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Sullivan PW, Ghushchyan VH, Skoner DP, LeCocq J, Park S, Zeiger RS. Complications and Health Care Resource Utilization Associated with Systemic Corticosteroids in Children and Adolescents with Persistent Asthma. J Allergy Clin Immunol Pract 2020; 9:1541-1551.e9. [PMID: 33290914 PMCID: PMC8393544 DOI: 10.1016/j.jaip.2020.11.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 10/22/2020] [Accepted: 11/20/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND: Limited comparative data are available on the impact of systemic corticosteroid (SCS) use in children and adolescents. OBJECTIVE: To determine if asthmatic children and adolescents treated with SCS have a higher likelihood of developing complications versus those not receiving SCS and to examine health care resource utilization (HCRU) in this population. METHODS: A retrospective study of data from children and adolescents with persistent asthma retrieved from the MarketScan database, a large US health claims data set, for the period 2000 to 2017 was performed. Propensity score matching was used to pair patients in the SCS and control cohorts. For complications, SCS subgroups (≥4 or 1-3 annual prescriptions) were compared with asthmatic controls without SCS using logistic regression, and for HCRU, cohorts were compared using negative binomial regression. RESULTS: A total of 67,081 patients were included (SCS: 23,898; control: 43,183). The odds of having a complication were 2.9 (95% confidence interval [CI], 2.5-3.2; P < .001) and 1.6 (95% CI, 1.6-1.7; P < .001) times higher in the ≥4 and 1 to 3 SCS groups, respectively, in the first year of follow-up versus controls. For asthma-related hospitalizations, the incidence rate ratio (IRR) was 6.9 (95% CI, 5.6-8.6) and 3.1 (95% CI, 2.8-3.4) times greater in the ≥4 SCS and 1 to 3 SCS groups, respectively, versus controls; for asthma-related emergency department visits, IRR was 5.0 (95% CI, 4.4-5.6) and 2.9 (95% CI, 2.7-3.0) times greater, respectively, versus controls (all P < .01). CONCLUSION: Children and adolescents receiving SCS for persistent asthma have an increased risk of developing complications and have greater HCRU in the first year of follow-up versus those without SCS exposure.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colo.
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, Armenia
| | - David P Skoner
- Department of Pediatrics, West Virginia University, Morgantown, WV
| | - Jason LeCocq
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Siyeon Park
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, Md
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente, Southern California Region, San Diego, Calif
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Sullivan PW, Li Q, Bilir SP, Dang J, Kavati A, Yang M, Rajput Y. Cost-effectiveness of omalizumab for the treatment of moderate-to-severe uncontrolled allergic asthma in the United States. Curr Med Res Opin 2020; 36:23-32. [PMID: 31491337 DOI: 10.1080/03007995.2019.1660539] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Uncontrolled asthma is associated with considerable clinical burden and costs to payers and patients. US economic models evaluating biologics using data from clinical trials demonstrate high incremental cost-effectiveness ratios (ICERs), but the cost-effectiveness based on real-world treatment patterns is unknown. This analysis used real-world evidence to assess the cost-effectiveness of adding omalizumab to standard of care (SOC).Methods: A Markov model was applied to track patients' health states in 2-week cycles, comparing costs and treatment effects of SOC alone versus SOC + omalizumab over a lifetime (US payer perspective). Outcomes included exacerbation events, life years, quality-adjusted life years (QALYs), total costs, and an ICER. Patient characteristics, exacerbations, patient-reported outcomes, and work productivity were derived from the real-world PROSPERO (Prospective Study to Evaluate Predictors of Clinical Effectiveness in Response to Omalizumab) study. Published literature informed mortality, exacerbation-related disutility, and unit costs. Sensitivity analyses assessed model robustness.Results: Over a lifetime horizon, omalizumab was associated with an increase of 2.0 QALYs at a cost of $US 148,319 in patients with uncontrolled asthma (ICER of $75,319/QALY gained) and a reduction in exacerbations of 6.0 events/patient. Accounting for responder status improved the ICER ($70,505/QALY); incorporating indirect costs further reduced the ICER. One-way and multivariate sensitivity analyses confirmed that the base case outcome was robust to variation in inputs.Conclusions: Based on real-world outcomes, omalizumab may be cost-effective for uncontrolled asthma from the US payer perspective. Including broader evidence on treatment discontinuation, caregiver burden, and oral corticosteroid reduction from real-world studies may better reflect the effects and value of omalizumab for all healthcare stakeholders.
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Affiliation(s)
| | | | | | - Joseph Dang
- Genentech, Inc., South San Francisco, CA, USA
| | | | - Ming Yang
- Genentech, Inc., South San Francisco, CA, USA
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Sullivan PW, Kavati A, Ghushchyan VH, Lanz MJ, Ortiz B, Maselli DJ, LeCocq J. Impact of allergies on health-related quality of life in patients with asthma. J Asthma 2019; 57:1263-1272. [PMID: 31311356 DOI: 10.1080/02770903.2019.1645168] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To estimate the health-related quality of life (HRQoL) and health utilities among asthma patients with and without comorbid allergies in a managed care population.Methods: This was a retrospective analysis of patient survey responses and pharmacy claims from the Observational Study of Asthma Control and Outcomes (OSACO). Patients ≥12 years-old with persistent asthma received four identical surveys between April-2011 and December-2012. The presence of allergy was identified by a positive response to a survey question about hay fever/seasonal allergies and ≥1 diagnosis-related ICD-9-CM code(s) for allergic conditions. HRQoL instruments included generic utility (EQ-5D-3L [including VAS]), asthma-specific utility (AQL-5D) and asthma-specific health status (Mini Asthma Quality of Life Questionnaire [MiniAQLQ]). Median regression was used for utility scores and Least Squares regression for MiniAQLQ, adjusting for sociodemographic characteristics and smoking.Results: Of the 2681 asthmatics who completed the first survey in the OSACO study, 971 had comorbid allergies. After adjusting for covariates, asthma patients with comorbid allergies had significantly lower MiniAQLQ scores than patients without allergies (-0.489 [95% CI -0.570, -0.409]; p < 0.01), with the greatest decrement/impairment observed for the environmental stimuli domain (-0.729 [95% CI -0.844, -0.613]; p < 0.01). Utility scores were also statistically significantly lower for asthma patients with comorbid allergies compared to those without allergies (EQ-5D, -0.031 [95% CI -0.047, -0.015]; AQL-5D, -0.036 [95% CI -0.042, -0.029]; p < 0.01 each).Conclusions: The presence of allergies with persistent asthma is associated with a significant deleterious impact on several different measures of HRQoL.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, CO, USA
| | - Abhishek Kavati
- US Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, CO, USA.,American University of Armenia, Yerevan, Armenia
| | - Miguel J Lanz
- Allergy, Asthma & Immunology, AAA DRS Clinical Research Center, Coral Gables, FL, USA
| | - Benjamin Ortiz
- US Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Diego J Maselli
- Department of Medicine, Division of Pulmonary Diseases and Critical Care, University of Texas Health, San Antonio, TX, USA
| | - Jason LeCocq
- US Medical Affairs, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Sullivan PW, Lanz MJ, Ghushchyan VH, Kavati A, LeCocq J, Ortiz B, Maselli DJ. Medication use and indicators of poor asthma control in patients with and without allergies. Allergy Asthma Proc 2019; 40:221-229. [PMID: 31053178 DOI: 10.2500/aap.2019.40.4226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Approximately two-thirds of people with asthma have some evidence of allergy; their condition differs from nonallergic asthma in terms of predominant symptoms and clinical outcomes. Objective: To compare asthma control and medication use among patients with persistent asthma with evidence of allergy (PA-EA) and patients with persistent asthma with no evidence of allergy (PA-NEA). Methods: A retrospective analysis of survey responses and medication claims data from the Observational Study of Asthma Control and Outcomes study, a prospective survey linked to retrospective claims-based analysis of patients ages ≥ 12 years with persistent asthma in a U.S. health maintenance organization. Evidence of allergy was defined as both a positive response to a survey question about hay fever and/or seasonal allergies and one or more medical diagnostic codes for atopic conditions. Regression models were used to compare asthma control (Asthma Control Questionnaire [ACQ] scores) and asthma medication use between PA-EA and PA-NEA. Results: Adjusted data showed that, versus the patients with PA-NEA (n = 312), patients with PA-EA (n = 971) had higher (worse) 5-item and 6-item ACQ (ACQ-5 and ACQ-6) scores (by 0.34 [95% confidence interval {CI}, 0.24-0.44]; and 0.31 [95% CI, 0.21-0.40], respectively), were more likely to have poorly controlled asthma (ACQ-5 score ≥ 1.5: odds ratio 3.37 [95% CI, 2.07-5.50]; ACQ-6 score ≥ 1.5: odds ratio 3.46 [95% CI, 2.13-5.62]) and less likely to have well-controlled asthma (ACQ-5 score ≤ 0.75: odds ratio 0.21 [95% CI, 0.13-0.34]; ACQ-6 score ≤ 0.75: odds ratio 0.21 [95% CI, 0.13-0.35]). Patients with PA-EA also had greater asthma medication use, most notably 2.5 times more prescriptions of high-dose inhaled corticosteroid in a 4-month period (95% CI, 1.21-5.16) and 16.15 times higher odds of chronic oral corticosteroid use (95% CI, 1.50-174.09) versus PA-NEA. Conclusion: The patients with PA-EA versus PA-NEA had worse asthma control and greater medication use. These patients may need more vigilant clinical oversight and treatment management to ensure adequate asthma control.
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Affiliation(s)
- Patrick W. Sullivan
- From the Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colorado
| | - Miguel J. Lanz
- Allergy, Asthma & Immunology, AAADRS Clinical Research Center, Coral Gables, Florida
| | - Vahram H. Ghushchyan
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado
| | - Abhishek Kavati
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Jason LeCocq
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Diego J. Maselli
- Department of Medicine, Division of Pulmonary Diseases and Critical Care, UT Health, San Antonio, Texas
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Sullivan PW, Lanz MJ, Ghushchyan VH, Kavati A, LeCocq J, Ortiz B, Maselli DJ. Healthcare resource utilization, expenditures, and productivity in patients with asthma with and without allergies. J Asthma 2019; 57:959-967. [PMID: 31264894 DOI: 10.1080/02770903.2019.1628253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: To compare healthcare resource utilization (HCRU), healthcare expenditures, and work productivity and activity impairment within a general asthma population with persistent asthma and evidence of allergy (PA-EA) and persistent asthma with no evidence of allergy (PA-NEA).Methods: We conducted a retrospective analysis of survey responses and claims from the Observational Study of Asthma Control and Outcomes (OSACO) study. Eligible patients with persistent asthma aged ≥12 years were sent four surveys over 15 months. Regression models were used to assess the association between: (1) PA-EA (defined as a positive response to a survey question about hay fever/seasonal allergies AND ≥1 diagnostic code for atopic conditions) and HCRU and expenditures; and (2) PA-EA and Work Productivity and Activity Impairment (WPAI)-Asthma questionnaire scores (vs. PA-NEA).Results: Adjusted data showed that, vs. PA-NEA (n = 312), patients with PA-EA (n = 971) incurred 1.34-times more all-cause prescriptions (95% confidence interval [CI], 1.20-1.48), $132.79 higher prescription costs (95% CI, $22.03-243.56), and $926.11 higher all-cause total healthcare costs (95% CI, $279.67-1572.54), per 4-month period. Patients with PA-EA were 4.1% less productive while working (95% CI, 3.75-4.48%) and experienced a 6.5% reduction in all activities (95% CI, 6.11-6.88%) vs. those with PA-NEA.Conclusions: Patients with PA-EA had greater HCRU, healthcare expenditures, and lower productivity compared with those patients with PA-NEA. These results highlight the burden of atopy in patients with persistent asthma and underscore the importance of allergic endotype identification for more vigilant disease management.
