Reserve University, Cleveland, OH, USA
| | - Rylee Beckstead
- School of Medicine, University of UT, Salt Lake City, UT, USA
| | - Manish Kohli
- Division of Oncology-Department of Medicine, University of UT/Huntsman Cancer Institute, Salt Lake City, UT, USA
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Mondal A, Yoo M, Tuttle S, Mah D, Nelson R, Sachse FB, Hitchcock R, Kaza AK. Cost of Pacing in Pediatric Patients With Postoperative Heart Block After Congenital Heart Surgery. JAMA Netw Open 2023; 6:e2341174. [PMID: 37921766 PMCID: PMC10625035 DOI: 10.1001/jamanetworkopen.2023.41174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/22/2023] [Indexed: 11/04/2023] Open
Abstract
Importance Surgical correction of congenital heart defects (CHDs) has improved the lifespan and quality of life of pediatric patients. The number of congenital heart surgeries (CHSs) in children has grown continuously since the 1960s. This growth has been accompanied by a rise in the incidence of postoperative heart block requiring permanent pacemaker (PPM) implantation. Objective To assess the trends in permanent pacing after CHS and estimate the economic burden to patients and their families after PPM implantation. Design, Setting, and Participants In this economic evaluation study, procedure- and diagnosis-specific codes within a single-institution database were used to identify patients with postoperative heart block after CHS between January 1, 1960, and December 31, 2018. Patients younger than 4 years with postoperative PPM implantation were selected, and up to 20-year follow-up data were used for cost analysis based on mean hospital event charges and length of stay (LOS) data. Data were analyzed from January 1, 2020, to November 30, 2022. Exposure Implantation of PPM after CHS in pediatric patients. Main Outcomes and Measures Annual trends in CHS and postoperative PPM implantations were assessed. Direct and indirect costs associated with managing conduction health for the 20 years after PPM implantation were estimated using Markov model simulation and patient follow-up data. Results Of the 28 225 patients who underwent CHS, 968 (437 female [45.1%] and 531 male [54.9%]; 468 patients aged <4 years) received a PPM due to postoperative heart block. The rate of CHS and postoperative PPM implantations increased by 2.2% and 7.2% per year between 1960 and 2018, respectively. In pediatric patients younger than 4 years with PPM implantation, the mean (SD) 20-year estimated direct and indirect costs from Markov model simulations were $180 664 ($32 662) and $15 939 ($1916), respectively. Using follow-up data of selected patients with clinical courses involving 1 or more complication events, the mean (SD) direct and indirect costs were $472 774 ($212 095) and $36 429 ($16 706), respectively. Conclusions and Relevance In this economic evaluation study, the cost of PPM implantation in pediatric patients was found to accumulate over the lifespan. This cost may represent not only a substantial financial burden but also a health care burden to patient families. Reducing the incidence of PPM implantation should be a focused goal of CHS.
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Affiliation(s)
- Abhijit Mondal
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Minkyoung Yoo
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Stephanie Tuttle
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
| | - Douglas Mah
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Richard Nelson
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Frank B. Sachse
- Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Robert Hitchcock
- Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Aditya K. Kaza
- Department of Cardiac Surgery, Boston Children’s Hospital, Boston, Massachusetts
- Department of Surgery, Harvard Medical School, Boston, Massachusetts
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Rogers MJ, Nishimoto J, Yoo M, Presson AP, Stephens AR, Kazmers NH. Evaluating the Performance of an Automated Patient-Reported Outcomes Collection Platform in a Postoperative Hand Surgery Population. J Hand Surg Am 2023:S0363-5023(23)00256-3. [PMID: 37354194 DOI: 10.1016/j.jhsa.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 04/30/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Reliable collection of postoperative patient-reported outcome measures (PROMs) is critical to understanding surgical outcomes and the value of care. Automated PROMs collection, triggered by the electronic medical record at the 1-year postoperative anniversary, may provide a simple way to acquire outcomes for patients who have been discharged from clinic. The purposes of this study were to (1) evaluate the percentage of responses with an automated PROMs collection platform and (2) identify whether such a system may introduce selection bias by comparing responders with nonresponders. METHODS Adult patients (aged ≥18 years) undergoing hand and upper-extremity surgeries between August 2017 and January 2019 were included. Preoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores were collected using tablet computer. Postoperative QuickDASH scores were collected using a single electronic survey request 1 year after surgery via an email with a personalized REDCap link. Univariate and multivariable regression analyses were performed to identify factors that differed between responders and nonresponders. RESULTS A response rate of 27% (269 of 1010) was observed for the eligible postoperative patients. On multivariable analysis, the following were associated with greater odds of response: older age, Caucasian race (vs unknown), longer surgery duration, attending the first postoperative visit, and responding to the preoperative QuickDASH. CONCLUSIONS The poor response rate that was observed highlights that an automated single email postoperative contact for PROMs collection is insufficient-active follow-up via reminder emails and/or telephone calls is needed. Outcome researchers and clinicians must be aware of potential selection biases, such as age and race, that may exist with automated PROMs collection. CLINICAL RELEVANCE Single email postoperative contact to obtain postoperative PROMs is insufficient.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Jordan Nishimoto
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Minkyoung Yoo
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
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Yoo M, Nelson RE, Cutshall Z, Dougherty M, Kohli M. Cost-Effectiveness Analysis of Six Immunotherapy-Based Regimens and Sunitinib in Metastatic Renal Cell Carcinoma: A Public Payer Perspective. JCO Oncol Pract 2023; 19:e449-e456. [PMID: 36599117 PMCID: PMC10022876 DOI: 10.1200/op.22.00447] [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: 01/06/2023] Open
Abstract
PURPOSE Several new treatment combinations have been approved in metastatic renal cell carcinoma (mRCC). To determine the optimal therapy on the basis of cost and health outcomes, we performed a cost-effectiveness analysis of approved immunotherapy-tyrosine kinase inhibitor/immunotherapy drug combinations and sunitinib using public payer acquisition costs in the United States. METHODS We constructed a decision model with a 10-year time horizon. The seven treatment drug strategies included atezolizumab + bevacizumab, avelumab + axitinib, pembrolizumab + axitinib, nivolumab + ipilimumab (NI), nivolumab + cabozantinib, lenvatinib + pembrolizumab, and sunitinib. The effectiveness outcome in our model was quality-adjusted life-years (QALYs) with utility values on the basis of the published literature. Costs included drug acquisition costs and costs for management of grade 3-4 drug-related adverse events. We used a partitioned survival model in which patients with mRCC transitioned between three health states (progression-free, progressive disease, and death) at monthly intervals on the basis of parametric survival function estimated from published survival curves. To determine cost-effectiveness, we constructed incremental cost-effectiveness ratios (ICERs) by dividing the difference in cost by the difference in effectiveness between nondominated treatments. RESULTS The least expensive treatment was sunitinib ($357,948 US dollars [USD]-$656,100 USD), whereas the most expensive was either lenvatinib + pembrolizumab or pembrolizumab + axitinib ($959,302 USD-$1,403,671 USD). NI yielded the most QALYs (3.6), whereas avelumab + axitinib yielded the least (2.5). NI had an incremental ICER of $297,465 USD-$348,516 USD compared with sunitinib. In sensitivity analyses, this ICER fell below $150,000 USD/QALY if the initial 4-month cost of NI decreased by 22%-38%. CONCLUSION NI was the most effective combination for mRCC, but at a willingness-to-pay threshold of $150,000 USD/QALY, sunitinib was the most cost-effective approach.
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Affiliation(s)
- Minkyoung Yoo
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Richard E Nelson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.,Informatics Decision Enhancement and Surveillance (IDEAS) Center, VA Salt Lake City Healthcare System, Salt Lake City, UT
| | | | - Maura Dougherty
- Department of Economics, University of Utah, Salt Lake City, UT
| | - Manish Kohli
- Division of Oncology, Department of Medicine, University of Utah, Salt Lake City, UT.,Huntsman Cancer Institute, Salt Lake City, UT
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Kohli M, Dougherty M, Cutshall Z, Beckstead R, Kohli R, Haaland B, Nelson R, Yoo M. Cost-effectiveness analysis of seven treatment regimens in metastatic hormone-sensitive prostate cancer (mHSPC): A public payer perspective using network meta-analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.268] [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: 03/15/2023] Open
Abstract
268 Background: Recently several new treatment regimens have been approved for treating mHSPC, building on the previous standard of care using androgen deprivation therapy (ADT) alone. These include docetaxel+ADT (DA), Abiraterone Acetate+Prednisone+ADT (AAP), Apalutamide+ADT (AAT), Enzalutamide+ADT (ET), Darolutamide+Docetaxel+ADT (DAD) and Abiraterone+Prednisone+ADT+Docetaxel (AAD). There are no current predictive biomarkers for choosing any specific regimen. The goal of this study was to determine the cost-effectiveness of these new treatments from the US public sector perspective with a lifetime horizon. Methods: We developed a partitioned survival model in which mHSPC patients transitioned between three health states (progression free, progressive disease to castrate resistance state, and death) at monthly intervals based on Weibull survival model estimated from published Kaplan-Meier curves using a network meta-analysis. A Bayesian network meta-analysis of seven clinical trials included 7,208 patients. The effectiveness outcome in our model was quality-adjusted life-years (QALYs) with utility values obtained from published literature. Costs in our model included those associated with treatment regimens and subsequent therapies, terminal care, and for managing grade 3-4 drug related adverse events, and were obtained from the Federal Supply Schedule and published literature. Results: Average lifetime costs ranged from $154,139 (AAP) to $770,848 (DAD) and mean QALYs ranged from 3.33 (ADT) to 5.08 (ET). All treatment strategies other than AAP and ET were eliminated due to dominance. Compared to AAP, the incremental cost-effectiveness ratio for ET was $484,943/QALY. Results from our analysis including all regimens are shown. Conclusions: Our simulation model found that ET in mHSPC state yielded the most QALYs and would be the most cost-effective option with a WTP threshold as high as $500,000/QALY. However, for a WTP threshold of $150,000/QALY, AAP was the most cost-effective treatment strategy. [Table: see text]
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Affiliation(s)
- Manish Kohli
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
| | | | | | - Rylee Beckstead
- Huntsman Cancer Institute at the University of Utah, Salt LAKE Cty, UT
| | - Rhea Kohli
- Case Western Reserve University, Cleveland, OH
| | - Benjamin Haaland
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT
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Federer AE, Yoo M, Stephens AS, Nelson RE, Steadman JN, Tyser AR, Kazmers NH. Minimizing Costs for Dorsal Wrist Ganglion Treatment: A Cost-Minimization Analysis. J Hand Surg Am 2023; 48:9-18. [PMID: 36402604 PMCID: PMC9812920 DOI: 10.1016/j.jhsa.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/19/2022] [Accepted: 09/06/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE Dorsal wrist ganglions are treated commonly with aspiration, or open or arthroscopic excision in operating room (OR) or procedure room (PR) settings. As it remains unclear which treatment strategy is most cost-effective in yielding cyst resolution, our purpose was to perform a formal cost-minimization analysis from the societal perspective in this context. METHODS A microsimulation decision analytic model evaluating 5 treatment strategies for dorsal wrist ganglions was developed, ending in either resolution or a single failed open revision surgical excision. Strategies included immediate open excision in the OR, immediate open excision in the PR, immediate arthroscopic excision in the OR, or 1 or 2 aspirations before each of the surgical options. Recurrence and complications rates were pooled from the literature for each treatment type. One-way sensitivity and threshold analyses were performed. RESULTS The most cost-minimal strategy was 2 aspiration attempts before open surgical excision in the PR setting ($1,603 ± 1,595 per resolved case), followed by 2 aspirations before open excision in the OR ($1,969 ± 2,165 per resolved case). Immediate arthroscopic excision was the costliest strategy ($6,539 ± 264 per resolved case). Single aspiration preoperatively was more cost-minimal than any form of immediate surgery ($2,918 ± 306 and $4,188 ± 306 per resolved case performed in the PR and OR, respectively). CONCLUSIONS From the societal perspective, performing 2 aspirations before surgical excision in the PR setting was the most cost-minimal treatment strategy, although in reference to surgeons who do not perform this procedure in the PR setting, open excision in the OR was nearly as cost-effective. As patient preferences may preclude routinely performing 2 aspirations, performing at least 1 aspiration before surgical excision improves the cost-effectiveness of dorsal wrist ganglions treatment. TYPE OF STUDY/LEVEL OF EVIDENCE Economic Decision Analysis II.