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Affiliation(s)
| | - Miguel J Lanz
- AAADRS Clinical Research Center, Coral Gables, FL, USA
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, University of Colorado, Aurora, CO, USA.,American University of Armenia, Yerevan, Armenia
| | | | - Jason LeCocq
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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Sullivan PW, Ghushchyan VH, Marvel J, Barrett YC, Fuhlbrigge AL. Association Between Pulmonary Function and Asthma Symptoms. J Allergy Clin Immunol Pract 2019; 7:2319-2325. [PMID: 31034996 DOI: 10.1016/j.jaip.2019.04.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/19/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND FEV1 as a percentage of predicted (FEV1%pred) is commonly measured in asthma clinical studies; however, reports vary on its association with asthma control instruments evaluating symptoms. OBJECTIVE Assess the association between FEV1%pred and Asthma Control Questionnaire (ACQ) scores in a managed-care population with persistent asthma. METHODS Retrospective analysis of survey responses and spirometry results of patients (aged ≥12 years) with persistent asthma from the Observational Study of Asthma Control and Outcomes was done. Eligible patients received 4 identical surveys including the 5-item ACQ (ACQ-5)/6-item ACQ (ACQ-6) and completed spirometry in parallel. Longitudinal analyses, comparisons of change over time, and fixed- and random-effects regression analyses were conducted, with/without adjustment for covariates. RESULTS There were 1748 survey responses with valid spirometry results. In unadjusted models, coefficients for ACQ-5/ACQ-6 scores were not statistically significant and coefficient of determination (R2) was low (0.03). When adjusted for covariates, ACQ-5 and ACQ-6 scores were significantly associated with FEV1%pred (P < .001) and R2 increased to 0.11 and 0.12, respectively. In adjusted models, every 1-point increase in ACQ-5 and ACQ-6 scores was associated with a 1.7% and 1.9% decrease, respectively, in FEV1%pred. Change in FEV1%pred and change in ACQ-5/ACQ-6 scores were not significantly associated in regressions with/without covariates. CONCLUSIONS The weak and statistically insignificant association between FEV1%pred and ACQ-5/ACQ-6 scores in unadjusted models suggests a high degree of unexplained variation between these measures. Results support the use of both symptoms and pulmonary function, rather than relying on one measure alone, to assess asthma control in clinical care and outcomes studies.
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Affiliation(s)
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, Armenia
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Sullivan PW, Ghushchyan V, Kavati A, Navaratnam P, Friedman HS, Ortiz B. Trends in Asthma Control, Treatment, Health Care Utilization, and Expenditures Among Children in the United States by Place of Residence: 2003-2014. J Allergy Clin Immunol Pract 2019; 7:1835-1842.e2. [PMID: 30772478 DOI: 10.1016/j.jaip.2019.01.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 01/11/2019] [Accepted: 01/29/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Examining national trends in asthma treatment and control is essential to inform treatment and public health initiatives. OBJECTIVE Explore national trends in asthma control and treatment over time among children and those residing in poor-urban areas. METHODS This was an analysis of trends from 2003 to 2014 among children (aged 1-17 years) in the Medical Expenditure Panel Survey. Indicators of poor control included use of more than 3 canisters of short-acting β-agonists (SABAs) in 3 months, asthma attack, emergency department/inpatient hospitalization, and systemic corticosteroids. Treatment included inhaled corticosteroids, controller medications, SABAs, and greater than or equal to 0.7 ratio of controller-to-total prescriptions. Other measures included the number of asthma medications, outpatient visits, asthma-specific drug, and total expenditures per-patient-per-year. RESULTS There were 8.4 million children with asthma in the United States in 2014; 11.1% lived in poor-urban areas. There was a statistically significant decrease in the percentage of children using inhaled corticosteroids, controller medications, daily preventive medications, systemic corticosteroids, SABAs, more than 3 canisters of SABAs (in 3 months), overall asthma prescriptions, and outpatient visits. There was a significant increase in the percentage of children reporting having an asthma attack. Trends for children residing in poor-urban areas were compared with all others; however, limited data and variability in annual estimates prevent clear conclusions. CONCLUSIONS Results suggest lack of improvement in treatment and control since 2003 among children with asthma in the United States. There is significant room for improvement in asthma control and disease management among children.
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Affiliation(s)
| | - Vahram Ghushchyan
- University of Colorado, Denver, Colo; American University of Armenia, Yerevan, Armenia
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Sullivan PW, Ghushchyan V, Navaratnam P, Friedman HS, Kavati A, Ortiz B, Lanier B. Exploring factors associated with health disparities in asthma and poorly controlled asthma among school-aged children in the U.S. J Asthma 2019; 57:271-285. [PMID: 30732486 DOI: 10.1080/02770903.2019.1571080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Certain populations suffer disproportionately from asthma and asthma morbidity. The objective was to provide a national descriptive profile of asthma control and treatment patterns among school-aged children (SAC: aged 6-17) in the U.S. Methods: This was a cross-sectional analysis using the nationally representative 2007-2014 Medical Expenditure Panel Survey. Among SAC with asthma, indicators of poor control included: exacerbation/asthma attack; >3 canisters short-acting beta agonist (SABA)/3 months; and asthma-specific Emergency Department or inpatient visits (ED/IP). Results: Non-Hispanic black, non-Hispanic multiple races, Puerto Rican, obese, Medicaid, poor, ≥2 non-asthma chronic comorbidities (CC), and family average CC ≥ 2 were associated with higher odds of having asthma. The following had significantly higher odds ratios (OR) of excessive SABA use compared to non-Hispanic whites [OR; CI; p < 0.05]: Puerto Rican (3.8; 2.1-6.9), Mexican (3.6; 2.0-6.4), Central/South American (3.0; 1.2-7.7), Hispanic-other (3.1; 1.1-9.0), non-Hispanic black (2.5; 1.6-3.9), and non-Hispanic Asian (4.0; 1.7-9.2). SABA OR were also significant for Spanish spoken at home (2.5; 1.6-3.8), obese (2.1; 1.3-3.3), Medicaid (2.9; 2.0-4.1), no medical insurance (2.1; 1.1-4.1), no prescription insurance (2.5; 1.8-3.5), poor (2.8; 1.7-4.7), CC ≥ 2 (2.1; 1.6-2.8), parent-without high-school degree (2.5; 1.8-3.6), parent-SF-12 Physical Component Scale <50 (1.6; 1.2-2.1) and Mental Component Scale <50 (1.5; 1.1-2.0). Significant differences also existed across subgroups for ED/IP visits. Conclusions: There are disparities in asthma control and prevalence among certain populations in the U.S. These results provide national data on disparities in several indicators of poor asthma control beyond the standard race/ethnicity groupings.
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Affiliation(s)
- P W Sullivan
- Regis University School of Pharmacy, Denver, Colorado, USA
| | - V Ghushchyan
- University of Colorado, Denver, Colorado, USA.,American University of Armenia, Yerevan, Armenia
| | | | | | - A Kavati
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - B Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USA
| | - B Lanier
- University of North Texas, Fort Worth, Texas, USA
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Sullivan PW, Ghushchyan V, Kavati A, Navaratnam P, Friedman HS, Ortiz B. Health Disparities Among Children with Asthma in the United States by Place of Residence. J Allergy Clin Immunol Pract 2018; 7:148-155. [PMID: 29782937 DOI: 10.1016/j.jaip.2018.05.001] [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] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/08/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Children residing in poor-urban areas may have greater asthma morbidity. It is unclear whether this is due to individual characteristics such as race and ethnicity or place of residence. OBJECTIVE Assess indicators of control and treatment by residence. METHODS This was a cross-sectional analysis of children (aged 1-17 years) in the 2000-2014 Medical Expenditure Panel Survey (MEPS). Indicators of poor control included use of more than 3 canisters of short-acting beta agonist (SABA) in 3 months, asthma attack, and emergency department (ED) or inpatient (IP) visit during the year. Treatment measures included use of controller medications and a ratio of controller-to-total prescriptions of 0.7 or more. RESULTS There were 15,052 children with asthma in the MEPS 2000-2014 data, reflecting 8.4 million children in 2014. After controlling for covariates, children with asthma residing in poor-urban areas had lower odds of using controller medications (odds ratio [OR] = 0.77), having a controller-to-total ratio of 0.7 or more (OR = 0.75), and reporting an asthma attack (OR = 0.75) and higher odds of having an ED/IP visit (OR = 1.3) compared with those living elsewhere. Black race and Hispanic ethnicity were associated with greater odds of excessive SABA use (OR = 2.11) and ED/IP visits (OR = 2.03) and lower odds of controller-to-total ratio of 0.07 or more (OR = 0.50). CONCLUSIONS Poor-urban residence may be independently associated with asthma control and treatment even after controlling for individual characteristics such as race and ethnicity. Future research is needed to understand the sources of these geographic health disparities to more successfully target public health interventions.
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Affiliation(s)
| | - Vahram Ghushchyan
- University of Colorado, Denver, Colo; American University of Armenia, Yerevan, Armenia
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Sullivan PW, Ghushchyan V, Navaratnam P, Friedman HS, Kavati A, Ortiz B, Lanier B. Indicators of poorly controlled asthma and health-related quality of life among school-age children in the United States. Allergy Asthma Proc 2017; 38:431-439. [PMID: 28800789 DOI: 10.2500/aap.2017.38.4084] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Poorly controlled asthma has far-reaching effects on school-age children and their parents, but little is known about the national impact on health-related quality of life (HRQoL). OBJECTIVE To examine HRQoL associated with asthma and indicators of poorly controlled asthma in the United States. METHODS This was a cross-sectional analysis of HRQoL among school-age children (age range, 6-17 years) with asthma in the nationally representative 2007-2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included the following: exacerbation in the previous 12 months, use of more than three canisters of short-acting beta agonist in 3 months, and annual asthma-specific emergency department or inpatient visits. Health status and HRQoL instruments included the following: the Columbia Impairment Scale (CIS), Child Health Questionnaire (CHQ), Children with Special Health Care Needs Screener (CSHCN), and self-perceived physical and mental health. Ordered logistic regression was used for ordered categorical variables, and logistic regression was used for binary variables. All regressions controlled for sociodemographics and other covariates. RESULTS There were 44,320 school-age children in the MEPS, of whom 5890 had asthma. School-age children with indicators of poorly controlled asthma had higher odds of feeling unhappy and/or sad or nervous and/or afraid, and of having problems with sports and/or hobbies and schoolwork on the CIS. Results from the CHQ showed that parents of school-age children with asthma and indicators of poorly controlled asthma had higher odds of worrying about their child's health and future. Results from the CSHCN showed that school-age children with asthma and indicators of poorly controlled asthma were more likely to have special health care needs. School-age children with asthma and indicators of poorly controlled asthma had higher odds of having poor perceived physical health. CONCLUSION This nationally representative study provided novel information on the burden of poorly controlled asthma on emotional problems, school-related and activity limitations, general health status, and worry among school-age children and their families as measured by validated instruments.
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Abstract
BACKGROUND Asthma control is the main focus of treatment guidelines. Valid instruments such as the Asthma Control Questionnaire (ACQ) require prospective survey. These surveys may be challenging for large population health applications. OBJECTIVE To develop an algorithm for estimating ACQ-5 scores from commonly available claims data. METHODS Data was derived from four prospective surveys including the ACQ-5 combined with retrospective claims of Kaiser Permanente of Colorado (KPCO) patients. The statistical approach consisted of derivation and validation of a prediction algorithm including medical and pharmacy claims data using stepwise regression elimination. Validation was conducted by estimating mean squared error (MSE) and mean absolute error (MAE) in one hundred split-sample iterations. Ordinary least squares (OLS), Tobit and Median regression were used. RESULTS There were 2,657 individuals with valid ACQ-5 scores, claims and eligibility at baseline. The following had statistically significant associations with ACQ-5 scores: gender, use of oral corticosteroids and short-acting beta agonists, the number of asthma drug classes, and emergency and outpatient visits. Average MSE and MAE were similar for the estimation and validation samples. CONCLUSION This research provides preliminary results of the feasibility of predicting ACQ-5 scores using commonly available medical and pharmacy claims data. The resulting algorithm may facilitate public health and population level analyses of asthma control. Future studies in different populations will be important to validate the algorithm.
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Affiliation(s)
- Patrick W Sullivan
- a Department of Pharmacy Practice , Regis University School of Pharmacy , Denver , CO
| | - Vahram H Ghushchyan
- b Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy , University of Colorado Denver , Aurora , CO.,c College of Business and Economics , American University of Armenia , Yerevan , Armenia
| | - Gary Globe
- d Global Health Economics , Amgen, Inc. , Thousand Oaks , CA
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Sullivan PW, Ghushchyan V, Navaratnam P, Friedman HS, Kavati A, Ortiz B, Lanier B. The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States. J Asthma 2017; 55:659-667. [PMID: 28981368 DOI: 10.1080/02770903.2017.1350972] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The degree of poorly controlled asthma and its association with missed school days and parental missed work days is not well understood. METHODS This was a retrospective analysis of missed school days and missed work days for school-aged children (SAC; aged 6-17) and their caregivers in the nationally representative 2007-2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included: exacerbation in previous 12 months; use of >3 canisters of short-acting beta agonist (SABA) in 3 months; and annual asthma-specific (AS) Emergency Department (ED) or inpatient (IP) visits. Negative binomial regression was used for missed school days, and a Heckman two-step selection model was used for missed work days. All analyses controlled for sociodemographics and other covariates. RESULTS There were 44,320 SAC in MEPS, of whom 5,890 had asthma. SAC with asthma and an indicator of poor control missed more school days than SAC without asthma: exacerbation (1.8 times more; p < 0.001); >3 canisters SABA (2.7 times more; p < 0.001) and ED/IP visit (3.8 times more; p < 0.001). The parents/caregivers of SAC with asthma and an exacerbation missed 1.2 times more work days (p < 0.05), while those with SAC with asthma and an ED/IP visit missed 1.8 times more work days (p < 0.01) than the parents of SAC without asthma. CONCLUSIONS This study provides evidence of the significant national burden of poorly controlled asthma due to missed school and work days in the United States. More effective and creative asthma management strategies, with collaboration across clinical, community and school-based outreach, may help address this burden.
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Affiliation(s)
- P W Sullivan
- a Rueckert-Hartman College for Health Professions , Regis University School of Pharmacy , Denver , CO , USA
| | - V Ghushchyan
- b Pharmaceutical Outcomes Research , University of Colorado , Denver CO , USA.,c American University of Armenia , Yerevan , Armenia
| | | | | | - A Kavati
- e Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - B Ortiz
- e Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | - B Lanier
- f Department Pediatrics/Immunology , University of North Texas , Fort Worth , TX , USA
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Sullivan PW, Ghushchyan V, Navaratnam P, Friedman HS, Kavati A, Ortiz B, Lanier B. The national cost of asthma among school-aged children in the United States. Ann Allergy Asthma Immunol 2017; 119:246-252.e1. [PMID: 28890020 DOI: 10.1016/j.anai.2017.07.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent research has quantified the national health care resource use (HCRU) and health care expenditure (HCE) burden associated with adult asthma; however, estimates specific to school-aged children are more than 2 decades old. OBJECTIVE To estimate the national HCRU and HCEs attributable to asthma among school-aged children in the United States. METHODS This was a cross-sectional retrospective analysis of school-aged children (aged 6-17 years) in the nationally representative 2007-2013 Medical Expenditure Panel Survey. All-cause HCRU and HCEs of school-aged children with asthma were compared with school-aged children without asthma, controlling for sociodemographics and comorbidities. HCRU encounters included emergency department (ED) and outpatient visits, hospitalizations, and prescriptions. Expenditures included total, medical, ED, inpatient, outpatient, and pharmacy. Negative binomial regression analyses were used for HCRU and Heckman selection with logarithmic transformation, and smearing retransformation was used for HCEs. RESULTS There were 44,320 school-aged children of whom 5,890 had asthma. Children with asthma incurred a higher rate of all-cause annual ED visits (incidence rate ratio [IRR], 1.5; P < .001), hospitalizations (IRR, 1.4; P < .05), outpatient visits (IRR, 1.4; P < .001), and prescription drugs (IRR, 3.3; P < .001) compared with school-aged children without asthma. They incurred US$847 (2015 dollars) more annually in all-cause expenditures (P < .001). Private insurance and Medicaid paid the largest share of expenditures. Pharmacy and outpatient costs represented the largest proportion of total expenditures. On the basis of the nationally representative Medical Expenditure Panel Survey sample weights from 2013, the total annual HCEs attributable to asthma for school-aged children in the United States was US$5.92 billion (2015 dollars). CONCLUSION Childhood asthma continues to represent a prevalent and significant clinical and economic burden in the United States. More aggressive treatment and asthma management programs are needed to address this national financial and resource burden.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colorado.
| | - Vahram Ghushchyan
- Department of Clinical Pharmacy, University of Colorado, Denver, Colorado; College of Business and Economics, American University of Armenia, Yerevan, Armenia
| | | | | | - Abhishek Kavati
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey
| | - Bob Lanier
- Department of Pediatrics, University of North Texas, Fort Worth, Texas
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Sullivan PW, Ghushchyan V, Navaratnam P, Friedman HS, Kavati A, Ortiz B, Lanier B. National Prevalence of Poor Asthma Control and Associated Outcomes Among School-Aged Children in the United States. J Allergy Clin Immunol Pract 2017; 6:536-544.e1. [PMID: 28847656 DOI: 10.1016/j.jaip.2017.06.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND The degree of asthma control among school-aged children (SAC) nationally is not well understood. OBJECTIVE The objective of this study was to characterize poor control among SAC (aged 6-17 years) in the United States. METHODS This was a retrospective analysis of the 2007-2013 Medical Expenditure Panel Survey. Indicators of poor control included exacerbation in previous year; use of >3 canisters of short-acting β-agonist (SABA) in 3 months; and asthma-specific (AS) emergency department (ED) or inpatient (IP) visits. Treatment indicators included daily controller medication and peak flow meter use. Negative binomial regression was used for health resource utilization (HRU); generalized linear models with log-link were used for health care expenditures. RESULTS There were 44,320 SAC, of whom 5,890 had asthma. The prevalence of poor control and treatment among SAC with asthma were as follows: exacerbation (59%), >3 canisters of SABA (4%), ED/IP visit (3%), daily controller (19%), peak flow (12%). In 2013, 3.4 million SAC had an asthma exacerbation and 200,000 had an AS ED/IP visit. SAC with asthma and an exacerbation had 18.9 times more annual AS ED visits (and 43.3 times more AS hospitalizations) than SAC with asthma but no exacerbation. SAC with asthma and an indicator of poor control incurred greater annual all-cause expenditures than SAC without asthma ($US 2015): $1,144 (exacerbation), $1,859 (≥3 canisters of SABA), and $3,063 (ED/IP visit). Use of daily controller medication was low even among SAC with poor control (27% to 61%). CONCLUSION Renewed and vigilant asthma management and treatment is necessary to mitigate the current and long-term public health effects and expenditures associated with poor asthma control.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colo.
| | - Vahram Ghushchyan
- Department of Clinical Pharmacy, University of Colorado, Denver, Colo; College of Business and Economics, American University of Armenia, Yerevan, Armenia
| | | | | | | | | | - Bobby Lanier
- Department of Pediatrics, University of North Texas, Fort Worth, Texas
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Sullivan PW, Globe G, Ghushchyan VH, Campbell JD, Bender B, Magid DJ. Exploring asthma control cutoffs and economic outcomes using the Asthma Control Questionnaire. Ann Allergy Asthma Immunol 2017; 117:251-257.e2. [PMID: 27613458 DOI: 10.1016/j.anai.2016.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/01/2016] [Accepted: 07/15/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Understanding the effect of worsening asthma control on expenditures and health resource utilization (HRU) is important. OBJECTIVE To explore the association of economic outcomes with asthma control cutoffs and longitudinal changes on the Asthma Control Questionnaire 5 (ACQ-5). METHODS The Observational Study of Asthma Control and Outcomes was a survey of patients with persistent asthma who were patients of Kaiser Colorado, including claims-based HRU. Patients completed the ACQ-5 three times during 1 year between April 2011 and June 2012. The ACQ-5 cutoffs that indicated control were assessed in cross-sectional analyses. Longitudinal changes in control were explored: controlled (ACQ-5 score <0.75), indeterminate (ACQ-5 score 0.75 to <1.5), not well controlled (ACQ-5 score 1.5 to <3.0), and very poorly controlled (ACQ-5 score ≥3.0). Analyses used generalized linear models with log link (expenditures) and negative binomial regression (HRU). RESULTS There were 6,666 completed surveys (1,799 individuals completed all 3 survey waves). In the cross-sectional analyses, compared with an ACQ-5 score less than 0.5, individuals with ACQ-5 scores of 4 to 4.5 incurred 7.2 times the number of oral corticosteroid prescriptions, 4.3 times the number of emergency department visits, 6 times the number of inpatient visits, 10.4 times the number of asthma-specific emergency department visits, 4.58 times the number of asthma-specific inpatient visits, and $2,892 more in all-cause and $1,877 in asthma-specific expenditures during 4 months. In the longitudinal change analyses, individuals who improved from an ACQ-5 of 3.0 or greater to less than 0.75 incurred $6,023 less in asthma-specific expenditures during 4 months than those remaining at an ACQ-5 score of 3.0 or higher. CONCLUSION Results provide preliminary economic data on possible control cutoffs for the ACQ-5. Improving asthma control over time may result in significant savings that may justify financial investments designed to improve control.
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Affiliation(s)
| | | | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado; American University of Armenia, Yerevan, Armenia
| | - Jonathan D Campbell
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado
| | - Bruce Bender
- Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - David J Magid
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado
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Sullivan PW, Ghushchyan VH, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthmatic patients. J Allergy Clin Immunol 2017; 141:110-116.e7. [PMID: 28456623 DOI: 10.1016/j.jaci.2017.04.009] [Citation(s) in RCA: 191] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/23/2017] [Accepted: 04/03/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Significant adverse effects (AEs) have been associated with continuous exposure to oral corticosteroids (OCSs). The potential association with intermittent exposure is unknown. OBJECTIVE We sought to assess the association between OCSs and AEs based on the number of OCS prescriptions. METHODS This was a retrospective cohort study of asthmatic patients 18 years and older in the 2000-2014 MarketScan data set. Propensity score matching was used at baseline (12 months before the index date: first OCS use). Logistic regression was used to examine the association between OCSs and new incident AEs (either combined or individual) controlling for covariates. Follow-up continued for 24 months minimum and 10 years maximum after the index date. RESULTS There were 72,063 and 156,373 subjects in the OCS and no OCS cohorts, respectively. Subjects taking 4 or more OCS (1-3) prescriptions within the year had 1.29 (1.04) times the odds of experiencing a new AE within the year. Each year of exposure to 4 or more OCS prescriptions (current and past) resulted in 1.20 times the odds of having an AE in the current year. Exposure to 4 or more prescriptions was associated with significantly greater odds of AEs for osteoporosis, hypertension, obesity, type 2 diabetes, gastrointestinal ulcers/bleeds, fractures, and cataracts (odds, 1.21-1.44 depending on the AE). CONCLUSION Although previous research has documented the deleterious effect of continuous OCS exposure in patients with severe asthma, our results suggest that each OCS prescription might result in a cumulative burden on current and future health regardless of dose and duration. OCS-sparing strategies are extremely important to improve patient outcomes.