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Affiliation(s)
- Andrew E Federer
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, UT
| | | | - Richard E Nelson
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Jesse N Steadman
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
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Marchand WR, Zhang C, Hamilton C, Presson AP, Nelson R, Yoo M, Garland EL, Nazarenko E, Herrmann T. Utilization and outcomes of a Whole Health model of care by Veterans with psychiatric illness. Complement Ther Med 2022; 71:102884. [PMID: 36096414 DOI: 10.1016/j.ctim.2022.102884] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The Veterans Health Administration (VHA) is implementing a model of healthcare known as Whole Health (WH). The goal of WH is to shift from a disease-oriented system to one that emphasizes health promotion and disease prevention as well as promotes the use of Complementary and Integrative Health. The aim of this project was to investigate utilization and outcomes of WH programming among Veterans with psychiatric disorders. DESIGN This was a retrospective study. Subjects were 7138 Veterans who had a mental health diagnosis. Descriptive data, as well as within- and between-subjects analyses were conducted to investigate utilization and outcomes. SETTING The study was conducted at a large VHA medical center. INTERVENTIONS Whole health interventions considered in this study were mindfulness training, health education, wellbeing, and nutrition classes as well as health coaching. Other whole health interventions, such as acupuncture and message were not evaluated. MAIN OUTCOME MEASURES Utilization of mental health treatment services, medication prescriptions, pain scores and suicide-related behaviors were the primary outcome measures. RESULTS There were 305 Veterans with at least one WH appointment. The existence of several specific psychiatric disorders was associated with WH utilization. The mean number of appointments completed per individual was 6.9 for all WH programming. Finally, WH participation was associated with decreased risk of suicide as well as reduced use of mental health services. There were no significant changes to other outcome variables. CONCLUSIONS WH programming shows promise to reduce suicide risk and the need for mental health services among this population. Additionally, WH services were underutilized and there was a lack of treatment engagement.
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Affiliation(s)
- W R Marchand
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah School of Medicine Department of Psychiatry, 501 Chipeta Way, Salt Lake City, UT 84108, the United States of America; Animal, Dairy and Veterinary Sciences, Utah State University, 4815 Old Main Hill, Logan, UT 84322, the United States of America.
| | - Chong Zhang
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Clayton Hamilton
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Angela P Presson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Richard Nelson
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Minkyoung Yoo
- University of Utah Study Design and Biostatistics Center, 27 S Mario Capecchi Dr, Salt Lake City, Utah 84133, the United States of America
| | - Eric L Garland
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, College of Social Work, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America; University of Utah Center on Mindfulness and Integrative Health Intervention Development, 395 S 1500 E, Salt Lake City, UT 84112, the United States of America
| | - Elena Nazarenko
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America
| | - Tracy Herrmann
- VISN 19 Whole Health Flagship Site Located at VA Salt Lake City Health Care System, 500 Foothill, Salt Lake City, UT 84148, the United States of America; University of Utah, Health Sciences Center, Department of Nutrition and Integrative Physiology, Salt Lake City, UT 84108, the United States of America
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Wolpert KH, Kestle R, Weaver N, Huynh K, Yoo M, Nelson R, Lane RD. Reducing Admission for Anaphylaxis in a Pediatric Emergency Department Using a Clinical Decision Support Tool. Pediatr Qual Saf 2022; 7:e590. [PMID: 38584955 PMCID: PMC10997234 DOI: 10.1097/pq9.0000000000000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Anaphylaxis is a life-threatening condition necessitating emergent management. However, the benefits of prolonged observation and indications for hospitalization are not well established. Through the implementation of a disposition-focused clinical decision support tool (CDST), this quality improvement initiative aimed to reduce hospitalization for low-risk patients presenting to the pediatric emergency department (PED) with anaphylaxis from 49% to ≤12% within 12 months of implementation. Methods The intervention included patients 18 years and younger of age presenting with anaphylaxis to the PED. A multidisciplinary team identified a 2006 evidence-based guideline as a significant contributor to hospitalization. The updated guideline incorporated a disposition-focused CDST that stratified patients as low-risk or high-risk and recommended discharge of low-risk patients after a 4-hour observation period. The primary outcome measure was the percentage of low-risk patients hospitalized. Balancing measures included low-risk patient 72-hour return rate and PED length of stay for all comers. Secondary outcomes included a focused cost analysis. Results Fifty-three children preintervention and 43 children postintervention presenting with anaphylaxis met low-risk criteria. Postimplementation, hospitalization of low-risk patients decreased from 49% to 7% (P < 0.0001). No low-risk patients returned in 72 hours for an anaphylaxis-related concern (P = 0.83). The median PED length of stay increased from 189 to 193 minutes (P < 0.0001). The median cost per low-risk encounter decreased by $377 (P = 0.013). Conclusions After implementing an evidence-based disposition-focused CDST, hospitalization of low-risk patients presenting to the PED with anaphylaxis significantly decreased without an increase in 72-hour returns. In addition, patient encounters demonstrated cost savings.
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Affiliation(s)
- Katherine H Wolpert
- From the Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Rebecca Kestle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Salt Lake City, Utah
| | - Nicholas Weaver
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Salt Lake City, Utah
| | - Kelly Huynh
- Department of Pediatrics, Salt Lake City, Utah
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, Utah
| | - Richard Nelson
- Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Roni D Lane
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
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Hubbard J, Zhang Y, Qiu Y, Yoo M, Stephens AR, Zeidan M, Kazmers NH. Establishing the Substantial Clinical Benefit in a Non-Shoulder Hand and Upper Extremity Population for the QuickDASH and PROMIS Upper Extremity and Physical Function Computer Adaptive Tests. J Hand Surg Am 2022; 47:358-369.e3. [PMID: 35210143 PMCID: PMC8995349 DOI: 10.1016/j.jhsa.2021.12.013] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 11/04/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE It is unclear what score changes on the abbreviated Disabilities of the Arm, Hand, and Shoulder (QuickDASH), Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) computer adaptive test (CAT), and PROMIS physical function (PF) CAT represent a substantial improvement. We calculated the substantial clinical benefit (SCB) for these 3 instruments in a non-shoulder hand and upper extremity population. METHODS Adult patients treated between March 2015 and September 2019 at a single academic tertiary institution were identified. The QuickDASH, PROMIS UE CAT v2.0, and PROMIS PF CAT v2.0 scores were collected using a tablet computer. Responses to the QuickDASH both at baseline and follow-up 6 ± 4 weeks later, and a response to the anchor question "Compared to your first evaluation at the University Orthopaedic Center, how would you describe your physical function level now?" were required for inclusion. A second anchor question querying treatment-related improvement was also used. The SCB was calculated using an anchor-based approach comparing the mean change difference between groups reporting no change and a maximal change for both anchor questions. RESULTS Of 1,119 included participants, the mean age was 48 ± 17 years, 53% were women, and half were recovering from surgery. Score changes between baseline and follow-up were significantly different between groups reporting no improvement and maximal improvement on both anchor questions. The SCB values ranged between 16.9 and 22.8 on the QuickDASH, 5.9 and 7.1 on the UE CAT, and 3.5 and 6.7 on the PF CAT. CONCLUSIONS These score improvements for the QuickDASH, UE CAT, and PF CAT represent a substantial clinical improvement in a non-shoulder hand and upper extremity population. CLINICAL RELEVANCE These SCB estimates may assist with the interpretation of outcome scores at a population level.
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Affiliation(s)
- James Hubbard
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Yue Zhang
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT 84108
| | - Yuqing Qiu
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT 84108
| | - Minkyoung Yoo
- University of Utah, Department of Economics, 260 Central Campus Dr #4100, Salt Lake City, UT, United States
| | - Andrew R. Stephens
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Michelle Zeidan
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
| | - Nikolas H. Kazmers
- University of Utah, Department of Orthopaedics, 590 Wakara Way, Salt Lake City, UT 84108
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Kohli M, Cutshall Z, Dougherty M, Nelson R, Yoo M. A VA Federal Supply Schedule (VAFSS)–based cost-effectiveness analysis of immunotherapy-tyrosine kinase inhibitor (IO-TKI) regimens and sunitinib in the treatment of metastatic renal cell carcinoma (mRCC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.312] [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
312 Background: Recent FDA approvals for mRCC treatment have resulted in increased effectiveness, drug choices, and costs. We performed a cost effectiveness analysis (CEA) of six recently approved IO-TKI drug combinations and sunitinib. Methods: We used a Markov simulation model from the healthcare sector perspective with a lifetime time horizon. The 7 treatment drug strategies considered in this model included: (1) atezolizumab + bevacizumab (AB), (2) avelumab + axitinib (AA), (3) pembrolizumab + axitinib (PA), (4) nibolumab + ipilimumab(NI), (5) nibolumab + cabozantinib (NC), (6) lenvatinib + pembrolizumab (LP), and (7) sunitinib (S). Input parameters of drug effectiveness and toxicities to construct the model were based on published randomized studies that led to drug approvals. Direct costs for treatment were derived using the VA Federal Supply Schedule (VAFSS). Markov model simulates patient transition between 3 health states at monthly intervals: progression free, progressive disease, and death. The cost-effectiveness outcome in our model were and life-years (LYs), progression-free life-years (PFLYs) gained, and quality-adjusted life-years (QALYs) with utility values based on published literature. Results: The table highlights results of the CEA. The least expensive drug combination was NI ($442,218) while the most expensive was LP ($963,610). AA yielded the most LYs (5.51) and QALYs (5.62) and LP yielded the most PFLYs (1.64) while NL yielded the least LYs (4.35) and PFLYs (1.47) and LP yielded the least QALYs (4.19). AB and S were absolutely dominated strategies yielding less effectiveness and cost more in terms of effectiveness measures. Depending on acceptable willingness-to-pay (WTP) and effectiveness measures, PA or AA were the most cost-effective strategies. Conclusions: Our analyses suggest that based on direct cost acquisition using VA FSS, PA or AA were cost-effective strategies for mRCC with WTP of $20,000 to $200,000 per QALY.[Table: see text]
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11
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Rogers MJ, Stephens AR, Yoo M, Nelson RE, Kazmers NH. Optimizing Costs and Outcomes for Carpal Tunnel Release Surgery: A Cost-Effectiveness Analysis from Societal and Health-Care System Perspectives. J Bone Joint Surg Am 2021; 103:00004623-990000000-00322. [PMID: 34428186 PMCID: PMC8866519 DOI: 10.2106/jbjs.20.02126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is unclear which carpal tunnel release (CTR) strategy (i.e., which combination of surgical technique and setting) is most cost-effective. A cost-effectiveness analysis was performed to compare (1) open CTR in the procedure room (OCTR/PR), (2) OCTR in the operating room (OCTR/OR), and (3) endoscopic CTR in the operating room (ECTR/OR). METHODS A decision analytic model was used to compare costs and health utilities between treatment strategies. Utility and probability parameters were identified from the literature. Medical costs were estimated with Medicare ambulatory surgical payment data. Indirect costs were related to days out of work due to surgical recovery and complications. The effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic sensitivity analyses and one-way sensitivity analyses were performed. Cost-effectiveness was assessed from the societal and health-care system perspectives with use of a willingness-to-pay threshold of $100,000/QALY. RESULTS In the base-case analysis, OCTR/PR was more cost-effective than OCTR/OR and ECTR/OR from the societal perspective. The mean total costs and QALYs per patient were $29,738 ± $4,098 and 0.88 ± 0.08 for OCTR/PR, $30,002 ± $4,098 and 0.88 ± 0.08 for OCTR/OR, and $41,311 ± $4,833 and 0.87 ± 0.08 for ECTR/OR. OCTR/PR was also the most cost-effective strategy from the health-care system perspective. These findings were robust in the probabilistic sensitivity analyses: OCTR/PR was the dominant strategy (greater QALYs at a lower cost) in 55% and 61% of iterations from societal and health-care system perspectives, respectively. One-way sensitivity analysis demonstrated that OCTR/PR and OCTR/OR remained more cost-effective than ECTR/OR from a societal perspective under the following conditions: $0 surgical cost of ECTR, 0% revision rate following ECTR, equalization of the return-to-work rate between OCTR and ECTR, or 0 days out of work following ECTR. OCTR/OR became more cost-effective than OCTR/PR with the median nerve injury rate tripling and doubling from societal and health-care system perspectives, respectively, or if surgical direct costs in the PR exceeded those in the OR. CONCLUSIONS Compared with OCTR/OR and ECTR/OR, OCTR/PR minimizes costs to the health-care system and society while providing favorable outcomes. LEVEL OF EVIDENCE Economic and Decision Analysis Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Andrew R Stephens
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, Utah
| | - Richard E Nelson
- VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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12
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Biskupiak J, Unni S, Telford C, Yoo M, Ye X, Deka R, Brixner D, Stenehjem D. Estimation of healthcare-related charges in women with BRCA mutations and breast cancer. BMC Health Serv Res 2021; 21:58. [PMID: 33435985 PMCID: PMC7805040 DOI: 10.1186/s12913-020-06038-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Background Breast cancer costs were estimated at $16.5 billion in 2010 and were higher than other cancer costs. There are limited studies on breast cancer charges and costs by BRCA mutations and receptor status. We examined overall health care and breast cancer-related charges by BRCA status (BRCAm vs. BRCAwt), receptor status (HER2+ vs. HER2-), and treatment setting (neoadjuvant vs. adjuvant). Methods Retrospective cohort study of charge data from 1995-2014 in an academic medical center. Facilities, physician, pharmacy, and diagnosis-related charges were presented as mean and median charges with standard deviation (SD) and interquartile ranges (25%-75%). Wilcoxon rank-sum test was used to assess statistically significant differences in charges between comparators. Results Total median breast-cancer related charges were $65,414 for BRCAm and $54,635 for BRCAwt (p=0.19); however all-cause charges were higher for BRCAm patients ($145,066 vs. $119,119, p<0.001). HER2+ status was associated with higher median breast cancer charges ($152,159 vs. $44,087, p<0.0001) that was driven by the charges for biological agents. Patients initially seen in the neoadjuvant setting had higher mean breast cancer charges than in the adjuvant setting ($117,922 vs. $80,061, p<0.0001). Conclusion BRCA mutation status was not associated with higher breast cancer charges but HER2+ status had significantly higher charges, due to charges for biological agents. Patients who initially received neoadjuvant treatment had significantly higher overall treatment charges than adjuvant therapy patients. With the advent of novel therapies for BRCAm, the economic impact of these treatments will be important to consider relative to their survival benefits.
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Affiliation(s)
- Joseph Biskupiak
- Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, USA.
| | - Sudhir Unni
- Daiichi-Sanyko Inc, Baskin Ridge, New Jersey, Utah, USA
| | | | - Minkyoung Yoo
- Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, USA
| | - Xiangyang Ye
- Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, USA
| | - Rishi Deka
- University of California San Diego, La Jolla, California, USA
| | - Diana Brixner
- Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, USA
| | - David Stenehjem
- Department of Pharmacotherapy, Outcomes Research Center, University of Utah, Salt Lake City, USA.,University of Minnesota, Minneapolis, Minnesota, USA
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13
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Nieri T, Webb M, Goodwin D, Yoo M. Falling short of a culture of health: Planning alcohol-permitted events at a U.S. university. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.408] [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: 11/14/2022] Open
Abstract
Abstract
The Healthy Campus movement in the United States aims to infuse health promotion into higher education operations. We examined the extent to which event planners employ a culture-of-health approach related to alcohol consumption when planning alcohol-permitted events in a large, public university in California. We interviewed 31 event planners to assess their strategies for ensuring health and safety at the events and accommodating people in recovery from substance use disorders. We focused on events that involved faculty, staff, and graduate students. Event planners were most concerned about avoiding legal liabilities at the events, were less concerned about promoting responsible drinking among drinkers, and often failed to consider the needs of non-drinkers at the events. Their actions were informed by problematic beliefs about alcohol (e.g., people need alcohol to relax), drinkers (e.g., only undergraduate students engage in risky consumption), and people in recovery (e.g., they lack self-control). Planners over-relied on informal control to shape attendees' behavior, failing to acknowledge how contextual factors can shape individual behavior. Planners need to be educated about how to shape the event context to promote healthy behaviors, avoid exclusively focusing on preventing unhealthy behaviors and informal control, and promote better inclusion of people who don't drink.
Key messages
There is fertile ground for infusing a culture of health into events in higher education. Event planners need expanded perspectives that consider context, inclusivity, and health promotion.
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Affiliation(s)
- T Nieri
- Sociology, University of California at Riverside, Riverside, USA
| | - M Webb
- Sociology, University of California at Riverside, Riverside, USA
| | - D Goodwin
- Sociology, University of California at Riverside, Riverside, USA
| | - M Yoo
- Sociology, University of California at Riverside, Riverside, USA
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14
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Lischka A, Braid HE, Pannell JL, Pook CJ, Gaw S, Yoo M, Bolstad KSR. Regional assessment of trace element concentrations in arrow squids (Nototodarus gouldi, N. sloanii) from New Zealand waters: Bioaccessibility and impact on food web and human consumers. Environ Pollut 2020; 264:114662. [PMID: 32559885 DOI: 10.1016/j.envpol.2020.114662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
The New Zealand arrow squids, Nototodarus gouldi and N. sloanii, play an important role in the marine food web, and are both economically important fishery species. This study compares trace element concentrations (As, Cd, Co, Cr, Cu, Fe, Hg, Ni, Mn, Pb, U, and Zn) in these animals from different fishing locations within New Zealand's Exclusive Economic Zone (Auckland Islands, Chatham Rise, Dunedin, Golden Bay, Taranaki, and West Coast of the South Island). Muscular mantle (the tissue usually consumed by humans) and digestive gland tissue (the primary organ for trace element accumulation) concentrations were compared among regions, revealing size, species, and sampling location effects. Overall, N. gouldi had higher concentrations of As and Zn. The Taranaki region had the highest concentrations for Cd, Co, Cu, and Zn in both tissues analysed. To assess the bioaccessibility of these trace elements to humans, an in-vitro digestion simulation experiment was conducted, revealing bioavailable concentrations overall below the maximum levels presently considered tolerable for human consumption. However, the in-vitro digestion had no observable effect upon Cd concentrations in arrow squid mantle tissue (implying that the measured concentrations are bioaccessible to humans), and revealed that Cd had the highest potential impact on marine food webs and human health. Digestive gland concentrations in particular indicate that arrow squids can be considered important vectors for trace element transfer to top predators (mean concentration for Cd: 123 ± 148 μg g-1 dw), with region-specific differences.
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Affiliation(s)
- A Lischka
- AUT Lab for Cephalopod Ecology & Systematics, School of Science, Auckland University of Technology, Private Bag 92006, 1142, Auckland, New Zealand.
| | - H E Braid
- AUT Lab for Cephalopod Ecology & Systematics, School of Science, Auckland University of Technology, Private Bag 92006, 1142, Auckland, New Zealand
| | - J L Pannell
- AUT Lab for Cephalopod Ecology & Systematics, School of Science, Auckland University of Technology, Private Bag 92006, 1142, Auckland, New Zealand
| | - C J Pook
- Liggins Institute, University of Auckland, 85 Park Rd, Grafton, Auckland, 1023, New Zealand
| | - S Gaw
- School of Physical and Chemical Sciences, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand
| | - M Yoo
- AUT Lab for Cephalopod Ecology & Systematics, School of Science, Auckland University of Technology, Private Bag 92006, 1142, Auckland, New Zealand
| | - K S R Bolstad
- AUT Lab for Cephalopod Ecology & Systematics, School of Science, Auckland University of Technology, Private Bag 92006, 1142, Auckland, New Zealand
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15
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Chalmers PN, Uffman W, Christensen G, Greis P, Aoki S, Nelson R, Yoo M, Tashjian RZ. A single-institution analysis of factors affecting costs in the arthroscopic treatment of glenohumeral instability. JSES Int 2020; 4:297-301. [PMID: 32490417 PMCID: PMC7256881 DOI: 10.1016/j.jseint.2020.01.006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Although surgical shoulder stabilization is a substantial cost nationally within the United States, little information exists to analyze this cost. The purpose of this study was to identify factors associated with variation in direct costs with the arthroscopic treatment of glenohumeral instability. Methods This was a retrospective study of all patients who underwent arthroscopic treatment of glenohumeral instability between January 12, 2012 and July 11, 2017. Patient and procedure factors were collected. Direct perioperative costs were collected using a validated internal tool. Patient and procedure characteristics significantly associated with costs were identified using multivariate generalized linear models. Results The study included 302 patients, of whom 12% were undergoing revision and 32% were contact or collision athletes. Anterior instability was present in 73%, whereas 14% had posterior and 10% had multidirectional instability. Of the patients, 67% were recurrent dislocators and 33% were first-time dislocators or subluxators. Remplissage was performed in 13%; biceps tenodesis, 5%; and rotator cuff repair, 3%. An average of 4.0 ± 1.4 anchors were used. Of costs, 39% were operative facility utilization costs and 41% were implant costs. Factors associated with cost increase included an increased number of anchors (P < .0001), posterior vs. anterior instability (P = .001), recurrent instability vs. first-time dislocation (P = .025), remplissage (P = .006), rotator interval closure (P = .021), bicep tenodesis (P = .020), rotator cuff repair (P < .0001), an inpatient stay (P = .003), and repair of humeral avulsion of the glenohumeral ligaments (P = .012). Conclusion Most perioperative costs associated with the arthroscopic treatment of glenohumeral instability are facility utilization and implant costs. Nonmodifiable factors associated with increased cost included posterior direction of instability and recurrent instability. Modifiable factors included additional procedures and inpatient stay.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - William Uffman
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Garrett Christensen
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Patrick Greis
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Stephen Aoki
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Richard Nelson
- Department of Epidemiology, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Minkyoung Yoo
- Department of Economics, University of Utah Medical Center, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah Medical Center, Salt Lake City, UT, USA
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Abstract
Background: The optimal surgical treatment for scapholunate advanced collapse (SLAC) and
scaphoid nonunion advanced collapse (SNAC) remains unclear. To inform
clinical decision-makers, we conducted a cost-effectiveness analysis
comparing proximal row carpectomy (PRC) and four-corner arthrodesis
(FCA). Methods: A Markov microsimulation model was used to compare clinical outcomes, costs,
and health utilities between PRC and FCA. The model used a 10-year time
horizon and a 1-month cycle length, and it was evaluated from the societal
perspective. Utilities and clinical parameters including transition
probabilities for debridement for infection, removal of implants, conversion
to total wrist arthrodesis, revision FCA, and revision total wrist
arthrodesis were obtained from published literature. Timing of complications
was estimated from the literature. Direct medical costs were derived from
Medicare ambulatory surgical cost data, and indirect costs for missed work
due to surgical procedures and complications were included. The
effectiveness outcome was quality-adjusted life years (QALYs). Probabilistic
sensitivity analysis and 1-way threshold analysis for utilities were
performed. Results: In the base-case model, PRC dominated FCA (i.e., PRC had lower cost and
greater effectiveness). The mean (and standard deviation) for the total cost
and QALYs per patient were $30,970 ± $5,931 and 8.24 ± 1.28,
respectively, for PRC and $44,526 ± $11,205 and 8.23 ± 1.26,
respectively, for FCA. In the probabilistic sensitivity analysis, PRC
dominated FCA in 57% of the 1 million iterations. The cost-effectiveness
acceptability curve indicated that PRC is the most cost-effective strategy
regardless of the willingness-to-pay threshold up to $100,000/QALY. Conclusions: PRC dominated FCA in the base-case analysis and in the probabilistic
sensitivity analysis. These results suggest that PRC is the optimal strategy
for Stage-I or II SLAC and for SNAC in patients ≥55 years of age. Level of Evidence: Economic Level IV. See Instructions for Authors for a
complete description of levels of evidence.