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Affiliation(s)
| | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, Armenia
| | | | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif
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Sullivan PW, Ghushchyan V, Navaratnam P, Friedman H, Kavati A, Xiang P, Ortiz B, Lanier BQ. The National Burden of Asthma in Children in the U.S.: Results from a Nationally Representative Study. J Allergy Clin Immunol 2017. [DOI: 10.1016/j.jaci.2016.12.910] [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: 10/20/2022]
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Sullivan PW, Ghushchyan VH. EQ-5D Scores for Diabetes-Related Comorbidities. Value Health 2016; 19:1002-1008. [PMID: 27987626 DOI: 10.1016/j.jval.2016.05.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [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: 12/01/2015] [Revised: 04/13/2016] [Accepted: 05/28/2016] [Indexed: 05/07/2023]
Abstract
BACKGROUND A single-source catalogue of nationally representative EuroQol five-dimensional questionnaire (EQ-5D) scores for chronic conditions in the United States and the United Kingdom from the Medical Expenditure Panel Survey (MEPS) has been published and has been used extensively for public health and cost-effectiveness modeling. OBJECTIVES To estimate EQ-5D scores for diabetes-related chronic conditions that are consistent with the previous catalogue. METHODS The MEPS is a nationally representative survey of the US civilian population. EQ-5D-3L questionnaire responses were mapped from short-form 12 health survey responses in 2000 to 2011 MEPS data using multinomial logistic regression. Country-specific tariffs were applied to the mapped EQ-5D responses for the United Kingdom, the United States, France, and Spain. EQ-5D scores were regressed on diabetes-related comorbidities controlling for sociodemographic characteristics, body mass index, and comorbidity using robust (median) regression. Methods were consistent with the previously published catalogue of EQ-5D scores for the United States. RESULTS There were 20,705 individuals with diabetes and a valid mapped EQ-5D score in the 2000 to 2011 MEPS data. Unadjusted mapped EQ-5D scores for individuals with diabetes varied by country-specific tariff from 0.70 (France) to 0.79 (United States). Regression results reflecting marginal disutility estimates for EQ-5D scores are provided for 17 diabetes-related comorbidities and body mass index categories for US, UK, French, and Spanish tariffs. CONCLUSIONS The estimates provided in this research may be useful for analysts attempting to model the impact of diabetes and diabetes-related comorbid conditions on utility. They are derived from a single-source, nationally representative population and augment the existing "off-the-shelf" catalogue of EQ-5D scores for chronic conditions.
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Affiliation(s)
| | - Vahram H Ghushchyan
- Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes Research, University of Colorado, Aurora, CO, USA; American University of Armenia, Yerevan, Armenia
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Sullivan PW, Ghushchyan VH, Globe G, Sucher B. Health-related quality of life associated with systemic corticosteroids. Qual Life Res 2016; 26:1037-1058. [PMID: 27757775 DOI: 10.1007/s11136-016-1435-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Systemic corticosteroids (SCS) are commonly used but are associated with adverse effects. Given their prevalent use, the potential impact of SCS use on health-related quality of life (HRQoL) is important to characterize. OBJECTIVE To assess the HRQoL of patients taking SCS. METHODS The 2000-2003 Medical Expenditure Panel Survey was used to examine EQ-5D and SF-6D scores associated with SCS use in adults. The study sample was restricted to those with a condition for which SCS are prescribed. SCS use was categorized into three levels: none; 1-3; and ≥4 prescriptions per year. HRQoL scores were regressed on SCS use (1-3 or ≥4 annual prescriptions) controlling for age, gender, race, ethnicity, education, income category, geographic region, number of ER visits, number of outpatient visits, total number of chronic conditions (for which SCS are not used) and conditions for which SCS are clinically indicated. RESULTS There were 54,856 individuals with no SCS exposure, 2245 with 1-3 and 624 with ≥4 annual SCS prescriptions. In adjusted analyses, use of ≥4 annual SCS prescriptions appeared to be associated with significantly lower EQ-5D (US), EQ-5D (UK), SF-6D and EQ-5D VAS scores compared to no exposure: -0.032, -0.047, -0.036, and -7.58. CONCLUSION While SCS are efficacious and widely used for numerous conditions, results suggest that their use may be associated with a substantial deleterious impact on HRQoL. This potential negative effect should be considered in balance with the cost and efficacy of comparable treatments.
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Affiliation(s)
| | - Vahram H Ghushchyan
- Department of Clinical Pharmacy, Center for Pharmaceutical Outcomes Research, University of Colorado Aurora, Aurora, CO, USA.,American University of Armenia, Yerevan, Armenia
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Abstract
BACKGROUND Previous studies have shown an association between cost and poor asthma control. However, longitudinal studies of general populations are lacking. OBJECTIVE To examine the cost of poor asthma control and exacerbations across a broad spectrum of asthma patients. METHODS The Observational Study of Asthma Control and Outcomes (OSACO) was a prospective survey of persistent asthma patients in Kaiser Colorado in 2011-2012. Patients received a survey 3 times in one year, which included the Asthma Control Questionnaire (ACQ) and questions on exacerbations. Self-reported exacerbations were compared to actual oral corticosteroid (OCS) use. Regression analyses examined the association of control (ACQ-5 scores) and exacerbations with healthcare expenditures, controlling for sociodemographics and smoking. Analyses of expenditures used Generalized Linear Models (GLM) with log-link. RESULTS 2681 individuals completed at least one survey; 1799 completed all three. ACQ-5 scores were associated with higher all-cause and asthma-specific expenditures across all categories of costs (medical, outpatient, ER, pharmacy) except for inpatient expenditures. Each 1-point increase in the ACQ-5 score (i.e., worse control) was associated with a corresponding increase in all-cause annual healthcare and asthma-specific expenditures of $1443 and $927 ($US 2013). Asthma exacerbations with documented OCS use were associated with an increase of $3014 and $1626 over 4 months, while self-reported exacerbations were $713 and $506. CONCLUSION Results demonstrate that poor asthma control and exacerbations are strongly associated with higher healthcare expenditures. Results also confirm that collection of validated measures of control such as the ACQ-5 may provide valuable information toward improving clinical and economic outcomes.
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Affiliation(s)
| | - Vahram H Ghushchyan
- c Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy , University of Colorado Aurora , CO , USA.,d American University of Armenia , Yerevan , Armenia
| | - Jonathan D Campbell
- c Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy , University of Colorado Aurora , CO , USA
| | - Gary Globe
- e Amgen, Inc. , Thousand Oaks , CA , USA
| | - Bruce Bender
- f Department of Pediatrics , National Jewish Health , Denver , CO , USA
| | - David J Magid
- b Institute for Health Research, Kaiser Permanente Colorado , Denver , CO , USA.,g Colorado School of Public Health, University of Colorado , Denver , CO , USA
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Sullivan PW, Campbell JD, Ghushchyan VH, Globe G, Lange J, Woolley JM. Characterizing the severe asthma population in the United States: claims-based analysis of three treatment cohorts in the year prior to treatment escalation. J Asthma 2015; 52:669-80. [PMID: 25731600 DOI: 10.3109/02770903.2015.1004683] [Citation(s) in RCA: 13] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Little is known about the disposition of severe patients prior to treatment escalation. To classify patients by treatment step using pharmacy data and describe their economic and healthcare utilization, insurance status, and sociodemographic characteristics in the year prior to escalation to Global Initiative for Asthma (GINA) steps 4 and 5. METHODS This was a retrospective claims cohort study of asthma patients (age 12-75 years) newly initiated on "stable therapy" (three consecutive months of therapy) with omalizumab, high intensity corticosteroids (HICS; ≥1000 µg/d inhaled fluticasone equivalent or oral prednisone), or high-dose inhaled corticosteroid (HDICS; ≥500-<1000 µg/d fluticasone equivalent) from 2002 to 2011. Other asthma treatments were compared as a reference. RESULTS Of 25,297 patients, 856 initiated omalizumab, 6926 initiated HICS, and 11,445 initiated HDICS. In the year prior to treatment escalation to omalizumab, HICS, and HDICS, respectively, individuals had high annual mean medical expenditures ($14,071, $12,030, and $7570), utilization (27 outpatient and 10 specialty care visits; 19 outpatient and three specialty; 15 outpatient and two specialty), asthma-related prescription drugs (11.74, 7.8, and 5.17) and chronic comorbidities (2.68, 2.67, and 2.19). Prior to omalizumab treatment, patients were more likely to be salaried, full-time employees with commercial PPO/POS insurance. CONCLUSIONS Prior to escalating treatment to GINA steps 4 and 5, individuals experienced significant annual medical expenditures, healthcare resource utilization and polypharmacy burden, which may reflect poorly controlled asthma and the need to escalate treatment. Medical claims data and utilization-based measures may be helpful in classifying individuals by GINA treatment step.
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Sullivan PW, Campbell JD, Globe G, Ghushchyan VH, Bender B, Schatz M, Chon Y, Woolley JM, Magid DJ. Measuring the effect of asthma control on exacerbations and health resource use. J Allergy Clin Immunol 2015; 136:1409-11.e1-6. [PMID: 26073753 DOI: 10.1016/j.jaci.2015.04.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Jonathan D Campbell
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colo
| | | | - Vahram H Ghushchyan
- Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colo; American University of Armenia, Yerevan, Armenia
| | - Bruce Bender
- Department of Pediatrics, National Jewish Health, Denver, Colo
| | | | | | | | - David J Magid
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colo
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Sullivan PW, Campbell JD, Ghushchyan VH, Globe G. Outcomes before and after treatment escalation to Global Initiative for Asthma steps 4 and 5 in severe asthma. Ann Allergy Asthma Immunol 2015; 114:462-9. [DOI: 10.1016/j.anai.2015.03.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 11/30/2022]
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Sullivan PW, Ghushchyan V. The Burden of Asthma in the United States: Updated Nationally Representative Estimates of the Cost of Asthma. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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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Slejko JF, Sullivan PW, Anderson HD, Ho PM, Nair KV, Campbell JD. Dynamic medication adherence modeling in primary prevention of cardiovascular disease: a Markov microsimulation methods application. Value Health 2014; 17:725-731. [PMID: 25236996 DOI: 10.1016/j.jval.2014.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 12/16/2013] [Revised: 06/02/2014] [Accepted: 06/14/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Real-world patients' medication adherence is lower than that of clinical trial patients. Hence, the effectiveness of medications in routine practice may differ. OBJECTIVES The study objective was to compare the outcomes of an adherence-naive versus a dynamic adherence modeling framework using the case of statins for the primary prevention of cardiovascular (CV) disease. METHODS Statin adherence was categorized into three state-transition groups on the basis of an epidemiological cohort study. Yearly adherence transitions were incorporated into a Markov microsimulation using TreeAge software. Tracker variables were used to store adherence transitions, which were used to adjust probabilities of CV events over the patient's lifetime. Microsimulation loops "random walks" estimated the average accrued quality-adjusted life-years (QALYs) and CV events. For each 1,000-patient microsimulations, 10,000 outer loops were performed to reflect second-order uncertainty. RESULTS The adherence-naive model estimated 0.14 CV events avoided per person, whereas the dynamic adherence model estimated 0.08 CV events avoided per person. Using the adherence-naive model, we found that statin therapy resulted in 0.40 QALYs gained over the lifetime horizon on average per person while the dynamic adherence model estimated 0.22 incremental QALYs gained. Subgroup analysis revealed that maintaining high adherence in year 2 resulted in 0.23 incremental QALYs gained as compared with 0.16 incremental QALYs gained when adherence dropped to the lowest level. CONCLUSIONS A dynamic adherence Markov microsimulation model reveals risk reduction and effectiveness that are lower than with an adherence-naive model, and reflective of real-world practice. Such a model may highlight the value of improving or maintaining good adherence.
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Affiliation(s)
- Julia F Slejko
- Pharmaceutical Outcomes Research and Policy Program, University of Washington School of Pharmacy, Seattle, WA.
| | | | - Heather D Anderson
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - P Michael Ho
- VA Eastern Colorado Health Care System, University of Colorado, Denver CO
| | - Kavita V Nair
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
| | - Jonathan D Campbell
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
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Sullivan PW, Slejko JF, Ghushchyan VH, Sucher B, Globe DR, Lin SL, Globe G. The relationship between asthma, asthma control and economic outcomes in the United States. J Asthma 2014; 51:769-78. [PMID: 24697738 DOI: 10.3109/02770903.2014.906607] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Asthma, a serious chronic lung disease affecting approximately 26 million Americans, remains clinical and economic burdens on the healthcare system. Although associations between uncontrolled asthma and poor health outcomes is known, the extent of this impact of uncontrolled asthma on economic outcomes in the United States (US) is unknown. We sought to determine the relationship between asthma, asthma control and economic outcomes in the US. METHODS The 2008-2010 Medical Expenditure Panel Surveys were used to estimate the impact of uncontrolled asthma (asthma-related emergency department [ED] visit, use of >3 canisters of quick-relief inhaler in past 3 months or asthma attack in past 12 months) on medical expenditures, utilization and productivity. Estimates were generated using multivariate regression controlling for sociodemographics and comorbidity. RESULTS Medical expenditures attributable to asthma were up to $4423 greater for those with markers of uncontrolled asthma compared with those who did not have asthma. Frequency of hospital discharges were up to 4.6-fold greater for those with uncontrolled asthma than those without asthma (p < 0.01), while all others with asthma did not have significantly more discharges. ED visits were up to 1.8-fold greater for those with uncontrolled asthma compared with those without asthma (p < 0.01). Productivity was significantly (p < 0.01) decreased (more likely to be unemployed, more days absent from work and more activity limitations) for those with uncontrolled asthma. CONCLUSIONS In recent national data, individuals with asthma and markers of uncontrolled asthma had higher medical expenditures, greater utilization and decreased productivity.
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Sullivan PW, Campbell J, Ghushchyan V, Globe G, Lange J, Woolley JM. Characterizing The Severe Asthma Population In The United States: Claims-Based Analysis Of Three Treatment Cohorts In The Year Prior To Treatment Escalation. J Allergy Clin Immunol 2014. [DOI: 10.1016/j.jaci.2013.12.173] [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: 11/28/2022]
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Slejko JF, Ho M, Anderson HD, Nair KV, Sullivan PW, Campbell JD. Adherence to statins in primary prevention: yearly adherence changes and outcomes. J Manag Care Pharm 2014; 20:51-7. [PMID: 24372460 PMCID: PMC10438208 DOI: 10.18553/jmcp.2014.20.1.51] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Adherence to statins in real-world practice settings is known to be suboptimal. However, less is known about how adherence changes over time and whether changes in adherence are associated with adverse cardiovascular (CV) outcomes. OBJECTIVES To (a) characterize yearly changes in adherence among initially adherent patients taking statins for primary prevention and (b) assess the association between changes in statin adherence with subsequent risk of CV events. METHODS A 10% random sample of the IMS LifeLink Health Plan Claims Database covering the time period from July 1, 1997, to December 31, 2008, was used to identify a cohort of primary prevention statin users. Adherence was estimated in yearly segments beginning with the index statin prescription using proportion of days covered (PDC). PDC was categorized into 3 levels: PDC ≥ 0.80, 0.20 ≤ PDC < 0.80, PDC < 0.20. Patients were excluded if they experienced CV events or had PDC < 0.80 in their first year of statin exposure. Descriptive statistics were used to explore proportions of the cohort in each PDC category during each year. Cox-proportional hazards models were used to estimate the 5-year CV event risk associated with yearly adherence transitions. RESULTS Of the 11,126 patients beginning at the highest level of adherence (PDC ≥ 0.80) in year 1, 70% remained at this level in year 2. Of those in this level during year 2, 73% remained at this level in year 3. 828 (7.44%) experienced a CV event during their observable follow-up time. It was found that those who transitioned from the highest to the lowest level of adherence in year 2 (PDC < 0.20) experienced 2.26 greater CV event hazard (P < 0.0001). Adjusting for year 2 adherence, patients at the lowest level in year 3 experienced a 271% increase in CV hazard (P < 0.0001), as compared with the highest level of adherence. CONCLUSION This study found that patients' adherence levels tend to decline over time, and a transition to levels of adherence lower than a PDC of 80% was associated with increased risk of CV events. These results are useful in the context of targeting interventions that aim to improve patients' adherence.
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Affiliation(s)
- Julia F. Slejko
- University of Washington School of Pharmacy, Seattle, WA, 98195-7630, USA.
| | - Michael Ho
- University of Washington School of Pharmacy, Seattle, WA, 98195-7630, USA.
| | | | - Kavita V. Nair
- University of Washington School of Pharmacy, Seattle, WA, 98195-7630, USA.
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Slejko JF, Ghushchyan VH, Sucher B, Globe DR, Lin SL, Globe G, Sullivan PW. Asthma control in the United States, 2008-2010: indicators of poor asthma control. J Allergy Clin Immunol 2013; 133:1579-87. [PMID: 24331376 DOI: 10.1016/j.jaci.2013.10.028] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/09/2013] [Accepted: 10/11/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND An estimated 23 million Americans have asthma, of whom at least 12 million experience an asthma exacerbation every year. Clinical practice guidelines focus on asthma control, with an emphasis on reducing both impairment and risk. OBJECTIVE We sought to explore broad patterns of asthma prevalence, self-reported medication use, and indicators of control in a nationally representative sample. METHODS The 2008, 2009, and 2010 Medical Expenditure Panel Surveys were used to examine the national prevalence of self-reported asthma, trends in medication use, and demographic characteristics of asthmatic patients. History of lifetime asthma and current diagnosis were ascertained based on self-report. Asthma management and control were examined by using patient-reported medication use. RESULTS Of the 102,544 subjects asked about an asthma diagnosis, 9,782 reported lifetime asthma, and 8,837 reported current asthma. Five thousand five subjects (4.8% of the population) reported experiencing an asthma exacerbation in the previous year. Four thousand five hundred twenty-one subjects used a quick-relief inhaler for asthma symptoms, and 14.6% used more than 3 canisters of this type of medication in the past 3 months. Of this group, 60% were using daily long-term control medication but still required significant use of quick-relief inhalers, whereas 28% had never used long-term control medication. Of those who had a recent exacerbation, 29% were using daily preventive medication, whereas 54% had never used long-term control medication. CONCLUSIONS Improvement of asthma control continues to be a US public health concern. Results suggest suboptimal asthma control with underuse of long-term control medications, overuse of quick-relief inhalers, and a significant number of self-reported asthma exacerbations.
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Affiliation(s)
- Julia F Slejko
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Seattle, Wash
| | - Vahram H Ghushchyan
- College of Business and Economics, American University of Armenia, Yerevan, Armenia
| | | | | | - Shao-Lee Lin
- Global Health Economics, Amgen, Thousand Oaks, Calif
| | - Gary Globe
- Global Health Economics, Amgen, Thousand Oaks, Calif
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Abstract
OBJECTIVES Given the growing prevalence of asthma in USA, it is important to understand its national burden from the patient's perspective. The objective of this research is to examine the national burden of asthma and poor asthma control on health function, health perception and preference-based health-related quality of life (HRQL). METHODS The Medical Expenditure Panel Survey (MEPS), a nationally representative survey, was used to estimate the impact of asthma and indicators of poor asthma control on health function, self-rated health perception and preference-based HRQL using multivariate regression methods controlling for socioeconomic, clinical and demographic characteristics. Two HRQL instruments were used: SF-12v2 Physical Component Scale (PCS-12) and Mental Component Scale (MCS-12); EQ-5D-3L index and visual analogue scale (VAS). Two multivariate regression methods were used, Censored Least Absolute Deviation [EQ-5D-3L and VAS (due to censoring)] and Ordinary Least Squares (OLS) (PCS-12 and MCS-12). RESULTS After controlling for covariates, asthma resulted in a statistically significant reduction in preference-based HRQL, health perception and physical and mental function (EQ-5D -0.023; VAS -2.21; PCS-12 -2.36; MCS-12 -0.96). Likewise, experiencing an exacerbation in the previous year and using more than three canisters of quick-relief medication in the previous 3 months were both associated with a statistically significant and clinically meaningful reduction in all four measures. CONCLUSIONS Asthma itself and especially indicators of poor asthma control were associated with a deleterious effect on health function, preference-based HRQL and self-perceived health status. Given the prevalence of asthma, poorly controlled asthma constitutes a significant national burden in USA.
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Sullivan PW, Ghushchyan VH, Bayliss EA. The impact of co-morbidity burden on preference-based health-related quality of life in the United States. Pharmacoeconomics 2012; 30:431-442. [PMID: 22452633 DOI: 10.2165/11586840-000000000-00000] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Many statistical analyses, clinical trials and cost-utility analyses designed to measure the impact of a particular disease on utility scores often overlook the important influence of co-morbidity burden. OBJECTIVES This study aims to examine the impact of co-morbidity burden on EQ-5D index scores in a nationally representative sample of the US. METHODS The pooled 2001 and 2003 Medical Expenditure Panel Survey was used. The total number of chronic conditions for each individual was calculated based on Clinical Classification Categories codes. Spline regression was used to identify nonlinear age effects: individuals were separated into four quartiles based on age. Censored least absolute deviation was used to regress EQ-5D index scores on age and chronic co-morbidity, controlling for income, gender, race, ethnicity, education, physical activity and smoking status. Interactions between age and chronic conditions were also explored. RESULTS The coefficients for chronic co-morbidities were highly statistically significant with large magnitudes for those with two or more chronic conditions (coefficient two chronic conditions=-0.16; coefficient nine chronic conditions=-0.28). After controlling for chronic co-morbidities and other confounders, age was not statistically significant except for those aged>58 years and the magnitude of this coefficient was very small (coefficient aged>58 years=-0.0006). The interactions between age and chronic co-morbidity were significant, but the deleterious impact of their interaction was largely dominated by the existence and number of chronic conditions. CONCLUSIONS Chronic conditions have a significant deleterious impact on EQ-5D index scores that is much more pronounced than age and other sociodemographic and behavioural characteristics. Future analyses and cost-utility models should incorporate the impact of multiple morbidity.