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Affiliation(s)
- Minkyoung Yoo
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Richard E Nelson
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah.,VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Damian A Illing
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Brook I Martin
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Departments of Economics (M.Y.) and Orthopaedics (D.A.I., B.I.M., A.R.T., and N.H.K.), and Division of Epidemiology (R.E.N.), University of Utah, Salt Lake City, Utah
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17
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Kazmers NH, Qiu Y, Yoo M, Stephens AR, Tyser AR, Zhang Y. The Minimal Clinically Important Difference of the PROMIS and QuickDASH Instruments in a Nonshoulder Hand and Upper Extremity Patient Population. J Hand Surg Am 2020; 45:399-407.e6. [PMID: 31955997 PMCID: PMC7200282 DOI: 10.1016/j.jhsa.2019.12.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 10/16/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The minimal clinically important difference (MCID) is used in research and clinical settings as a benchmark to gauge improvement following treatment. The purpose of this study was to provide anchor-based MCID estimates for Patient-Reported Outcomes Measurement Information System (PROMIS) and legacy instruments in a nonshoulder hand and upper extremity population. METHODS Adult patients (≥18 years) seeking care at a tertiary academic outpatient hand surgery clinic completed patient-reported outcome measures on tablet computers between January 2015 and August 2017. Data were collected at baseline and at 6 ± 2 weeks of follow-up. The PROMIS Upper Extremity (UE), Physical Function (PF), and Pain Interference (PI) Computer Adaptive Test (CAT) instruments were administered, along with the shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH). A mean change anchor-based method was used to estimate MCIDs by comparing scores between anchor groups reporting no change versus slightly improved in terms of function and pain. RESULTS Scores for each instrument significantly improved over the study period. With significant differences in scores between groups reporting no change and slightly improved function, anchor-based MCID estimates were calculated as follows: 2.1 for the PROMIS UE CAT, 1.7 for the PROMIS PF CAT, and 6.8 for the QuickDASH. There was no significant difference in PROMIS PI CAT scores between anchor groups when queried for level of pain improvement, precluding estimation of an anchor-based MCID. CONCLUSIONS We have provided anchor-based MCID estimates for the PROMIS UE CAT, PROMIS PF CAT, and the QuickDASH for a general nonshoulder hand and upper extremity population. These values may be useful in future research for informing power calculations and when interpreting whether the magnitude of change on these instruments is clinically significant at a population level. CLINICAL RELEVANCE This study provides clinicians with a reference for values that may reflect clinically meaningful changes in scores for patient-reported outcome instruments commonly utilized in the current hand surgery literature.
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Affiliation(s)
| | - Yuqing Qiu
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, UT
| | | | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, UT
| | - Yue Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
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Willis C, Menon J, Unni S, Au T, Yoo M, Biskupiak J, Brixner D, Ndife B, Joseph G, Bonifacio G, Stein E, Tantravahi S, Shami PJ, Kovacsovics T, Stenehjem D. Clinical and economic analysis of patients with acute myeloid leukemia by FLT3 status and midostaurin use at a Comprehensive Cancer Center. Leuk Res 2019; 87:106262. [PMID: 31756575 DOI: 10.1016/j.leukres.2019.106262] [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] [Received: 07/05/2019] [Revised: 10/11/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Identification of cytogenetic and molecular abnormalities has become vital for the appropriate treatment of acute myeloid leukemia (AML). One of the most common molecular alterations in AML is the constitutive activation by internal tandem duplication of FMS-like tyrosine kinase 3 (FLT3). METHODS This observational, retrospective, cohort study at the Huntsman Cancer Institute (HCI) had two time periods: 1) a historical pre-midostaurin time period which consisted of the FLT3 mutated (FLT3m) and FLT3 wild type (FLT3wt) cohorts from January 1, 2007, to December 31, 2016, and 2) a post-midostaurin cohort which consisted of the FLT3 mutated midostaurin-user cohort (early mido) from May 01, 2017 to December 31, 2018. RESULTS In total, 39 patients were included in the FLT3m cohort, 61 in the FLT3wt cohort, and seven in the early mido cohort. FLT3m patients spent fewer days in the hospital during the first consolidation regimen and received fewer consolidation cycles compared to FLT3wt patients. Overall survival (OS) was similar between FLT3m and FLT3wt patients. For patients without hematopoietic stem cell transplant, OS was significantly shorter for FLT3m patients compared to FLT3wt patients. Mean AML related inpatient charges and physician charges for FLT3m patients were significantly higher than FLT3wt patients. CONCLUSION The FLT3 mutation is historically associated with a shorter time to transplant and increased total health care charges. More information is needed to evaluate the real-world treatment strategies for FLT3-mutated patients in the presence of FLT3 inhibitors and the impact of these treatment strategies on clinical and economic outcomes.
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Affiliation(s)
- Connor Willis
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Jyothi Menon
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Sudhir Unni
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Trang Au
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Minkyoung Yoo
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Joseph Biskupiak
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Diana Brixner
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States
| | - Briana Ndife
- Novartis Pharmaceuticals, East Hanover, NJ, United States
| | - George Joseph
- Novartis Pharmaceuticals, East Hanover, NJ, United States
| | | | - Eytan Stein
- Department of Medicine, Leukemia Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Srinivas Tantravahi
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - Paul J Shami
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - Tibor Kovacsovics
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States
| | - David Stenehjem
- Department of Pharmacotherapy, College of Pharmacy, University of Utah, UT, United States; Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, MN, United States.
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19
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Uffmann WJ, Christensen GV, Yoo M, Nelson RE, Greis PE, Burks RT, Tashjian RZ, Chalmers PN. A Cost-Minimization Analysis of Intraoperative Costs in Arthroscopic Bankart Repair, Open Latarjet, and Distal Tibial Allograft. Orthop J Sports Med 2019; 7:2325967119882001. [PMID: 31799329 PMCID: PMC6873280 DOI: 10.1177/2325967119882001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The optimal surgical treatment of anterior shoulder instability remains
controversial. Hypothesis: (1) Implants and facility-related costs are the primary drivers of variation
in direct costs between arthroscopic Bankart and Latarjet procedures, and
(2) distal tibial allograft (DTA) is more costly than Latarjet as a function
of the graft expense. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Intraoperative cost data were derived for all arthroscopic anterior
stabilizations and Latarjet and DTA procedures performed at a single
academic institution from January 2012 to September 2017. Cost comparisons
were made between those undergoing arthroscopic stabilization and Latarjet
and between Latarjet and DTA. Multivariate regressions were performed to
determine the difference in direct costs accounting for various patient- and
surgery-related factors. Results: A total of 87 arthroscopic stabilizations, 44 Latarjet procedures, and 5 DTA
procedures were performed during the study period. Arthroscopic Bankart
repair was found to be 17% more costly than Latarjet, with suture anchor
implant cost being the primary driver of cost. DTA was 2.9-fold more costly
than Latarjet, with greater costs across all domains. Multivariate analysis
also found the number of prior arthroscopic procedures performed
(P = .007) and whether the procedure was performed in
an ambulatory or inpatient setting (P < .0001) to be
significantly associated with higher direct costs. Conclusion: Latarjet is less costly than arthroscopic Bankart repair, largely because of
implant cost. Value-driven strategies to narrow the cost differential could
focus on performing these procedures in an outpatient setting in addition to
reducing overall implant cost for arthroscopic procedures. Perceived
potential benefits of DTA over Latarjet may be outweighed by higher
costs.
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Affiliation(s)
- William J Uffmann
- Sports Medicine and Orthopaedics, Essentia Health-Duluth Clinic, Duluth, Minnesota, USA
| | | | - Minkyoung Yoo
- Health Economics Core, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Richard E Nelson
- Health Economics Core, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Patrick E Greis
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert T Burks
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
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20
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McAdam-Marx C, Tak C, Petigara T, Jones NW, Yoo M, Briley MS, Gunning K, Gren L. Impact of a guideline-based best practice alert on pneumococcal vaccination rates in adults in a primary care setting. BMC Health Serv Res 2019; 19:474. [PMID: 31291959 PMCID: PMC6621991 DOI: 10.1186/s12913-019-4263-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/01/2018] [Accepted: 06/14/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Despite the high burden of pneumococcal disease, pneumococcal vaccine coverage continues to fall short of Healthy People 2020 goals. A quasi-experimental design was used to investigate the impact of pneumococcal-specific best-practice alerts (BPAs) with and without workflow redesign compared to health maintenance notifications only, on pneumococcal vaccination rates in at-risk and high-risk adults, and on series completion in immunocompetent adults aged 65+ years. METHODS This retrospective study used electronic health record and administrative data to identify pneumococcal vaccinations using cross sectional and historical cohorts of adults age 19+ years from 2013 to 2017 who attended clinics associated with the University of Utah Health. Difference-in-differences (DD) analyses was used to assess the impact of interventions across three observation periods (Baseline, Interim, and Follow Up). Adherence to the 2-dose vaccination schedule in older adults was measured through a longitudinal analysis. RESULTS In DD analyses, implementing both workflow redesign and the BPA raised the vaccination rate by 8 percentage points (pp) (P < 0.001) and implementing the BPA only raised the rate by 7 pp. (P < 0.001) among at-risk adults age 19-64 years, relative to implementing health maintenance notifications (i.e., usual care) only in comparison clinics. In high-risk adults age 19-64 years, the BPA with or without workflow redesign did not significantly affect vaccination rates from baseline to follow up relative to health maintenance notifications. Per DD analyses, the effect of the BPA was mixed in immunocompetent and immunocompromised adults age 65+ years. However, immunocompetent older adults attending a clinic that implemented the BPA plus health maintenance notifications and workflow redesign (all 3 interventions) had 1.94 times higher odds (Odds ratio (OR) 1.94; P = 0.0003, 95% CI 1.24, 3.01) to receive the second pneumococcal dose than patients attending a usual practice clinic (i.e., no intervention). CONCLUSIONS A pneumococcal BPA tool that reflects current guidelines implemented with and without workflow redesign improved vaccination rates for at-risk adults age 19-64 years and increased the likelihood of adults aged 65+ to complete the recommended 2-dose series. However, in other adult patient groups, the BPA was not consistently associated with improvements in pneumococcal vaccination rates.
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Affiliation(s)
- Carrie McAdam-Marx
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA. .,Division of Pharmaceutical Evaluation & Policy, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA.
| | - Casey Tak
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Nathan W Jones
- Division of Public Health, University of Utah, Salt Lake City, UT, USA
| | - Minkyoung Yoo
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.,Department of Economics, University of Utah, Salt Lake City, UT, USA
| | | | - Karen Gunning
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA.,Department of Family & Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lisa Gren
- Division of Public Health, University of Utah, Salt Lake City, UT, USA
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21
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Yoo M, Kim S, Kim BS, Yoo J, Lee S, Jang HC, Cho BL, Son SJ, Lee JH, Park YS, Roh E, Kim HJ, Lee SG, Kim BJ, Kim MJ, Won CW. Moderate hearing loss is related with social frailty in a community-dwelling older adults: The Korean Frailty and Aging Cohort Study (KFACS). Arch Gerontol Geriatr 2019; 83:126-130. [PMID: 31003135 DOI: 10.1016/j.archger.2019.04.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 03/07/2019] [Revised: 04/04/2019] [Accepted: 04/07/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine whether hearing loss is associated with social frailty in older adults. METHODS Cross-sectional analysis of cohort study data. Hearing was measured using of Pure-tone audiometry. Hearing loss was determined based on the average of hearing thresholds at 0.5, 1, and 2 kHz in the ear that had better hearing. Social frailty was defined based on the summation of the following 5 social components (1. Neighborhood meeting attendance 2. Talking to friend(s) sometimes 3.Someone gives you love and affection 4. Living alone 5. Meeting someone every day). Participants who had no correspondence to the components were considered non-social frailty; those with 1-2 components were considered social prefrailty; and those having 3 or more components were considered social frailty. RESULTS The prevalence of non-social frailty, social prefrailty, social frailty was 27.6%, 60.7% and 11.7% respectively. Of the five questions, two components (Neighborhood meeting attendance and Presence of someone who shows love and affection to the participants) were associated with hearing loss (p < 0.001). Compared to non-social frailty, the odds ratio of social frailty for hearing loss was 2.24 (95% CI 1.48-3.38) after adjusting for age, residential area, economic status, smoking, depressive disorder and MMSE, and 2.17 (95% CI 1.43-3.30) after further adjustments with physical frailty. CONCLUSION Hearing loss was associated with social frailty even after controlling confounding factors even including physical frailty.
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Affiliation(s)
- M Yoo
- Department of Family Medicine, Kyung Hee University Medical Center, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - S Kim
- Department of Family Medicine, Kyung Hee University Medical Center, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - B S Kim
- Department of Family Medicine, Kyung Hee University Medical Center, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - J Yoo
- Department of Family Medicine, Kyung Hee University Medical Center, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - S Lee
- Department of Family Medicine, Kyung Hee University Medical Center, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea
| | - H C Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - B L Cho
- Department of Family Medicine, Center for Health Promotion and Optimal Aging, Seoul National University College of Medicine & Hospital, Seoul, Republic of Korea
| | - S J Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - J H Lee
- Catholic institute of U-healthcare, The Catholic University of Korea, Republic of Korea
| | - Y S Park
- Department of Family Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
| | - E Roh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University, Seoul, Republic of Korea
| | - H J Kim
- Department of Family Medicine, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - S G Lee
- Department of Physical & Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - B J Kim
- Department of Psychiatry, College of Medicine, Gyeongsang National University, Jinju, Republic of Korea
| | - M J Kim
- East-West Medical Research Institute, Kyung Hee University, Seoul, Republic of Korea
| | - C W Won
- Department of Family Medicine, Kyung Hee University Medical Center, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea; Elderly Frailty Research Center, Department of Family Medicine, Kyung Hee University College of Medicine, kyungheedaero 23, dongdaemun-gu, 02447, Seoul, Republic of Korea.
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22
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Abstract
INTRODUCTION Strategies are needed to improve recruitment of low-income adolescents into oral health studies. OBJECTIVES In this study, we assessed the feasibility of recruiting Medicaid-enrolled adolescents into a neighborhood-level oral health study using Medicaid enrollment files and to evaluate the degree of bias in the final recruited study population. METHODS We obtained Medicaid enrollment files from the Oregon Health Authority for 15,440 Medicaid enrollees aged 12 to 17 y from Multnomah, Hood River, and Tillamook counties. We attempted to contact the primary caregiver of each adolescent by telephone, and we tracked contact, recruitment, enrollment, and study completion rates. We further assessed if these rates were different across county-level rurality, neighborhood-level income, and caregiver-level language preference (Spanish vs. English). The Pearson chi-square test was used to compare rates (α = 0.05). We contacted 6,202 caregivers (40.2%), recruited 738 adolescents (11.9%), enrolled 335 (45.4%), and had complete data for 284 (84.8%). The overall enrollment yield from contacted caregivers was 5.4%. Contact rates did not differ significantly by rurality (P = 0.897), but they were significantly lower in the lowest-income neighborhoods (P = 0.023). Recruitment rates were significantly higher for adolescents from rural counties (P = 0.001), but they did not differ by income or language preference. Enrollment rates were significantly higher among adolescents from rural counties (P < 0.001) and were significantly associated with income (P = 0.041), but they were not different by language preference (P = 0.083). Among participants with complete data, there were no differences by rurality or income, but a significantly larger proportion of adolescents with complete data had caregivers with a language preference for Spanish (P = 0.043). RESULTS AND CONCLUSIONS It is feasible to recruit Medicaid-enrolled adolescents into a neighborhood oral health study through the use of Medicaid files. County-, neighborhood-, and caregiver-level factors may influence characteristics of the final study population. Additional research is needed to improve recruitment of Medicaid enrollees into neighborhood oral health studies. KNOWLEDGE TRANSFER STATEMENT Researchers can use the results of this study to plan neighborhood-level oral health studies involving recruitment of low-income adolescents. Findings further underscore the importance of assessing factors related to recruitment to evaluate participant bias and the generalizability of study findings.
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Affiliation(s)
- A A Basson
- 1 Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - M Yoo
- 1 Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
| | - D L Chi
- 1 Department of Oral Health Sciences, University of Washington, Seattle, WA, USA
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23
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Lee S, Lee H, Park J, Yoon S, So B, Seo H, Kim K, Yoo M, Cho Y, Hyun B. Seroprevalence of Anaplasma phagocytophilum, Borrelia burgdorferi, baBesia gibsoni, Ehrlichia canis and Ehrlichia chaffeensis in dogs from the republic of Korea. J Comp Pathol 2019. [DOI: 10.1016/j.jcpa.2018.10.102] [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: 10/27/2022]
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24
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Lee S, Kim S, Kim M, Yoo J, Kim B, Yoo M, Won CW. An Optimal Questionnaire Representing Slow Gait Speed(<1m/s) in Community-dwelling Older Adults: The Korean Frailty and Aging Cohort Study (KFACS). J Nutr Health Aging 2019; 23:648-653. [PMID: 31367730 DOI: 10.1007/s12603-019-1213-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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study was conducted to find an optimal questionnaire to evaluate the slow gait speed seen in community dwelling elderly. DESIGN Four questions asking about difficulty in walking were compared against the measured usual gait speed. The questions were: 1) Is it difficult to walk 100 m without help? 2) Is it difficult to walk 300 m without help? 3) Is it difficult to walk around one lap of a 400-meter track without help? 4) Can you cross a crosswalk before the green on the crosswalk light turns red? PARTICIPANTS The subjects were 1479 older adults aged 70 to 84 years who had responded to the four questions and completed gait speed measuring in the first baseline year (2016) of the Korean Frailty and Aging Cohort Study. RESULTS Of the four questions, "Is it difficult to walk around one lap of track (400 m) without help?" showed the highest kappa coefficient (0.357), sensitivity (0.61), and negative predictive value (0.82). CONCLUSION Based on the results of this study, the authors suggest that "Difficulty in walking around one lap of a 400-m track without help" may be the best question to use when evaluating slow gait speed.
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Affiliation(s)
- S Lee
- Chang Won Won, Ph.D. Elderly Frailty Research Center, Department of Family Medicine, College of Medicine, Kyung Hee University , 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea. Tel:+82 2 958 8697, E-mail:
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25
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Abstract
BACKGROUND AND AIMS Although Internet gaming disorder (IGD) is included as a condition in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders, little is known about its nature or treatment response. This study is a follow-up of 755 patients who received professional treatment for IGD over a 5-year period. METHODS The initial recommended treatment course lasted for 8 weeks, with additional care provided as needed. Treatment completion rates in the complete sample, as well as baseline predictors of treatment completion and long-term recovery among the 367 patients who completed the follow-up, are reported. RESULTS Nearly two thirds of patients who initiated treatment for IGD completed the 8-week psychotherapy. Of these, about two thirds who had not recovered completely by the end were offered additional care. Independent predictors of extended treatment were higher baseline scores on the Young Internet Addiction Scale, Beck Depression Inventory (BDI), and Korean-Attention Deficit Hyperactivity Disorder-Rating Scale (K-ADHD-RS). Between 1 and 5 years later, 33.5% of the complete sample was considered as recovered from IGD. Significant predictors of recovery from IGD were older age, earlier admission to the clinic, lower baseline scores on the BDI and K-ADHD-RS, and no offer of extended treatment. DISCUSSION AND CONCLUSIONS The majority of the patients seeking treatment for IGD continued experiencing difficulties and randomized controlled trials of interventions, which are needed to be conducted to improve outcomes. Age, family, social factors, and psychological symptoms should be considered, while designing and evaluating interventions, because they impact initial and sustained response to treatment for IGD.
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Affiliation(s)
- Doug Hyun Han
- Department of Psychiatry, Chung Ang University Hospital, Dongjak gu, Seoul Korea,Corresponding author: Doug Hyun Han, MD, PhD; Department of Psychiatry, Chung Ang University Hospital, 102 Heuk seok ro, Dongjak gu 06973, Seoul Korea; Phone: +82 2 6299 3132; Fax: +82 2 6298 1508; E-mail:
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, UT, USA
| | - Perry F. Renshaw
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Nancy M. Petry
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
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26
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Buss BA, Baures TJ, Yoo M, Hanson KE, Alexander DP, Benefield RJ, Spivak ES. Impact of a Multiplex PCR Assay for Bloodstream Infections With and Without Antimicrobial Stewardship Intervention at a Cancer Hospital. Open Forum Infect Dis 2018; 5:ofy258. [PMID: 30386809 PMCID: PMC6201152 DOI: 10.1093/ofid/ofy258] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 04/30/2018] [Accepted: 10/06/2018] [Indexed: 12/24/2022] Open
Abstract
Implementation of Biofire FilmArray Blood Culture Identification Multiplex PCR panel (BCID) at a cancer hospital was associated with reduced time to appropriate antimicrobial therapy. Additional reductions were not observed when BCID was coupled with antimicrobial stewardship intervention.
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Affiliation(s)
- Brian A Buss
- Department of Pharmacy, University of Wisconsin Health, Madison, Wisconsin
| | - Timothy J Baures
- Department of Infectious Diseases, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Minkyoung Yoo
- Department of Economics, University of Utah, Salt Lake City, Utah
| | - Kimberly E Hanson
- Department of Infectious Diseases, University of Utah Health, Salt Lake City, Utah.,ARUP Laboratories, Salt Lake City, Utah
| | - Donald P Alexander
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah.,University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Russell J Benefield
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah.,University of Utah College of Pharmacy, Salt Lake City, Utah
| | - Emily S Spivak
- Department of Infectious Diseases, University of Utah Health, Salt Lake City, Utah.,Department of Veterans Affairs, Salt Lake City, Utah
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27
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Karns MR, Jones DL, Todd DC, Maak TG, Aoki SK, Burks RT, Yoo M, Nelson RE, Greis PE. Patient- and Procedure-Specific Variables Driving Total Direct Costs of Outpatient Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2018; 6:2325967118788543. [PMID: 30094271 PMCID: PMC6080082 DOI: 10.1177/2325967118788543] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Few studies have investigated the influence of patient-specific variables or
procedure-specific factors on the overall cost of anterior cruciate ligament
reconstruction (ACLR) in an ambulatory surgery setting. Purpose: To determine patient- and procedure-specific factors influencing the overall
direct cost of outpatient arthroscopic ACLR utilizing a unique value-driven
outcomes (VDO) tool. Study Design: Cohort study (economic and decision analysis); Level of evidence, 3. Methods: All ACLRs performed by 4 surgeons over 2 years were retrospectively reviewed.