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McQueen RB, Ellis SL, Campbell JD, Nair KV, Sullivan PW. Cost-effectiveness of continuous glucose monitoring and intensive insulin therapy for type 1 diabetes. Cost Eff Resour Alloc 2011; 9:13. [PMID: 21917132 PMCID: PMC3180394 DOI: 10.1186/1478-7547-9-13] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Accepted: 09/14/2011] [Indexed: 02/04/2023] Open
Abstract
Background Our objective was to determine the cost-effectiveness of Continuous Glucose Monitoring (CGM) technology with intensive insulin therapy compared to self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes in the United States. Methods A Markov cohort analysis was used to model the long-term disease progression of 12 different diabetes disease states, using a cycle length of 1 year with a 33-year time horizon. The analysis uses a societal perspective to model a population with a 20-year history of diabetes with mean age of 40. Costs are expressed in $US 2007, effectiveness in quality-adjusted life years (QALYs). Parameter estimates and their ranges were derived from the literature. Utility estimates were drawn from the EQ-5D catalogue. Probabilities were derived from the Diabetes Control and Complications Trial (DCCT), the United Kingdom Prospective Diabetes Study (UKPDS), and the Wisconsin Epidemiologic Study of Diabetic Retinopathy. Costs and QALYs were discounted at 3% per year. Univariate and Multivariate probabilistic sensitivity analyses were conducted using 10,000 Monte Carlo simulations. Results Compared to SMBG, use of CGM with intensive insulin treatment resulted in an expected improvement in effectiveness of 0.52 QALYs, and an expected increase in cost of $23,552, resulting in an ICER of approximately $45,033/QALY. For a willingness-to-pay (WTP) of $100,000/QALY, CGM with intensive insulin therapy was cost-effective in 70% of the Monte Carlo simulations. Conclusions CGM with intensive insulin therapy appears to be cost-effective relative to SMBG and other societal health interventions.
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Affiliation(s)
- R Brett McQueen
- Pharmaceutical Outcomes Research Program, School of Pharmacy, University of Colorado Denver, Aurora, Colorado, USA
| | - Samuel L Ellis
- Department of Clinical Pharmacy, School of Pharmacy, University of Colorado Denver, Denver, Aurora, Colorado, USA
| | - Jonathan D Campbell
- Pharmaceutical Outcomes Research Program, School of Pharmacy, University of Colorado Denver, Aurora, Colorado, USA
| | - Kavita V Nair
- Pharmaceutical Outcomes Research Program, School of Pharmacy, University of Colorado Denver, Aurora, Colorado, USA
| | - Patrick W Sullivan
- Department of Pharmacy Practice, Regis University, Denver, Colorado, USA
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Abstract
Background. The National Institute for Health and Clinical Excellence (NICE) has issued guidance on cost-effectiveness analyses, suggesting that preference-based health-related quality of life (HRQL) weights or utilities be based on UK community preferences, preferably using the EQ-5D; ideally all analyses would use the same system for deriving HRQL weights, to encourage consistency and comparability across analyses. Development of a catalogue of EQ-5D scores for a range of health conditions based on UK preferences would help achieve many of these goals. Objective. To provide a UK-based catalogue of EQ-5D index scores. Methods. Methods were consistent with the previously published catalogue of EQ-5D scores for the US. Community-based UK preferences were applied to EQ-5D descriptive questionnaire responses in the US-based Medical Expenditure Panel Survey (MEPS). Ordinary least squares (OLS), Tobit, and censored least absolute deviations (CLAD) regression methods were used to estimate the ‘marginal disutility’ of each condition controlling for covariates. Results. Pooled MEPS files (2000-2003) resulted in 79,522 individuals with complete EQ-5D scores. Marginal disutilities for 135 chronic ICD-9 and 100 CCC codes are provided. Unadjusted descriptive statistics including mean, median, 25th and 75th percentiles are also reported. Conclusion. This research provides community-based EQ-5D index scores for a wide variety of chronic conditions that can be used to estimate QALYs in cost-effectiveness analyses in the UK. Although using EQ-5D questionnaire responses from the US-based MEPS is less than ideal, the estimates approximate HRQL guidelines by NICE and provide an easily accessible“off-the-shelf” resource for cost-effectiveness and publichealth applications.
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Affiliation(s)
- Patrick W. Sullivan
- Regis University, School of Pharmacy, Denver, CO (PWS)
- University of Colorado Denver School of Pharmacy, Pharmaceutical Outcomes Research Program, Denver, CO (JFS, VG)
- University of York, York, United Kingdom (MJS)
| | - Julia F. Slejko
- Regis University, School of Pharmacy, Denver, CO (PWS)
- University of Colorado Denver School of Pharmacy, Pharmaceutical Outcomes Research Program, Denver, CO (JFS, VG)
- University of York, York, United Kingdom (MJS)
| | - Mark J. Sculpher
- Regis University, School of Pharmacy, Denver, CO (PWS)
- University of Colorado Denver School of Pharmacy, Pharmaceutical Outcomes Research Program, Denver, CO (JFS, VG)
- University of York, York, United Kingdom (MJS)
| | - Vahram Ghushchyan
- Regis University, School of Pharmacy, Denver, CO (PWS)
- University of Colorado Denver School of Pharmacy, Pharmaceutical Outcomes Research Program, Denver, CO (JFS, VG)
- University of York, York, United Kingdom (MJS)
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Sullivan PW, Ghushchyan VH, Slejko JF, Belozeroff V, Globe DR, Lin SL. The burden of adult asthma in the United States: evidence from the Medical Expenditure Panel Survey. J Allergy Clin Immunol 2011; 127:363-369.e1-3. [PMID: 21281868 DOI: 10.1016/j.jaci.2010.10.042] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 10/18/2010] [Accepted: 10/20/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is important to have an accurate picture of the sources and extent of medical expenditures and productivity loss to understand the nature and scope of the burden of asthma in the United States (US). OBJECTIVE The current study aims to provide recent nationally representative estimates of direct and productivity-related costs attributable to asthma in adults in the US. METHODS The 2003 and 2005 Medical Expenditure Panel Surveys were used to estimate the effect of asthma on medical expenditures, use, productivity, and chronic comorbidity among adults (≥ 18 years). Productivity-related outcome variables included employment, annual wages, missed work days, days spent sick in bed, and activity limitations. Multivariate regression was conducted, controlling for sociodemographics and comorbidity. RESULTS Of 44,795 adults, 1,935 reported an encounter for asthma [corrected]. Compared with those without, subjects with asthma were significantly less likely to be employed (odds ratio, 0.78), spent 1.4 more days sick in bed annually, and were significantly more likely to have activity limitations or to be unable to work. Adults with asthma incurred an additional $1,907 (2008 US dollars) annually and experienced higher health care use and comorbidity. The total national medical expenditure attributable to adult asthma was $18 billion. Adults with asthma were more likely to be covered by Medicaid (30%) than the general adult population (10%). The largest contributors to medical expenditures for adults with asthma were prescription drugs, followed by inpatient hospitalizations and home health care. CONCLUSIONS In recent national data adult asthma is associated with a significant deleterious effect on direct and indirect costs in the US.
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Slejko JF, Page RL, Sullivan PW. Cost-effectiveness of statin therapy for vascular event prevention in adults with elevated C-reactive protein: implications of JUPITER. Curr Med Res Opin 2010; 26:2485-97. [PMID: 20828360 DOI: 10.1185/03007995.2010.516994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES High-sensitivity C-reactive protein (hs-CRP) has been explored for use in predicting cardiovascular risk. The recent Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) study found that statin therapy reduced cardiovascular events in those with low-density lipoprotein (LDL) cholesterol levels below current treatment thresholds (≤130 mg/dL, 3.4 = mmol/L), but with elevated hs-CRP levels (≥2.0 mg/L). This study examines the cost-effectiveness of statin treatment for individuals with elevated hs-CRP but normal LDL cholesterol. METHODS A Markov decision-analytic model was conducted from the U.S. societal perspective. Data from JUPITER were used to estimate rates of myocardial infarction, angina and stroke. Statin costs were based on generic simvastatin 80 mg, equipotent to the rosuvastatin 20 mg dose used in JUPITER. Primary prevention was the focus and secondary prevention was not modeled explicitly. Quality-adjusted life-years (QALYs) were calculated using nationally representative preference-based utility weights. One-way sensitivity analyses and multivariate probabilistic sensitivity analysis were used to explore uncertainty in model parameters as well as estimate the likelihood of cost-effectiveness when all event rates, costs and utilities were drawn randomly from distributions reflecting uncertainty. RESULTS Statin therapy cost $10,889/QALY for vascular event prevention in this population. Results were sensitive to the cost of statin treatment. Based on 10,000 simulations, statin therapy was cost-effective in 99.5% of simulations, using a willingness-to-pay threshold of $20,000/QALY, and 100% of simulations using a threshold of $50,000/QALY. CONCLUSIONS Treatment with statins in patients with elevated hs-CRP but normal cholesterol appears to be cost-effective. Limitations of this study include the assumption that an equipotent dose of simvastatin resulted in the same risk reduction as rosuvastatin. Further, post-event states simulated the average experience of a patient. Continued statin use, subsequent events and/or heart failure were not explicitly modeled.
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Affiliation(s)
- Julia F Slejko
- Pharmaceutical Outcomes Research Program, University of Colorado School of Pharmacy, Aurora, CO 80045, USA.
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Abstract
OBJECTIVES A new classification of persistent allergic rhinitis (PER) has been developed by the ARIA working group. Although the burden of AR is significant, treatment itself is also costly. It is unclear if treatment based on the new definition of PER is cost-effective. METHODS The current study simulated the cost-effectiveness of desloratadine compared to placebo in the treatment of PER from the French societal perspective. Decision analysis was used to model the costs, effectiveness and cost-effectiveness over 12 months. Costs included medical expenditures (physician visits and prescription drugs) attributable to PER and related comorbidities and lost productivity due to absenteeism and presenteeism. Prices, tariffs and national wages were estimated from French national sources. MEASURES OF EFFECTIVENESS INCLUDED: symptom-based visual analogue scale (VAS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Total 5 Symptoms Score (T5SS), categorical improvement in therapeutic response, interference with activities of daily living (ADL) and sleep outcomes. Mild or symptom-free days and 'responders' were also captured as outcomes. Univariate and second-order multivariate probabilistic sensitivity analyses were conducted. RESULTS Treatment with desloratadine dominated placebo (cost less and resulted in greater effectiveness) for all measures of effectiveness. Of the individuals taking desloratadine 46.8% were classified as 'responders' vs. 34.8% for placebo (p = 0.0012). Individuals taking desloratadine experienced mild/no symptoms for 57.6% of study days vs. 36.5% for placebo (p = 0.002). The expected annual cost of treatment with desloratadine (1819 euro) was less than placebo (2618 euro). Lost productivity was the most significant contributor to total cost. Results of the 10,000 Monte Carlo simulations showed that treatment was cost-saving in 99.6% of simulations. CONCLUSIONS Treatment of PER with desloratadine resulted in improved effectiveness and significant savings. While the cost of drug treatment is greater than that of no treatment, the downstream costs associated with not treating PER significantly outweigh the cost of treatment. Key limitations include the comparison of desloratadine to placebo and the sources of cost and effectiveness measures. Future studies should examine the cost-effectiveness of all available treatments for PER. In addition, many utilization, productivity and effectiveness measures were taken from clinical trials and may not accurately reflect 'real world' treatment patterns and outcomes.
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Affiliation(s)
- Patrick W Sullivan
- Department of Pharmacy Practice, Regis University, School of Pharmacy, Denver, CO 80221, USA.