Cost data were derived from the VDO tool. Patient-specific variables
included age, body mass index, comorbidities, American Society of
Anesthesiologists (ASA) classification, smoking status, preoperative
Patient-Reported Outcomes Measurement Information System (PROMIS) Physical
Function Computerized Adaptive Testing (PF-CAT) score, and preoperative
Single Assessment Numeric Evaluation (SANE) score. Procedure-specific
variables included graft type, revision status, associated injuries and
procedures, time from injury to ACLR, surgeon, and operating room (OR) time.
Multivariate analysis determined patient- and procedure-related predictors
of total direct costs. Results: There were 293 autograft reconstructions, 110 allograft reconstructions, and
31 hybrid reconstructions analyzed. Patient-specific factors did not
significantly influence the ACLR cost. The mean OR time was shorter for
allograft reconstruction (P < .001). Predictors of an
increased direct cost included the use of an allograft or hybrid graft
(44.5% and 33.1% increase, respectively; P < .001),
increased OR time (0.3% increase per minute; P < .001),
surgeon 3 or 4 (9.1% or 5.9% increase, respectively; P <
.001 or P = .001, respectively), and concomitant meniscus
repair (24.4% increase; P < .001). Within the meniscus
repair cohort, all-inside, root, and combined repairs correlated with a
15.5%, 31.4%, and 53.2% increased mean direct cost, respectively, compared
with inside-out repairs (P < .001). Conclusion: This study failed to identify modifiable patient-specific factors influencing
direct costs of ACLR. Allografts and hybrid grafts were associated with an
increased total direct cost. Meniscus repair independently predicted an
increased direct cost, with all-inside, root, and combined repairs being
costlier than inside-out repairs. The time-saving potential of all-inside
meniscus repair was not realized in this study, making implant use a
significant factor in the overall cost of ACLR with meniscus repair.
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Affiliation(s)
- Michael R Karns
- Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Daniel L Jones
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Dane C Todd
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Travis G Maak
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Stephen K Aoki
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Robert T Burks
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
| | - Minkyoung Yoo
- Health Economics Core, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Richard E Nelson
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA.,Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA
| | - Patrick E Greis
- Department of Orthopaedics, University of Utah Orthopaedic Center, University of Utah, Salt Lake City, Utah, USA
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28
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Chalmers PN, Granger E, Nelson R, Yoo M, Tashjian RZ. Factors Affecting Cost, Outcomes, and Tendon Healing After Arthroscopic Rotator Cuff Repair. Arthroscopy 2018; 34:1393-1400. [PMID: 29371013 DOI: 10.1016/j.arthro.2017.11.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Received: 06/26/2017] [Revised: 11/03/2017] [Accepted: 11/08/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to simultaneously examine costs, functional outcomes, and tendon healing after arthroscopic rotator cuff repair. METHODS This was a retrospective, single-surgeon, single-hospital study. Pre- and postoperative Simple Shoulder Test (SST), visual analog scale (VAS) pain, and American Shoulder and Elbow Surgeons (ASES) scores, and postoperative magnetic resonance images (MRIs) were obtained. Direct costs were derived using a unique, validated tool. Costs included overall total direct cost, which included facility use costs, medication costs, supply costs, and other ancillary costs. RESULTS 85 patients had a minimum 1-year follow-up of functional outcomes (mean of 1.24 years, range 1-3.2 years) and 56 of 85 (66%) had postoperative MRI healing data at an average follow-up of 1.3 years (range 1-3.2 years). Increased direct cost was associated with ASA class III (P < .001) compared with ASA class I, procedures performed at the main operative room (P = .017) compared with those at the surgical center, single-row repair (P < .001) compared with double-row repair, medium and large tear sizes (P < .001 and P = .001) compared with small tear, and increased number of anchors (P ≤ .001 or P < .039 for each additional). Arthroscopic biceps tenodesis was associated with decreased improvement in SST, VAS-pain, and ASES scores (P < .001, .012, and .024), whereas infraspinatus atrophy and large/massive tear size was associated with decreased improvement in ASES scores (P = .03). Obesity (P = .004) and smoking (P = .034) were associated with greater improvement in VAS-pain scores as these were associated with decreased preoperative scores. Seventy percent of tears healed. CONCLUSIONS Within our study, factors that increased direct costs were outcome neutral, and factors that improved outcome were cost neutral. LEVEL OF EVIDENCE Level IV, retrospective.
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Affiliation(s)
- Peter N Chalmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A..
| | - Erin Granger
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
| | - Richard Nelson
- Department of Epidemiology, University of Utah, Salt Lake City, Utah, U.S.A
| | - Minkyoung Yoo
- Economics Department, University of Utah, Salt Lake City, Utah, U.S.A
| | - Robert Z Tashjian
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah, U.S.A
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Floyd A, Wilkes J, Yoo M, Nelson R, VanDerslice J, Minich LL, Pinto N. FACTORS INFLUENCING READMISSION BURDEN AFTER CONGENITAL HEART SURGERY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31145-8] [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: 11/16/2022]
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30
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JoungSun P, Pyo J, Jeon H, Kim Y, Yoo M. DNA DAMAGE RESPONSE IS ESSENTIAL FOR THE MAINTENANCE OF INTESTINAL HOMEOSTASIS WITH AGE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- P. JoungSun
- Pusan National University, Busan, Korea (the Republic of)
| | - J. Pyo
- Pusan National University, Busan, Korea (the Republic of)
| | - H. Jeon
- Pusan National University, Busan, Korea (the Republic of)
| | - Y. Kim
- Pusan National University, Busan, Korea (the Republic of)
| | - M. Yoo
- Pusan National University, Busan, Korea (the Republic of)
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31
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Biltaji E, Yoo M, Jennings BT, Leiser JP, McAdam-Marx C. Outcomes Associated with Pharmacist-Led Diabetes Collaborative Drug Therapy Management in a Medicaid Population. J Pharm Health Serv Res 2017. [PMID: 28630653 DOI: 10.1111/jphs.12162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Pharmacist-led diabetes collaborative drug therapy management (CDTM) has been shown to improve outcomes. Whether such programs are effective specifically in Medicaid patients, who face barriers to access and self-management, has not been well characterized. This pilot study explores glycemic control, utilization and costs associated with pharmacist-led CDTM in a small population of Medicaid patients with type 2 diabetes mellitus (T2DM). METHODS A pre-post, historical cohort study was conducted of patients with T2DM and Medicaid coverage who received pharmacist-led CDTM in community-based primary clinics between 2008-2012. Outcomes included change in HbA1c, healthcare costs and utilization. RESULTS This study included 79 Medicaid patients with T2DM who received pharmacist-led CDTM. A subset of 46 patients with Medicaid coverage through an affiliated Medicaid Plan, Healthy U, was identified for additional analysis. At 6-months follow-up, HbA1c was a mean (SD) of 2.0% (2.0) lower than the baseline of 10.3% (1.7). Primary care clinic encounters increased by a mean (median) of 3.4 (2) visits. Per patient health system charges increased by a mean (median) of $4,392 ($620) and the amount paid by Medicaid in the Healthy U subset was $822 ($68) higher in the follow-up period. CONCLUSION A pharmacist-led diabetes CDTM intervention was associated with improved glycemic control in Medicaid patients, which corresponded with a higher number of primary care visits and observed costs. These findings are consistent with studies not limited to Medicaid, suggesting that CDTM can be effective in type 2 diabetes patients with Medicaid coverage.
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Affiliation(s)
- Eman Biltaji
- Department of Pharmacotherapy, Pharmacotherapy Outcomes Research Center, University of Utah, 30 S. 2000 E., Salt Lake City, UT 84112, 801 585 1065,
| | - Minkyoung Yoo
- Department of Economics, University of Utah, 332 S 1400 E, Salt Lake City, UT 84112, 801 581 7481,
| | - Brandon T Jennings
- Department of Pharmacy Practice, Shenandoah University Bernard J. Dunn School of Pharmacy, 1460 University Drive, Winchester, VA 22601, 540 665 1282,
| | - Jennifer P Leiser
- Department of Family & Preventive Medicine, 375 Chipeta Way Rm 201, Salt Lake City, UT 84108, 801 581 7961,
| | - Carrie McAdam-Marx
- Department of Pharmacotherapy, University of Utah, 30 S. 2000 E., Salt Lake City, UT 84112, 801 587 7728,
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Kim J, Yoo M, Park H, Yu Y, Jo I, Park D, Hwang Y. Immunosuppressive effects of tonsil derived mesenchymal stem cells by proinflammatory cytokines. Cytotherapy 2017. [DOI: 10.1016/j.jcyt.2017.02.088] [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: 10/19/2022]
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Biskupiak JE, Telford C, Yoo M, Unni SK, Ye X, Deka R, Brixner DI, Stenehjem DD. Abstract P3-12-03: Evaluation of women with BRCA mutations and breast cancer tested at an NCI designated comprehensive cancer center: A cost of illness estimation. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-12-03] [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
Abstract
Objectives: Little is known regarding the impact of mutation status on the costs of breast cancer care. This study sought to estimate health care charges (all-cause, BC related, other cancer related and non-cancer related) among women with breast cancer (BC) and BRCA mutations (BRCAm) in terms of BRCA status, HER2 expression status, ER/PR status, treatment patterns, serious adverse events related to the cancer or its treatment, and cancer treatment period.
Methods: Adult women with invasive BC diagnosed from 1995-2014 and tested for a BRCAm were identified from the Huntsman Cancer Institute tumor registry (Salt Lake City, Utah) and via chart review. Patients with available charge data were included in the study. Patients were categorized by mutation status, receptor status and initial treatment setting. Charges were categorized as inpatient, outpatient and pharmacy (both anticancer and other medication) related charges as well as by type of service (diagnosis, surgery, reconstruction, radiation, office visit, and medication). Descriptive statistics were used to describe mean (SD) charges. Wilcoxon Rank-Sum test was used to compare health care charges.
Results: There were 816 women with BC who underwent BRCA testing and had available charge data. There were 134 women with a BRCAm vs 682 with BRCA wild type (wt). Age at diagnosis was similar between the two groups, however, BRCAm patients had more triple negative BC and higher histologic grade. Total breast cancer related mean (SD) charges were similar between BRCAm vs BRCAwt ($86,689 (75,937) vs $85,843 (97,304), p=0.19). Of this a similar amount was due to facilities/ technical and pharmacy (41% each), while the remainder was physician/professional costs. Within pharmacy costs, similar amounts were due to chemotherapy (23%) and biologics (21%). However, while 58% received chemotherapy, only 8% received biologics. Patients seen initially in the neoadjuvant treatment setting (N=148) had higher breast cancer related mean charges than those in the adjuvant setting (N=553; $117,922 (102,108) vs $80,061 (90,010), p<.0001), while those seen initially in metastatic setting had a mean charge of $103,525 (135,029).There were 142 HER2+ (ER+/PR+/HER2+ or ER-/PR-/HER2+) and 521 HER2- (TNBC or ER-/PR+/HER2-) breast cancer patients (receptor status unknown in 153 patients). HER2+ patients had higher breast cancer related mean charges than HER2- patients ($155,858 (122,227) vs $69,883 (67,642), p<.0001). Further, anticancer treatment charges accounted for 53% ($82,890 (81,269)) of HER2+ costs and 11% ($7,929 (21,782)), p<.0001 of HER2- costs. Biologics accounted for 87% of the former and chemotherapy accounted for 78% of the latter charge.
Conclusions: Mutation status was not associated with higher breast cancer charges. Patients initially seen in the neoadjuvant setting had higher breast cancer charges than those seen in the adjuvant setting. Receptor status (being HER2+) was associated with higher breast cancer charges and this was driven by expenditure on biologics.
Citation Format: Biskupiak JE, Telford C, Yoo M, Unni SK, Ye X, Deka R, Brixner DI, Stenehjem DD. Evaluation of women with BRCA mutations and breast cancer tested at an NCI designated comprehensive cancer center: A cost of illness estimation [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-12-03.
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Affiliation(s)
- JE Biskupiak
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - C Telford
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - M Yoo
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - SK Unni
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - X Ye
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - R Deka
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - DI Brixner
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
| | - DD Stenehjem
- College of Pharmacy, University of Utah, Salt Lake City, UT; AstraZeneca Pharmaceuticals, Gaithersburg, MD; Program in Personalized Health Care, University of Utah, Salt Lake City, UT; Huntsman Cancer Institute, Salt Lake City, UT
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Stenehjem DD, Yoo M, Unni SK, Singhal M, Bauer H, Saverno K, Quah C, Masaquel A, Brixner DI. Assessment of HER2 testing patterns, HER2+ disease, and the utilization of HER2-directed therapy in early breast cancer. Breast Cancer (Dove Med Press) 2014; 6:169-77. [PMID: 25378949 PMCID: PMC4218922 DOI: 10.2147/bctt.s69416] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Context Determining human epidermal growth factor receptor 2 (HER2) status is critical for the management of early-stage breast cancer (ESBC). An understanding of HER2 testing practices can provide insight into how test results influence the use of HER2-directed therapy. Objective To assess HER2 testing, HER2+ disease, and HER2-directed therapy in ESBC at the Huntsman Cancer Institute before and after the 2007 American Society of Clinical Oncology and College of American Pathologist (ASCO/CAP) guidelines on HER2 testing were published. Methods Patients were identified from an institutional tumor registry. HER2 testing patterns and results were examined using a chart review of pathology and clinical notes. Patient characteristics, HER2+ rate, and trastuzumab use were evaluated descriptively. Discordance rate with reflex testing (immunohistochemistry [IHC]2+ retested by fluorescence in situ hybridization [FISH]) was also evaluated. Results A total of 1,459 women were included (mean age: 57 years). The rate of HER2+ disease was 17% (number [N] =245). The discordance rate between IHC2+ and FISH was 10%. After the 2007 ASCO/CAP guidelines, fewer tumors were classified as IHC3+ (16% post- versus 21.9% pre-2007), more tumors were characterized as IHC2+ (26.4% post- versus 20.7% pre-2007), and the overall HER2+ rate was decreased (18.7% versus 21.9%), but this was not statistically significant (P=0.519). Most patients with HER2+ ESBC received HER2-targeted therapy (N=185). Conclusion The HER2+ rate was 17% and within the range of the reported rates in the literature. Reflex testing identified additional HER2+ tumors by approximately 10%, and should be considered a potential quality indicator. ASCO/CAP HER2 testing guidelines in 2007 appeared to impact the interpretation and classification of HER2+ tumors.
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Affiliation(s)
- David D Stenehjem
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA ; Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Minkyoung Yoo
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Sudhir K Unni
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Mukul Singhal
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Hillevi Bauer
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Kim Saverno
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Cheng Quah
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Diana I Brixner
- Pharmacotherapy Outcomes Research Center (PORC), College of Pharmacy, University of Utah, Salt Lake City, UT, USA ; Program in Personalized Health Care, University of Utah, Salt Lake City, UT, USA
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Yoo M, Jung M, Shin H, Park H, Kim H, Ahn J. Hypoxia affects proliferation and pancreatic differetiation of adipose derived mesenchymal stem cells. Cytotherapy 2014. [DOI: 10.1016/j.jcyt.2014.01.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lee S, In Chang N, Yoo M, Hoon Choi J, Shin D. Development and Validation of S-Allyl-L-Cysteine in Rat Plasma Using a Mixed-Mode Reversed-Phase and Cation-Exchange LC-ESI-MS/MS Method: Application to Pharmacokinetic Studies. J Chromatogr Sci 2014; 53:54-9. [DOI: 10.1093/chromsci/bmu013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Stenehjem DD, Yoo M, Unni SK, Singhal M, Bauer H, Saverno K, Quah CS, Masaquel A, Brixner DI. Assessment of single-institution HER2 testing patterns, rate of HER2+ disease, and utilization of trastuzumab in early breast cancer. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.31_suppl.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
124 Background: Improved outcomes with HER2-directed therapies highlight the importance of standardized testing for HER2 positivity. This study aimed to assess HER2 testing practices, rate of HER2+ disease, and trastuzumab use in early breast cancer (EBC) at the Huntsman Cancer Institute (HCI) a National Cancer Institute-Designated Center and member of the National Comprehensive Cancer Network. Methods: Included patients’ records from the HCI electronic data warehouse (EDW) and the HCI tumor registry were female, age ≥ 18 years, ≥ 2 visits in the EDW and a stage I to IIIa EBC diagnosis from 2005 to 2012. HER2 testing patterns were identified through chart review of pathology and clinical notes in the EDW. HER2+ was defined as either FISH+ or IHC3+. Patient characteristics, HER2+ rate, and trastuzumab use were evaluated descriptively. Discordance rate associated with reflex testing (IHC 2+ retested by FISH) was also evaluated. Results: A total of 1,459 women were included with stage I (49%, n=720), IIa (26%, n=374), IIb (14%, n=197), and IIIa (12%, n=168) EBC. Mean age was 57 years. HER2+ disease was identified in 243 (17%) tumors. Of HER2+ tumors, 104 (43%) were ER+/PR+, 33 (14%) ER+/PR-, 1 (<1%) ER-/PR+, 79 (32%) ER-/PR-, and 26 (11%) unknown. Tumors were first tested for HER2 using: 1,192 (82%) IHC, 36 (3%) FISH, 227 (15%) unknown and 4 (<1%) other tests. First IHC results were scored 0 (23%), 1+ (33%), 2+ (26%), 3+ (17%), and unknown (<1%). Reflex testing within one month was performed in 301/308 (98%) of IHC 2+ tumors. The discordance rate of IHC/FISH was 10%. Trastuzumab was prescribed for 184/243 (76%) women whose tumors were considered HER2+ based on final interpretation and in 1 HER2 equivocal tumor. Documented reasons for lack of trastuzumab use in HER2+ patients (n=59) included low risk of recurrence based on stage or other treatments (n=18), loss to follow-up (n=13), unknown (n=11), not clinically appropriate due to age or comorbidity (n=10), and patient declined (n=7). Conclusions: This is one of few cancer registries assessing the rate of HER2+ disease in EBC. Reflex testing identified additional HER2+ tumors. The HER2+ rate was within range of previously published studies.
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Affiliation(s)
| | - Minkyoung Yoo
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Sudhir K. Unni
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Mukul Singhal
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Hillevi Bauer
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | - Kim Saverno
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
| | | | | | - Diana I. Brixner
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT
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Ryu K, Kang H, Yoo M, Kim J, Kim S, Wie G. Comparison of Nutrient Intake and Diet Quality between Hyperuricemia and Controls : A Cancer Screening Examination Cohort in Korea. J Acad Nutr Diet 2013. [DOI: 10.1016/j.jand.2013.06.090] [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: 10/26/2022]
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Baek JH, Lee SY, Yoo M, Park WS, Lee SJ, Boo YC, Koh JS. Effects of a new mild shampoo for preventing hair loss in Asian by a simple hand-held phototrichogram technique. Int J Cosmet Sci 2011; 33:491-6. [DOI: 10.1111/j.1468-2494.2011.00660.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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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Yu YM, Cristofanilli M, Valiveti A, Ma L, Yoo M, Morellini F, Schachner M. The extracellular matrix glycoprotein tenascin-C promotes locomotor recovery after spinal cord injury in adult zebrafish. Neuroscience 2011; 183:238-50. [PMID: 21443931 DOI: 10.1016/j.neuroscience.2011.03.043] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/19/2011] [Accepted: 03/21/2011] [Indexed: 12/31/2022]
Abstract
Adult zebrafish, by virtue of exhibiting spontaneous recovery after spinal lesion, have evolved into a paradigmatic vertebrate model system to identify novel genes vital for successful regeneration after spinal cord injury. Due to a remarkable level of conservation between zebrafish and human genomes, such genes, once identified, could point to possibilities for addressing the multiple issues on how to deal with functional recovery after spinal cord injury in humans. In the current study, the extracellular matrix glycoprotein tenascin-C was studied in the zebrafish spinal cord injury model to assess the often disparate functions of this multidomain molecule under in vivo conditions. This in vivo study was deemed necessary since in vitro studies had shown discrepant functional effects on neurite outgrowth: tenascin-C inhibits neurite outgrowth when presented as a molecular barrier adjacent to a conducive substrate, but enhances neurite outgrowth when presented as a uniform substrate. Thus, our current study addresses the question as to which of these features prevails in vivo: whether tenascin-C reduces or enhances axonal regrowth after injury in a well accepted vertebrate model of spinal cord injury. We show upregulation of tenascin-C expression in regenerating neurons of the nucleus of median longitudinal fascicle (NMLF) in the brainstem and spinal motoneurons. Inhibition of tenascin-C expression by antisense oligonucleotide (morpholino) resulted in impaired locomotor recovery, reduced regrowth of axons from brainstem neurons and reduced synapse formation by the regrowing brainstem axons on spinal motoneurons, all vital indicators of regeneration. Our results thus point to an advantageous role of tenascin-C in promoting spinal cord regeneration, by promoting axonal regrowth and synapse formation in the spinal cord caudal to the lesion site after injury.
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Affiliation(s)
- Y-M Yu
- W. M. Keck Center for Collaborative Neuroscience and Department of Cell Biology and Neuroscience, Rutgers, The State University of New Jersey, Piscataway, 604 Allison Road, NJ 08854, USA
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Kang HE, Bae SK, Yoo M, Lee DC, Kim YG, Lee MG. Interaction between udenafil and tamsulosin in rats: non-competitive inhibition of tamsulosin metabolism by udenafil via hepatic CYP3A1/2. Br J Pharmacol 2009; 156:1009-18. [PMID: 19254278 DOI: 10.1111/j.1476-5381.2008.00099.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND AND PURPOSE Orthostatic hypotension has been observed when PDE 5 (cGMP-specific phosphodiesterase type 5) inhibitors are co-administered with alpha-adrenoceptor antagonists. Here we assessed the pharmacokinetic and haemodynamic interactions between udenafil and tamsulosin in rats, as both drugs are metabolized via rat hepatic cytochrome P450 3A1/2. EXPERIMENTAL APPROACH Interactions between the two drugs were evaluated in rats after simultaneous 1 or 15 min i.v. infusion or after p.o. administration of udenafil (30 mg x kg(-1)) and/or tamsulosin (1 mg x kg(-1)). In vitro metabolism of tamsulosin with udenafil was measured to obtain the inhibition constant (K(i)) and [I]/K(i) ratio of udenafil. KEY RESULTS The total area under the plasma concentration-time curve from time zero to time infinity (AUC)s (or AUC(0-4 h)) of tamsulosin were significantly greater after 15 min of i.v. infusion or after oral administration with udenafil, compared with tamsulosin alone. The hepatic first-pass metabolism of tamsulosin was inhibited by udenafil, and the inhibition in vitro was in a non-competitive mode. The arterial systolic blood pressure was significantly lower at 5, 10 and 60 min after oral co-administration of the drugs. CONCLUSIONS AND IMPLICATIONS The significantly greater AUC of tamsulosin after i.v. and p.o. administration of both drugs may be attributable to non-competitive inhibition of cytochrome P450 3A1/2-mediated hepatic tamsulosin metabolism by udenafil. The inhibition was also observed in human liver S9 fractions, suggesting that a reassessment of the oral dosage of tamsulosin is necessary when udenafil and tamsulosin are co-administered to patients with benign prostatic hyperplasia.