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Slejko JF, Page RL, Sullivan PW. STATIN THERAPY IS COST-EFFECTIVE FOR VASCULAR EVENT PREVENTION IN ADULTS WITH ELEVATED C-REACTIVE PROTEIN: IMPLICATIONS OF JUPITER. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61230-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sullivan PW, Ghushchyan VH, Ben-Joseph R. The impact of obesity on diabetes, hyperlipidemia and hypertension in the United States. Qual Life Res 2008; 17:1063-71. [PMID: 18777200 DOI: 10.1007/s11136-008-9385-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [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: 04/25/2007] [Accepted: 08/11/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The prevalence of obesity and associated cardiometabolic risk factors such as diabetes, hyperlipidemia and hypertension is increasing significantly for all demographic groups. RESEARCH DESIGN AND METHODS The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the U.S. population, was used to estimate the marginal impact of obesity on health function, perception, and preferences for individuals with diabetes, hyperlipidemia, and hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, smoking status, comorbidity, and proxy response. Three different instruments were used: SF-12 physical component scale (PCS-12) and mental component scale (MCS-12); EQ-5D index and visual analogue scale (VAS). Censored least absolute deviation was used for the EQ-5D and VAS (due to censoring) and ordinary least squares (OLS) was used for the PCS-12 and MCS-12. RESULTS After controlling for sociodemographic characteristics, diabetes, hyperlipidemia, and hypertension were associated with significantly lower scores compared to normal weight individuals without the condition for all four instruments. Obesity significantly exacerbated this association. Controlling for comorbidity attenuated the negative association of obesity and cardiometabolic risk factors on instrument scores. In addition, scores decreased for increasing weight and number of risk factors. CONCLUSIONS Obesity significantly exacerbates the deleterious association between diabetes, hyperlipidemia, and hypertension, and health function, health perception, and preference-based scores in the United States.
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Affiliation(s)
- Patrick W Sullivan
- Pharmaceutical Outcomes Research Program, School of Pharmacy, University of at Denver Colorado and Health Sciences Center, 4200 East Ninth Avenue, C238, Denver, CO, 80262, USA.
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Sullivan PW, Ghushchyan V, Ben-Joseph RH. The effect of obesity and cardiometabolic risk factors on expenditures and productivity in the United States. Obesity (Silver Spring) 2008; 16:2155-62. [PMID: 19186336 DOI: 10.1038/oby.2008.325] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the effect of obesity and cardiometabolic risk factors on medical expenditures and missed work days. METHODS AND PROCEDURES The 2000 and 2002 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US population, was used to estimate the marginal effect of obesity (BMI > or = 30) on annual per-person medical expenditures and missed work days for patients with diabetes, dyslipidemia, or hypertension using multivariate regression methods controlling for age, sex, race, ethnicity, education, income, insurance, and smoking status. Maximum Likelihood Heckman Selection with Smearing retransformation was used to assess medical expenditures, and Negative Binomial regression was used for missed work days. RESULTS Normal weight individuals with diabetes, dyslipidemia, or hypertension had significantly greater medical expenditures than those without the respective condition ($6,006 (5,124-6,887), $4,760 (4,102-5,417), $3,911 (3,345-4,476)) and obesity significantly exacerbated this effect ($7,986 (7,397-8,574), $7,636 (7,072-8,200), $6,197 (5,745-6,649); $2007; all P < 0.05). In addition, diabetes, dyslipidemia, and hypertension resulted in greater missed work days (3.1 (0.94-6.21), 3.2 (0.42-7.91), 1.4 (0.0-3.52)) (all P < 0.05 except hypertension), which resulted in greater lost productivity ($433, $451, $199) and obesity significantly exacerbated the deleterious effect on work days (8.7 (4.44-15.2), 5.5 (2.18-10.5), 4.5 (2.92-6.34)) and lost productivity ($1,217, $763, $622) (all P < 0.05). In addition, medical expenditures increased for increasing weight category and increasing number of risk factors. DISCUSSION Obesity significantly exacerbates the deleterious effect of diabetes, dyslipidemia, and hypertension on medical expenditures and productivity loss in the United States. Obesity is preventable and public health efforts need to be undertaken to prevent its alarming increase in order to reduce the incidence and effect of cardiometabolic risk factors.
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Affiliation(s)
- Patrick W Sullivan
- Department of Clinical Pharmacy, University of Colorado at Denver, Colorado, USA.
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Abstract
Background—
Coronary heart disease (CHD) affects 15.8 million Americans. However, data on the national impact of CHD on health-related quality of life, particularly among people of different age, sex, racial, and ethnic groups, are limited.
Methods and Results—
Using data from the 2000 and 2002 Medical Expenditure Panel Survey, we examined various measures of patient-reported health status, including health-related quality of life, in the CHD and non-CHD populations and differences in the measures among demographic subgroups. These measures included short-form generic measures (Short Form 12; Mental Component Summary-12 and Physical Component Summary-12) and EuroQol Group measures (EQ-5D index and EQ visual analog scale). Ordinary least-squares regressions were used to adjust for sociodemographic characteristics, risk factors, comorbidities, and proxy report. The adjusted difference between the CHD and non-CHD populations was −1.2 for Mental Component Summary-12 (2.4% of the score in the non-CHD population), −4.6 for Physical Component Summary-12 (9.2%), −0.04 for EQ-5D (4.6%), and −7.3 for EQ visual analog scale (9.0%) (all
P
<0.05). Differences among demographic subgroups were observed. Particularly, compared with whites, the differences between CHD and non-CHD in blacks were bigger in all measures except Physical Component Summary-12. A significantly bigger difference in Mental Component Summary-12 also was observed among Hispanics compared with non-Hispanics.
Conclusions—
CHD is associated with significant impairment of health-related quality of life and other patient-reported health status in the US adult population. Differences in the impairment associated with CHD exist across different age, racial, and ethnic groups. In addition to preventing CHD, effective public health interventions should be aimed at improving health-related quality of life and perceived health status in the CHD population, especially the most vulnerable groups.
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Affiliation(s)
- Jipan Xie
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (J.X., D.R.L.); Northrop Grumman, Atlanta, Ga (J.X.); Analysis Group, Inc, Boston, Mass (E.Q.W.); Division for the Application of Research Discoveries, National Heart, Lung, and Blood Institute, Bethesda, Md (Z.-J.Z.); University of Colorado at Denver (P.W.S.); and University of Toledo, Toledo, Ohio (L.Z.)
| | - Eric Q. Wu
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (J.X., D.R.L.); Northrop Grumman, Atlanta, Ga (J.X.); Analysis Group, Inc, Boston, Mass (E.Q.W.); Division for the Application of Research Discoveries, National Heart, Lung, and Blood Institute, Bethesda, Md (Z.-J.Z.); University of Colorado at Denver (P.W.S.); and University of Toledo, Toledo, Ohio (L.Z.)
| | - Zhi-Jie Zheng
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (J.X., D.R.L.); Northrop Grumman, Atlanta, Ga (J.X.); Analysis Group, Inc, Boston, Mass (E.Q.W.); Division for the Application of Research Discoveries, National Heart, Lung, and Blood Institute, Bethesda, Md (Z.-J.Z.); University of Colorado at Denver (P.W.S.); and University of Toledo, Toledo, Ohio (L.Z.)
| | - Patrick W. Sullivan
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (J.X., D.R.L.); Northrop Grumman, Atlanta, Ga (J.X.); Analysis Group, Inc, Boston, Mass (E.Q.W.); Division for the Application of Research Discoveries, National Heart, Lung, and Blood Institute, Bethesda, Md (Z.-J.Z.); University of Colorado at Denver (P.W.S.); and University of Toledo, Toledo, Ohio (L.Z.)
| | - Lin Zhan
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (J.X., D.R.L.); Northrop Grumman, Atlanta, Ga (J.X.); Analysis Group, Inc, Boston, Mass (E.Q.W.); Division for the Application of Research Discoveries, National Heart, Lung, and Blood Institute, Bethesda, Md (Z.-J.Z.); University of Colorado at Denver (P.W.S.); and University of Toledo, Toledo, Ohio (L.Z.)
| | - Darwin R. Labarthe
- From the Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga (J.X., D.R.L.); Northrop Grumman, Atlanta, Ga (J.X.); Analysis Group, Inc, Boston, Mass (E.Q.W.); Division for the Application of Research Discoveries, National Heart, Lung, and Blood Institute, Bethesda, Md (Z.-J.Z.); University of Colorado at Denver (P.W.S.); and University of Toledo, Toledo, Ohio (L.Z.)
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McCollum M, Hansen LB, Ghushchyan V, Sullivan PW. Inconsistent health perceptions for US women and men with diabetes. J Womens Health (Larchmt) 2008; 16:1421-8. [PMID: 18062757 DOI: 10.1089/jwh.2006.0251] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Two health status measures for adults with diabetes are compared in order to identify gender-based differences between norm-based scores for health status and self-rated health scores. METHODS Data were obtained from the 2001 and 2003 Medical Expenditure Panel Survey(MEPS). Diabetes was identified by self-report or ICD-9 code. Demographic and clinical (e.g., body mass index [BMI], comorbidities) parameters were included. Outcomes were norm-based measures of physical and mental health (SF-12 Physical and Mental Component Scores: SF-12 PCS and SF-12 MCS) and self-rated perception of health status. Sex-based differences in the three outcome measures, SF-12 PCS, SF-12 MCS, and self-rated health scores, were evaluated in univariate analyses and multivariate linear regression for survey data. RESULTS A cohort of 3640 respondents with diabetes was identified (2037 women, 1603 men). In unadjusted analyses, women were older than men (60.7 vs. 59.3 years, p<0.001), reported higher mean BMI (31.1 vs. 30.4), more comorbidities, depression, and physical limitations (all p<0.001), had poorer SF-12 MCS scores (p=0.01), and self-rated their health status significantly higher than did men (p<0.01). In adjusted analyses, female gender was associated with lower SF-12 MCS scores and higher self-rated health scores. No factors were positively associated with higher scores across all three measures; only cognitive limitations consistently predicted lower health status scores in all three measures. CONCLUSIONS Among adults with diabetes in a nationally representative sample of the U.S. adult population, discrepancies exist in health status measures. Despite being older, having more comorbidities and physical limitations, and lower norm-based scores for mental functional status, women self-rate their own health status higher than do men. Further research into the gender-based determinants and clinical implications of self-rated health status is warranted.
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Affiliation(s)
- Marianne McCollum
- Department of Clinical Pharmacy, University of Colorado at Denver, and Health Sciences Center, Denver, Colorado, USA.
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Abstract
OBJECTIVE Diabetes, hypertension, hyperlipidemia, and overweight/obesity often cluster together. The prevalence of these cardiometabolic risk factor clusters (CMRFCs) is increasing significantly for all sociodemographic groups, but little is known about their economic impact. RESEARCH METHODS AND PROCEDURES The nationally representative Medical Expenditure Panel Survey was used (2000 and 2002). The current study estimated the national cost of CMRFCs independent of the cost of cardiovascular disease in the U.S., as well as the cost for all major payers and the marginal cost per individual using a Heckman selection model with Smearing retransformation. CMRFCs included BMI >or= 25 and two of the following three: diabetes, hyperlipidemia, and/or hypertension. All amounts are expressed in 2005 U.S. dollars. RESULTS National medical expenditures attributable to CMRFCs in the U.S. totaled 80 billion dollars, of which 27 billion dollars was spent on prescription drugs. Private insurance paid the largest amount of the national bill (28 billion dollars), followed by Medicare (11 billion dollars), Medicaid (6 billion dollars), and the Veterans Administration (4 billion dollars), whereas individuals paid 28 billion dollars out-of-pocket. For each individual with CMRFCs, 5477 dollars in medical expenditures was attributable to CMRFCs, of which 1832 dollars was for prescription drugs. On average, individuals with CMRFCs spent 1668 dollars out-of-pocket, of which 830 dollars was for prescription drugs. DISCUSSION The results of this study show that CMRFCs result in significant medical cost in the U.S. independent of the cost of cardiovascular disease. Individuals, private insurers, Medicare, Medicaid, the Veterans Administration, and other payers all share this burden.
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Affiliation(s)
- Patrick W Sullivan
- Pharmaceuticals Outcomes Research Program, University of Colorado at Denver Health Sciences Center, 4200 East Ninth Avenue, C238, Denver, CO 80262, USA.