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Affiliation(s)
- H E Kang
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul, South Korea
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Lee MS, Lee JH, Lee HS, Chang H, Kim YS, Cho KH, Ahn SH, Song JH, Yoo M, Han JK, Park HY. Scrub typhus as a possible aetiology of Guillain-Barré syndrome: two cases. Ir J Med Sci 2008; 178:347-50. [PMID: 19009332 DOI: 10.1007/s11845-008-0226-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2008] [Accepted: 09/10/2008] [Indexed: 11/26/2022]
Abstract
Neurological complications of scrub typhus are reported to be rare. Peripheral nervous system involvement has been reported in only one case. We present two cases of Guillan-Barré syndrome (GBS) associated with scrub typhus. In both cases, the findings of an elevated indirect immunofluorescent antibody titer for Orientia tsutsugamushi and nerve conduction study showing sensory-motor polyneuropathy, have led us to believe that scrub typhus could be one of the antecedent illnesses associated with GBS.
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Affiliation(s)
- M-S Lee
- Department of Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Jeonbuk 570-180, South Korea
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Abstract
The purpose of this paper was to characterize cytochrome P450 (CYP) enzymes involved in N-dealkylation of a new oral erectogenic, DA-8159 to DA-8164, a major circulating active metabolite, in human liver microsomes and to investigate the inhibitory potential of DA-8159 on CYP enzymes. CYP3A4 was identified as the major enzyme responsible for DA-8159 N-dealkylation to DA-8164 based on correlation analysis and specific CYP inhibitor and antibody-mediated inhibition study in human liver microsomes, and DA-8159 metabolism in cDNA expressed CYP enzymes. There is the possibility of drug-drug interactions when prescribing DA-8159 concomitantly with known inhibitors or inducers of CYP3A4. DA-8159 was found to be only a very weak inhibitor of eight major CYPs (1A2, 2A6, 2C8, 2C9, 2C19, 2D6, 2E1 and 3A4), the largest inhibition occurring against CYP2D6 (IC5o 67.7 microM) in human liver microsomes. Drug-drug interactions would not be predicted on the basis of DA-8159 inhibiting the metabolism of coadministered drugs.
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Affiliation(s)
- H Y Ji
- Drug Metabolism and Bioanalysis Laboratory, College of Pharmacy and Phytofermentation Research Center, Wonkwang University, Iksan 570-749, Korea
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Jung M, Lee I, Son J, Choi S, Cho C, Son M, Rhee J, Yoo M. Effects of DA-9102 on Atopic Dermatitis in Animal Models. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.919] [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: 10/24/2022]
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Kang KK, Yu JY, Yoo M, Kwon JW. The effect of DA-8159, a novel PDE5 inhibitor, on erectile function in the rat model of hypercholesterolemic erectile dysfunction. Int J Impot Res 2005; 17:409-16. [PMID: 15920460 DOI: 10.1038/sj.ijir.3901331] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined the effects of a new phosphodiesterase type 5 inhibitor, DA-8159, on erectile function associated with hypercholesterolemia. First of all, in order to investigate whether chronic administration of DA-8159 prevents the development of erectile dysfunction associated with hypercholesterolemia, male SD rats were divided into four groups (normal control, hypercholesterolemic control, DA-8159 5 or 20 mg/kg/day). Over a 5-month period, the animals were fed a 2% cholesterol diet and administered DA-8159 orally once a day. After 5 months, the electrostimulation-induced penile erection and the vascular function using acetylcholine-induced vasodilation with endothelium-intact aortic rings were examined. Furthermore, the plasma lipid profiles, endothelin and N(G),N(G)-dimethylarginine (asymmetrical dimethylarginine, ADMA) concentrations were measured. In order to investigate the acute treatment effect of DA-8159 on the erectile function in an established hypercholesterolemic model, additional animals were given a 2% cholesterol diet for 5 months without DA-8159. At the end of 5 months, the rats were divided into three groups (hypercholesterolemic control, DA-8159 0.3 or 1 mg/kg). DA-8159 was administered intravenously 1 min prior to the intracavernous pressure (ICP) measurement. In a chronic treatment study, while the hypercholesterolemic control showed a significantly lower erectile function, vascular reactivity, and increased plasma cholesterol, endothelin and ADMA concentration, the chronic DA-8159 treatment clearly restored the erectile responses by electric stimulation, preserved the potential of thoracic aortic relaxation in a dose-dependent manner, and significantly decreased the plasma endothelin and ADMA concentrations. In an acute treatment study, DA-8159 induced a dose- and frequency-dependent increase in ICP. The ICP/BP ratio and the corresponding AUC values, and the detumescence time were also significantly increased compared to the hypercholesterolemic control. These results suggest that DA-8159 is beneficial for erectile dysfunction in a rat hypercholesterolemic model and provided a rationale for the potential use of DA-8159 for treating erectile dysfunction secondary to hypercholesterolemia.
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Affiliation(s)
- K K Kang
- Research Laboratories of Dong-A Pharmaceutical Company, Preclinical Division, Sangal, Kiheung, Youngin, Kyunggi, Republic of Korea.
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Abstract
OBJECTIVES DA-8159 is a pyrazolopyrimidinone derivative showing potent and selective phosphodiesterase 5 (PDE5) inhibition. In the previous study, DA-8159 induced a dose-dependent increase in the intracavernous pressure (ICP) in anaesthetized dogs. The aim of this study was to investigate the effects of DA-8159 on penile erection in conscious and acute spinal cord injured (ASCI) rabbits. METHODS DA-8159 was given orally (0.3 to 10mg/kg) to normal rabbits and ASCI rabbits with a surgical transection of the spinal cord at the L2-L4 lumbar vertebra or ischemic-reperfusion. The erection was evaluated in a time-course manner by measuring the length of the uncovered penile mucosa in the absence or presence of intravenous sodium nitroprusside (SNP), a nitric oxide (NO) donor. RESULTS DA-8159 induced a dose-dependent penile erection in both the conscious and ASCI rabbits. The efficacy of DA-8159 was potentiated and the effective doses were significantly decreased by an intravenous injection of SNP. Potentiation of the effect by a nitric oxide donor implies that DA-8159 can enhance the erectile activity during sexual arousal. CONCLUSION These results demonstrate that DA-8159 may be a useful treatment option for erectile dysfunction in patients with or without a spinal cord injury, but further evaluation of the effects of DA-8159 on humans must be performed.
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Affiliation(s)
- Kyung Koo Kang
- Research Laboratories of Dong-A Pharmaceutical Company, 47-5 Sanggal, Kiheung, Youngin, Kyunggi, 449-900 South Korea.
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48
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Shim HJ, Lee EJ, Kim SH, Kim SH, Yoo M, Kwon JW, Kim WB, Lee HS, Lee MG. Pharmacokinetics, stability, and blood partition of DA-8159, a new phosphodiesterase V inhibitor. Res Commun Mol Pathol Pharmacol 2002; 108:275-86. [PMID: 11913718] [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: 02/24/2023]
Abstract
The pharmacokinetics of DA-8159, a new phosphodiesterase V inhibitor, after 1 min intravenous, 30 mg/kg, and oral, 30 mg/kg, administration of the drug to rats, the stability of DA-8159 in various pH solutions ranging from 1 to 13, and human and rat plasma and urine, and the blood partition of DA-8159 between plasma and blood cells of rabbit were evaluated. After intravenous administration, DA-8159 was eliminated fast with the mean total body clearance of 126 ml/min/kg, and was almost completely metabolized in rats; 5.98% of intravenous dose of DA-8159 were excreted unchanged in 24-hr urine. The extent of absolute oral bioavailibility of DA-8159 was approximately 25%. The apparent volume of distribution at steady state was considerably large, 15048 ml/kg, suggesting that DA-8159 has a good affinity to rat tissues. DA-8159 was relatively stable in various pH solutions, and human and rat plasma and urine for up to 48 h incubation in a water-bath shaker kept at 37 degrees C and at a rate of 50 oscillations per min. DA-8159 reached equilibrium fast (within 30 sec mixing manually) between plasma and blood cells of rabbit blood and the plasma-to-blood cell concentration ratios were independent of initial blood concentrations of DA-8159, 1, 5, and 10 microg/ml, when the rabbit whole blood was incubated for up to 120 min; the ratios were in the range of 0.662-0.812. There was no in vitro 'blood storage effect' in the plasma concentration of DA-8159.
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Affiliation(s)
- H J Shim
- College of Pharmacy, Seoul National University, Kwanak-Gu, South Korea
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49
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Abstract
UNLABELLED A case of a giant cervico-mediastinal cyst of thymic origin in an 8-year-old child is presented. The cyst was asymptomatic except for deformity due to its size. In spite of several diagnostic approaches like ultrasonography, computed tomography, cyst puncture with biochemical analysis of cyst content and direct contrast injection and radiography after emptying of the cyst, the ultimate diagnosis as to the origin of the cyst was not disclosed until after operation and histopathological examination of the operative specimen. On a more general basis the diagnostic possibilities and pitfalls are discussed. CONCLUSION a correct preoperative diagnosis of a thymus cyst is difficult and in many instances impossible even when all diagnostic measures at hand are utilized, including radiographic methods, computed tomography, magnetic resonance imaging, ultrasonography and biochemical examination of cyst aspirate and estimation of tumour markers in cyst fluid and serum.
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Affiliation(s)
- I Tollefsen
- Department of Radiology, Rogaland Central Hospital, Stavanger, Norway
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50
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Byun D, Mohan S, Yoo M, Sexton C, Baylink DJ, Qin X. Pregnancy-associated plasma protein-A accounts for the insulin-like growth factor (IGF)-binding protein-4 (IGFBP-4) proteolytic activity in human pregnancy serum and enhances the mitogenic activity of IGF by degrading IGFBP-4 in vitro. J Clin Endocrinol Metab 2001; 86:847-54. [PMID: 11158056 DOI: 10.1210/jcem.86.2.7223] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pregnancy-associated plasma protein-A (PAPP-A) has been identified as the insulin-like growth factor (IGF)-dependent IGF-binding protein-4 (IGFBP-4) protease produced by human fibroblasts. Recently, we found that serum proteases induced during human pregnancy cleaved IGFBP-4 in both an IGF-II-dependent and an IGF-II-independent fashion. This study sought to determine whether PAPP-A is the predominant IGFBP-4 protease in human pregnancy serum (PS) and to assess the in vitro role of serum PAPP-A. Immunoprecipitation with PAPP-A antibody effectively depleted PAPP-A from the PS and completely abolished both IGF-II-dependent and IGF-II-independent IGFBP-4 proteolytic activity in PS. Direct addition of PAPP-A antibody to PS completely blocked IGFBP-4 proteolysis and partially blocked IGFBP-5 proteolysis, but had no effect on IGFBP-3 proteolysis. To evaluate the role of serum PAPP-A, we tested whether PAPP-A in PS modulated the inhibitory activity of IGFBP-4 on IGF-II-induced cell proliferation in human osteosarcoma MG63 cells. The wild-type IGFBP-4 (WTBP-4; 200 ng/mL) failed to inhibit proliferation of the cells treated with PS (0.1% or 0.3%) alone or in combination with IGF-II (40 ng/mL), whereas the inhibitory effect of WTBP-4 was observed in the cells treated with nonpregnancy serum alone or in combination with IGF-II (P < 0.05). In contrast to WTBP-4, a protease-resistant IGFBP-4 was able to inhibit proliferation of the cells treated with PS alone or in combination with IGF-II (P < 0.05). In the presence of PAPP-A neutralizing antibody, the inhibitory effect of WTBP-4 on proliferation of the cells treated with IGF-II and PS was restored. In summary, these data demonstrate 1) that PAPP-A represents the predominant IGFBP-4 protease in PS; 2) that PAPP-A may in part contribute to IGFBP-5, but not IGFBP-3, proteolytic activity in PS; and 3) that PAPP-A enhances the bioactivity of IGFs in vitro by degrading IGFBP-4.
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Affiliation(s)
- D Byun
- Musculoskeletal Disease Center, J. L. Pettis Memorial Veterans Affairs Medical Center and Loma Linda University, Loma Linda, California 92357, USA
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