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Sullivan PW, Ghushchyan V, Wyatt HR, Wu EQ, Hill JO. Productivity costs associated with cardiometabolic risk factor clusters in the United States. Value Health 2007; 10:443-50. [PMID: 17970926 DOI: 10.1111/j.1524-4733.2007.00199.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Cardiometabolic risk factors such as overweight/obesity, hyperlipidemia, diabetes, and hypertension are prone to cluster together in the same individual and result in an elevated risk of cardiovascular disease and mortality. The purpose of this study was to examine and quantify the impact of cardiometabolic risk factor clusters independent of heart disease on productivity in a nationally representative sample of US adults. METHODS The current study estimated the impact of cardiometabolic risk factor clusters on missed work days and bed days, controlling for sociodemographic characteristics, comorbidity, and smoking status in a nationally representative, pooled 2000 and 2002 Medical Expenditure Panel Survey sample. Cardiometabolic risk factor clusters included BMI >or= 25 and two of the following three: diabetes, hyperlipidemia, and/or hypertension. All estimates were expressedin $US 2005. Sensitivity analyses were conducted to examine the impact of varying assumptions on the results. RESULTS After controlling for differences in sociodemographics, smoking and comorbidity, individuals with cardiometabolic risk factor clusters missed 179% more work days and spent 147% more days in bed (in addition to lost work days) than those without. Lost work days and bed days resulted in $17.3 billion annually in lost productivity attributable to cardiometabolic risk factor clusters in the United States. Sensitivity analyses resulted in a range of annual lost productivity costs from $3.2 to $23.1 billion. CONCLUSIONS Common cardiometabolic risk factor clusters have a significant deleterious impact on the US economy, resulting in $17.3 billion in lost productivity.
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Affiliation(s)
- Patrick W Sullivan
- University of Colorado at Denver and Health Sciences Center, Pharmaceutical Outcomes Research Program, School of Pharmacy, 4200 East Ninth Avenue, C238, Denver, CO 80262, USA.
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Abstract
BACKGROUND Many of the large ongoing national surveys of the US population contain a question that asks for the respondent's self-reported health status: "excellent," "very good," "good," "fair," or "poor." These surveys could be used to conduct cost-utility analyses of health care policies, treatments or other interventions if quality-of-life (QOL) weights for the self-reported health statuses were also available. OBJECTIVE The objective of this study was to produce nationally representative QOL weights for self-reported health status and for 10 "priority" health conditions, by a series of demographic variables. RESEARCH DESIGN The Medical Expenditure Panel Survey contains the questions from the EQ-5D health status measure. A recent study has calculated time-trade-off-derived QOL weights corresponding to the EQ-5D health states for a large sample of Americans. We use these data to construct QOL weights for the 5 self-reported health status categories and 10 priority health conditions, by a series of demographic variables. RESULTS Mean and median QOL weights were produced for self-reported health status, the 10 priority health conditions, and the demographic variables. We also report mean QOL weights for the self-reported health state and priority health conditions, by the demographic variables. Finally, ordinary least squares and censored least absolute deviation regression equations were used to estimate adjusted QOL weights for these variables. CONCLUSIONS By providing nationally representative QOL weights for self-reported health status and 10 priority health conditions, by demographic variable, we have facilitated the use of large national surveys for conducting cost-utility analysis and increased their value to researchers and policy makers.
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Affiliation(s)
- John A Nyman
- Division of Health Policy and Management, School of Public Health, University of Minnesota, 520 Delaware Street SE, Minneapolis, MN 55455, USA.
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Sullivan PW, Mulani PM, Fishman M, Sleep D. Quality of life findings from a multicenter, multinational, observational study of patients with metastatic hormone-refractory prostate cancer. Qual Life Res 2007; 16:571-5. [PMID: 17294287 DOI: 10.1007/s11136-006-9156-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [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: 05/22/2006] [Accepted: 12/08/2006] [Indexed: 11/12/2022]
Abstract
BACKGROUND The assessment of health-related quality of life (HRQL) for patients with hormone-refractory prostate cancer (HRPC) is of paramount importance because new treatments have a modest impact on survival but side effects of treatment and disease symptoms can significantly impact HRQL. METHODS This was an observational, non-interventional, multi-center, multi-national cohort study of patients with metastatic HRPC. Health-related quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ C30), the Functional Assessment of Cancer Therapy-Prostate (FACT-P) and the EQ-5D index. Mean changes from baseline to month 3, 6, and 9 were computed and tested using paired t-tests. RESULTS FACT-P PCS, EQ-5D index and 10 of 14 EORTC domains were statistically significantly lower (P < 0.05) than the baseline scores at the 3, 6 and 9 month visits. The domains that did not reach statistical significance were cognitive functioning, insomnia, diarrhea and financial difficulties. CONCLUSIONS These data demonstrate that patients with metastatic HRPC experience rapid, significant deterioration in HRQL, highlighting the need for effective palliative therapy for men with HRPC.
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Affiliation(s)
- Patrick W Sullivan
- Pharmaceutical Outcomes Research Program, University of Colorado School of Pharmacy, 4200 East Ninth Avenue, Box C238, Denver, CO, 80262, USA.
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McCollum M, Ellis SL, Regensteiner JG, Zhang W, Sullivan PW. Minor depression and health status among US adults with diabetes mellitus. Am J Manag Care 2007; 13:65-72. [PMID: 17286526] [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: 05/13/2023]
Abstract
OBJECTIVE To determine whether diabetes mellitus (DM) with minor depression is associated with poorer levels of mental and physical functioning compared with DM without depression. STUDY DESIGN Retrospective database study. METHODS US adults participating in the 2001 Medical Expenditure Panel Survey were included in these analyses. Main outcome measures were differences in health status, physical and cognitive limitations, and the Short-Form 12 (SF-12) Mental Component Summary (MCS) and Physical Component Summary (PCS) for US adults with DM stratified by minor depression status and evaluated using univariate and multivariate analyses to control for demographic, behavioral, and clinical covariates. RESULTS A total of 1572 respondents with DM were included (1443 without depression, 129 with depression). Compared with people with DM and without depression, those with DM and minor depression were younger (P = .04); were more likely to be female, white, and smokers; and to have physical and cognitive limitations and lower SF-12 MCS and PCS scores (all P < .01). In multivariate analyses, minor depression was independently associated with lower self-reported health status, MCS scores, and more cognitive limitations. CONCLUSION People with DM and minor depression have lower mental functional scores, more cognitive limitations, and lower self-reported health status scores compared with people with DM and without depression, differences that may adversely affect self-care activities. Primary and DM care providers should screen for and be aware of depression in their patients with DM.
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Affiliation(s)
- Marianne McCollum
- University of Colorado at Denver and Health Sciences Center, School of Pharmacy, Denver, CO 80262, USA.
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Abstract
OBJECTIVE Research has shown that risk factors for cardiovascular disease often cluster together, most notably overweight/obesity, diabetes, hyperlipidemia, and hypertension. The impact of cardiometabolic risk factor clusters on health-related quality of life (HRQL) is not well understood. The purpose of this study was to examine and quantify the impact of cardiometabolic risk factor clusters on HRQL as measured by the SF (Short Form)-12 Mental Component Scale (MCS-12), SF-12 Physical Component Scale (PCS-12), EQ-5D index (a generic quality of life index), and Visual Analogue Scale. RESEARCH METHODS AND PROCEDURES The Medical Expenditure Panel Survey is a nationally representative survey of the U.S. population. From 2000 to 2002, detailed information on sociodemographic characteristics and health conditions were collected for 36,697 adults with complete responses. Controlling for comorbidity and sociodemographic characteristics, this study estimated the marginal impact of cardiometabolic risk factor clusters on MCS-12, PCS-12, EQ-5D index, and Visual Analogue Scale scores. Cardiometabolic risk factor clusters were defined as the presence of BMI > or = 25 kg/m(2) and at least two of the following: diabetes, hyperlipidemia, and hypertension. Using BMI > or = 30 kg/m(2) as the cut-off was also examined. RESULTS The marginal impact of cardiometabolic risk factor clusters was highly statistically significant across all four HRQL measures and seemed to be clinically significant for all but the MCS-12. The PCS-12 showed a greater decrease in HRQL associated with physical function compared with mental function-related domains of the MCS-12. DISCUSSION Common cardiometabolic risk factor clusters such as overweight/obesity, diabetes, hypertension, and hyperlipidemia have a significant and negative impact on HRQL in the United States.
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Affiliation(s)
- Patrick W Sullivan
- University of Colorado Health Sciences Center, School of Pharmacy, Pharmaceutical Outcomes Research Program, Department of Clinical Pharmacy, Denver, Colorado, USA.
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Abstract
OBJECTIVE Given the risk of obesity and diabetes in the U.S., and clear benefit of exercise in disease prevention and management, this study aimed to determine the prevalence of physical activity among adults with and at risk for diabetes. RESEARCH DESIGN AND METHODS The Medical Expenditure Panel Survey is a nationally representative survey of the U.S. population. In the 2003 survey, 23,283 adults responded when asked about whether they were physically active (moderate or vigorous activity, > or =30 min, three times per week). Information on sociodemographic characteristics and health conditions were self-reported. Additional type 2 diabetes risk factors examined were age > or =45 years, non-Caucasian ethnicity, BMI > or =25 kg/m(2), hypertension, and cardiovascular disease. RESULTS A total of 39% of adults with diabetes were physically active versus 58% of adults without diabetes. The proportion of active adults without diabetes declined as the number of risk factors increased until dropping to similar rates as people with diabetes. After adjustment for sociodemographic and clinical factors, the strongest correlates of being physically active were income level, limitations in physical function, depression, and severe obesity (BMI > or =40 kg/m(2)). Several traditional predictors of activity (sex, education level, and having received past advice from a health professional to exercise more) were not evident among respondents with diabetes. CONCLUSIONS The majority of patients with diabetes or at highest risk for developing type 2 diabetes do not engage in regular physical activity, with a rate significantly below national norms. There is a great need for efforts to target interventions to increase physical activity in these individuals.
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Affiliation(s)
- Elaine H Morrato
- University of Colorado Health Sciences Center, School of Pharmacy, 4200 East Ninth Avenue, Denver, CO 80262, USA
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Abstract
BACKGROUND Previous mapping algorithms estimating EQ-5D index scores from the SF-12 were based on preferences from a UK community sample. However, preferences based on the general US population are most appropriate for costeffectiveness analyses done from the societal perspective in the United States. OBJECTIVE To provide a mapping algorithm for estimating EQ-5D index scores from the SF-12 based on a nationally representative sample and using preferences based on the general US population: METHODS The Medical Expenditure Panel Survey (MEPS) 2002 and 2000 data were used as independent derivation and validation sets to estimate the relationship between SF-12 scores and EQ-5D index scores, controlling for sociodemographic characteristics and comorbidity burden. Prediction equations for end-users who only have access to SF-12 scores were derived and compared. The empirical performance of censored least absolute deviations (CLAD), Tobit, and ordinary least squares (OLS) analytic methods were compared by calculating the mean prediction error in the validation set. RESULTS The fully specified CLAD model resulted in the lowest mean prediction error, followed by OLS and Tobit. The CLAD prediction equation based only on SF-12 scores performed better than the fully specified OLS and Tobit models. CONCLUSION The current research provides an algorithm for mapping EQ-5D index scores from the SF-12. This algorithm may provide analysts with an avenue to obtain appropriate preference-based health-related quality-of-life scores for use in cost-effectiveness analyses when only SF-12 data are available.
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Affiliation(s)
- Patrick W Sullivan
- University of Colorado School of Pharmacy, Pharmaceutical Outcomes Research Program, 4200 East Ninth Avenue, Box C238, Denver, CO 80262, USA.
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